Genitalia

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Genitalia

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Male Genitalia

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Clinical Objectives

1. Demonstrate knowledge of the SS 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.

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• How does a nurse create an environment that will
  be conducive for examination?

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Subjective Data for Male

• Privacy
• Reason for seeking care? Problem usually
  identified as Personal (not a diagnostic
  statement)
• How do you gather information?

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Did you identify all these areas?

• Frequency, urgency, nocturia
• Polyuria
• Oliguria (lt 400mls/24yrs)
• Dysuria
• Hesitancy and straining
• Urine color
• Past genitourinary history
• Penis
• Pain, lesion, discharge, bleeding

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• Scrotum
• TSE
• Sexual Activity and contraceptive use
• STD contact

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• After the client history in nonurgent cases
  ..What next?
• Remember you are doing Physical Assessment

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Male GenitaliaInspect 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

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• 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

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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

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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

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TSE

• T timing
• S shower
• E examine

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• 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

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PQRST (U)

• P provocative or palliative
• Q Quality or Quantity
• R Region or Radiation
• S Severity Scale.
• T Timing

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U is Holistically important

• Understand Patients Perception ask What do you
  think it means?

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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.

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Anus, Rectum, and Prostate
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• Standards for Family Practice expect this
  examination to be combined with the examination
  of the male and female genitalia.

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Clinical Objectives

1. Demonstrates knowledge of the SS related to the
   rectal area/ health history
2. Inspect and palpate the perianal region
3. Test stool specimen for occult blood
4. Document

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Health History

• Bowel Routine
• Changes
• Black/bloody stool
• Medications
• Rectal itching, pain, hemorrhoids
• Family history of colon/rectal polyps or cancer

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Physical examination
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• Position
• Female ? Having a PAP also
• Male
• Gloves
• Lubricating Jelly

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Perianal area

• Skin condition
• Sacrococcygeal area
• Valsalva maneuver

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Palpate Anus and Rectum

• Anal sphincter
• Anal Canal
• Rectal Wall
• Prostate Gland
• Size, shape, surface, consistency, mobility,
  tenderness
• Cervix

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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.

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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)

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Concerns

• Carcinoma
• A rectal malignant neoplasm is asymptomatic.
• Irregular cauliflower shape, fixed, stone hard
• About ½ of rectal lesions are malignant

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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

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• 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.

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• 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

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Female Genitalia

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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

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Health History

• LMP
• Pregnancies
• Periods/ menopause
• Pap test
• Urinary symptoms
• Vaginal discharge
• Genital sores / lesions

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• Sexual relationships
• Birth control
• STDs/ precautions
• Medications
• hormones

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Physical Examination
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• Privacy
• Position
• Comfort measures
• Empty bladder
• Wash hands in warm water
• Communication
• Chaperone

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Inspect External Genitalia
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• Gloves
• Assess pubic hair
• Spread labia to visualize urinary meatus
• Note discharge ulcerations

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Palpate external genitalia

• Skenes glands
• Bartholins glands
• Perineum
• Assess perineal muscle strength
• Nulliparous vs multiparous
• Vaginal bulging/ urinary incontinence
• discharge

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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

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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.

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Abnormalities

• External Genitalia
• Pediculosis Pubis (crab lice)
• Genital Warts
• Bartholin Cyst
• Cystocele bladder prolapse into vagina
• Uterine prolapse
• Rectocele prolapse into vagina

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• Cervical Carcinoma
• Abnormal bleeding
• Pap and biopsy
• Risk factors
• Intercourse at early age
• sex partners
• Smoking
• STDs

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Adnexal Enlargement

• PID
• Ectopic Pregnancy
• Ovarian Cyst
• Ovarian Cancer
• Usually asymptomatic.
• Abd. enlargement from fld.
• Malignancy heavy, solid, fixed, poorly defined
  mass