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Genitalia

Genitalia. Male Genitalia. Clinical Objectives. Demonstrate knowledge of the S&S related to the male genitalia by obtaining a pertinent health history. Inspect and palpate the penis and scrotum Teach TSE Record the history and PE accurately, assess, develop a plan of care.

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Genitalia

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  1. Genitalia

  2. Male Genitalia

  3. Clinical Objectives • Demonstrate knowledge of the S&S related to the male genitalia by obtaining a pertinent health history. • Inspect and palpate the penis and scrotum • Teach TSE • Record the history and PE accurately, assess, develop a plan of care.

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

  5. Subjective Data for Male • Privacy • Reason for seeking care? Problem usually identified as “Personal” (not a diagnostic statement) • How do you gather information?

  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

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

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

  9. 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

  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

  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

  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

  13. TSE • T = timing • S = shower • E = examine

  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

  15. PQRST (U) • P: provocative or palliative • Q: Quality or Quantity • R: Region or Radiation • S: Severity Scale. • T: Timing

  16. “U” is Holistically important • Understand Patient’s Perception ask “What do you think it means?”

  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.

  18. Anus, Rectum, and Prostate

  19. Standards for Family Practice expect this examination to be combined with the examination of the male and female genitalia.

  20. Clinical Objectives • Demonstrates knowledge of the S&S related to the rectal area/ health history • Inspect and palpate the perianal region • Test stool specimen for occult blood • Document

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

  22. Physical examination

  23. Position • Female ? Having a PAP also • Male • Gloves • Lubricating Jelly

  24. Perianal area • Skin condition • Sacrococcygeal area • Valsalva maneuver

  25. Palpate Anus and Rectum • Anal sphincter • Anal Canal • Rectal Wall • Prostate Gland • Size, shape, surface, consistency, mobility, tenderness • Cervix

  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.

  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)

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

  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

  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.

  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

  32. Female Genitalia

  33. Clinical Objectives • Demonstrate knowledge of the S & S related to the female genitalia by obtaining health history • Demonstrate knowledge of infection control precautions before, during and after the examination. • Inspect and palpate the external genitalia • Documentation

  34. Health History • LMP • Pregnancies • Periods/ menopause • Pap test • Urinary symptoms • Vaginal discharge • Genital sores / lesions

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

  36. Physical Examination

  37. Privacy • Position • Comfort measures • Empty bladder • Wash hands in warm water • Communication • Chaperone

  38. Inspect External Genitalia

  39. Gloves • Assess pubic hair • Spread labia to visualize urinary meatus • Note discharge; ulcerations

  40. Palpate external genitalia • Skene’s glands • Bartholin’s glands • Perineum • Assess perineal muscle strength • Nulliparous vs multiparous • Vaginal bulging/ urinary incontinence • discharge

  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

  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.

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

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

  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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