External Female Genitalia.330.No Pix.Gsu

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External Female Genitalia.330.No Pix.Gsu

  1. 1. External Female Genitalia Nursing 330 Governors State University Shirley Comer
  2. 2. Relevant History <ul><li>Menstrual History Obstetrical History </li></ul><ul><ul><li>LMP Gravida </li></ul></ul><ul><ul><li>Age of menarche Para </li></ul></ul><ul><ul><li>Cycle characteristics abortions </li></ul></ul><ul><li>Self care practices sexual activity </li></ul><ul><li>Urinary symptoms Vaginal discharge </li></ul><ul><li>Contraceptive use STD history </li></ul>
  3. 3. Inspection <ul><li>Skin color </li></ul><ul><ul><li>pink and smooth </li></ul></ul><ul><li>Hair distribution </li></ul><ul><ul><li>inverted triangle by age 13 </li></ul></ul><ul><li>Labia Majora </li></ul><ul><ul><li>symmetrical and plump </li></ul></ul><ul><li>No lesions </li></ul><ul><ul><li>may be sebaceous cysts </li></ul></ul><ul><ul><ul><li>small yellow firm nontender </li></ul></ul></ul>
  4. 4. Inspection cont <ul><li>Inspect Clitoris </li></ul><ul><li>Labia minora </li></ul><ul><ul><li>dark pink and symmetrical </li></ul></ul><ul><li>Urethral opening </li></ul><ul><li>Vaginal opening (introitus) </li></ul><ul><li>Perineum </li></ul><ul><ul><li>Episiotomy scar </li></ul></ul><ul><li>Anus </li></ul><ul><ul><li>increased pigmentation </li></ul></ul>
  5. 5. Palpation <ul><li>Glands </li></ul><ul><ul><li>Skene’s glands- milk urethra through vagina </li></ul></ul><ul><ul><li>Bartolin’s glands- palpated in labia majora through vagina </li></ul></ul><ul><ul><li>Assess </li></ul></ul><ul><ul><ul><li>Tenderness </li></ul></ul></ul><ul><ul><ul><li>Induration </li></ul></ul></ul><ul><ul><ul><li>Discharge </li></ul></ul></ul><ul><ul><ul><li>pain </li></ul></ul></ul>
  6. 6. Assess Support of Pelvis Musculature <ul><li>Palpate perineum </li></ul><ul><ul><li>Nulliparous-thick and smooth </li></ul></ul><ul><ul><li>Parous-thin and rigid </li></ul></ul><ul><li>Ask pt to bear down </li></ul><ul><ul><li>Should be no bulging or straining or urinary incontinence </li></ul></ul>
  7. 7. Practice Exam Question <ul><li>You are assessing your 12 year old female client upon admission to the pediatric unit. While helping her undress you notice a small amount of bloody discharge on her underwear. While questioning her and her mother about her health history, she denies the onset on menarche. What should you do next? </li></ul><ul><li>A. Ask the mother to step out for a moment and ask the patient about the bloody discharge you observed. </li></ul><ul><li>B. Tell the patient and her mother that you saw the the blood on her underwear </li></ul><ul><li>C. Perform an internal speculum exam </li></ul><ul><li>D. Assume you were mistaken </li></ul>
  8. 8. Rationale <ul><li>A is the correct answer. A 12 year old girl may not admit to sexual activity or abuse in front of her parents. </li></ul><ul><li>B is incorrect as the mother may inhibit the pt or prevent her from reporting </li></ul><ul><li>C. is incorrect as you shouldn’t perform an internal exam but report your finding to the primary HCP </li></ul><ul><li>D. Trust yourself, you saw what you saw. </li></ul>

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