Genitalia Slide Transcript
Slide 1: Genitalia
Slide 2: Male Genitalia
Slide 3: Clinical Objectives 1. Demonstrate knowledge of the S&S related to the male genitalia by obtaining a pertinent health history. 2. Inspect and palpate the penis and scrotum 3. Teach TSE 4. Record the history and PE accurately, assess, develop a plan of care.
Slide 4: How does a nurse create an environment that will be conducive for examination?
Slide 5: Subjective Data for Male Privacy Reason for seeking care? Problem usually identified as “Personal” (not a diagnostic statement) How do you gather information?
Slide 6: Did you identify all these areas? Frequency, urgency, nocturia Polyuria Oliguria (< 400mls/24yrs) Dysuria Hesitancy and straining Urine color Past genitourinary history Penis Pain, lesion, discharge, bleeding
Slide 7: Scrotum TSE Sexual Activity and contraceptive use STD contact
Slide 8: After the client history in nonurgent cases …..What next? Remember you are doing Physical Assessment
Slide 9: Male Genitalia Inspect and Palpate Wash Hands before and after examination Wear Gloves Discharge If a scrotal mass is suspected, what will you check for ? Pain Location Reduce Auscultate
Slide 10: Transillumination - performed if scrotol swelling or mass. Darken room. Shine flashlight from behind the sac. Normal contents do not transilluminate Serous fld does = red glow (hydrccele, spermatocele) Solid tissue and bld do not transilluminate
Slide 11: Normal Scrotal Findings Contents should slide easily Testes feel oval, firm, rubbery, smooth, = bilaterally Freely movable, Slightly tender to moderate pressure Left testicle lower than right
Slide 12: Inguinal Region Bear down (should be no change) Cough no longer accepted practice . Why? need steady , increased intra abdominal pressure. Likely to cough in your face
Slide 13: TSE T = timing S = shower E = examine
Slide 14: TSE Should be practiced from 13yrs on every month. Testicular cancer is the most common cancer in young men age 15 to 35. Testicular tumor has no early symptoms Early detection by palpation and Rx = almost 100% cure Prothesis
Slide 15: PQRST (U) P: provocative or palliative Q: Quality or Quantity R: Region or Radiation S: Severity Scale. T: Timing
Slide 16: “U” is Holistically important Understand Patient’s Perception ask “What do you think it means?”
Slide 17: Documentation If all is well this is what you write: No Lesions, inflammation, or d/c from penis. Scrotum, testes descended, symmetric, no masses. No inguinal hernia.
Slide 18: Anus, Rectum, and Prostate
Slide 19: Standards for Family Practice expect this examination to be combined with the examination of the male and female genitalia.
Slide 20: Clinical Objectives 1. Demonstrates knowledge of the S&S related to the rectal area/ health history 2. Inspect and palpate the perianal region 3. Test stool specimen for occult blood 4. Document
Slide 21: Health History Bowel Routine Changes Black/bloody stool Medications Rectal itching, pain, hemorrhoids Family history of colon/rectal polyps or cancer
Slide 22: Physical examination
Slide 23: Position Female ? Having a PAP also Male Gloves Lubricating Jelly
Slide 24: Perianal area Skin condition Sacrococcygeal area Valsalva maneuver
Slide 25: Palpate Anus and Rectum Anal sphincter Anal Canal Rectal Wall Prostate Gland Size, shape, surface, consistency, mobility, tenderness Cervix
Slide 26: Examination of Stool Visual Occult Blood – ( a false + may occur if the person has ingested significant amts. Of red meat in the last 3 days.
Slide 27: Documentation No fissure, hemorrhoids, fistula, or skin lesions in the perianal area. Sphincter tone good, no prolapse. Rectal walls smooth, no masses, tenderness. Stool brown, hematest neg. ( no prostate enlargement , no masses, no tenderness)
Slide 28: Concerns Carcinoma A rectal malignant neoplasm is asymptomatic. Irregular cauliflower shape, fixed, stone hard About ½ of rectal lesions are malignant
Slide 29: Abnormalities of Prostate Gland BPH – Benign Prostatic Hypertrophy Symptoms - urinary Symmetric, nontender enlargement Prostate surface feels smooth, rubbery, or firm with the median sulcus obliterated
Slide 30: Prostatitis Symptoms – infection, urinary, perineal and rectal pain Tender enlargement with acute inflammation Swollen, asymmetric gland, tender to palpation Chronic inflammation = tender enlargement, boggy feel or firm isolated areas or normal feel.
Slide 31: Carcinoma Symptoms = urinary, continuous pain lower back, pelvis, thighs Often starts as a single hard nodule posterior surface ; asymmetrical feel and change in consistency. Progression = multiple hard nodules until gland is stone hard and fixed
Slide 32: Female Genitalia
Slide 33: Clinical Objectives 1. Demonstrate knowledge of the S & S related to the female genitalia by obtaining health history 2. Demonstrate knowledge of infection control precautions before, during and after the examination. 3. Inspect and palpate the external genitalia 4. Documentation
Slide 34: Health History LMP Pregnancies Periods/ menopause Pap test Urinary symptoms Vaginal discharge Genital sores / lesions
Slide 35: Sexual relationships Birth control STDs/ precautions Medications hormones
Slide 36: Physical Examination
Slide 37: Privacy Position Comfort measures Empty bladder Wash hands in warm water Communication Chaperone
Slide 38: Inspect External Genitalia
Slide 39: Gloves Assess pubic hair Spread labia to visualize urinary meatus Note discharge; ulcerations
Slide 40: Palpate external genitalia Skene’s glands Bartholin’s glands Perineum Assess perineal muscle strength Nulliparous vs multiparous Vaginal bulging/ urinary incontinence discharge
Slide 41: Bimanual Examination Obstetric Hand position intravaginal other hand on the abdomen Vaginal Wall - smooth Cervix – Consistency = tip of nose Contour = evenly rounded Movable side to side , no pain Uterus Adnexa – ovaries, fallopian tubes (often not palpable) Rectovaginal – change gloves
Slide 42: Documentation External genitalia – no swelling, lesions, or discharge. No urethral swelling or discharge. Internal – vaginal walls have no bulging or lesions. Bimanual – no pain, ovaries not enlarged. Rectal- no hemorrhoids, fissures or lesions, no masses, no tenderness. Stool brown, neg. occult blood.
Slide 43: Abnormalities External Genitalia Pediculosis Pubis (crab lice) Genital Warts Bartholin Cyst Cystocele – bladder prolapse into vagina Uterine prolapse Rectocele – prolapse into vagina
Slide 44: Cervical Carcinoma Abnormal bleeding Pap and biopsy Risk factors Intercourse at early age + sex partners Smoking STDs
Slide 45: Adnexal Enlargement PID Ectopic Pregnancy Ovarian Cyst Ovarian Cancer Usually asymptomatic. Abd. enlargement from fld. Malignancy = heavy, solid, fixed, poorly defined mass
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