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Genitalia. Male Genitalia Clinical Objectives 1. Demonstrate knowledge of the S&S related to the male genitalia by obtaining a pertinent health history.

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Presentation on theme: "Genitalia. Male Genitalia Clinical Objectives 1. Demonstrate knowledge of the S&S related to the male genitalia by obtaining a pertinent health history."— Presentation transcript:

1 Genitalia

2 Male Genitalia

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.

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

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

6 Did you identify all these areas? Frequency, urgency, nocturia Frequency, urgency, nocturia Polyuria Polyuria Oliguria (< 400mls/24yrs) Oliguria (< 400mls/24yrs) Dysuria Dysuria Hesitancy and straining Hesitancy and straining Urine color Urine color Past genitourinary history Past genitourinary history Penis Penis Pain, lesion, discharge, bleeding Pain, lesion, discharge, bleeding

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

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

9 Male Genitalia Inspect and Palpate Wash Hands before and after examination Wash Hands before and after examination Wear Gloves Wear Gloves Discharge Discharge If a scrotal mass is suspected, what will you check for ? If a scrotal mass is suspected, what will you check for ? Pain Pain Location Location Reduce Reduce Auscultate Auscultate

10 Transillumination - performed if scrotol swelling or mass. Darken room. Shine flashlight from behind the sac. Transillumination - performed if scrotol swelling or mass. Darken room. Shine flashlight from behind the sac. Normal contents do not transilluminate Normal contents do not transilluminate Serous fld does = red glow (hydrccele, spermatocele) Serous fld does = red glow (hydrccele, spermatocele) Solid tissue and bld do not transilluminate Solid tissue and bld do not transilluminate

11 Normal Scrotal Findings Contents should slide easily Contents should slide easily Testes feel oval, firm, rubbery, smooth, = bilaterally Testes feel oval, firm, rubbery, smooth, = bilaterally Freely movable, Freely movable, Slightly tender to moderate pressure Slightly tender to moderate pressure Left testicle lower than right 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 T = timing S = shower S = shower E = examine E = examine

14 TSE Should be practiced from 13yrs on every month. TSE Should be practiced from 13yrs on every month. Testicular cancer is the most common cancer in young men age 15 to 35. Testicular cancer is the most common cancer in young men age 15 to 35. Testicular tumor has no early symptoms Testicular tumor has no early symptoms Early detection by palpation and Rx = almost 100% cure Early detection by palpation and Rx = almost 100% cure Prothesis Prothesis

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

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

17 Documentation If all is well this is what you write: 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. 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. Standards for Family Practice expect this examination to be combined with the examination of the male and female genitalia.

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

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

22 Physical examination

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

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

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

26 Examination of Stool Visual Visual Occult Blood – ( a false + may occur if the person has ingested significant amts. Of red meat in the last 3 days. 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) 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 Carcinoma A rectal malignant neoplasm is asymptomatic. A rectal malignant neoplasm is asymptomatic. Irregular cauliflower shape, fixed, stone hard Irregular cauliflower shape, fixed, stone hard About ½ of rectal lesions are malignant About ½ of rectal lesions are malignant

29 Abnormalities of Prostate Gland BPH – Benign Prostatic Hypertrophy BPH – Benign Prostatic Hypertrophy Symptoms - urinary Symptoms - urinary Symmetric, nontender enlargement Symmetric, nontender enlargement Prostate surface feels smooth, rubbery, or firm with the median sulcus obliterated Prostate surface feels smooth, rubbery, or firm with the median sulcus obliterated

30 Prostatitis Prostatitis Symptoms – infection, urinary, perineal and rectal pain Symptoms – infection, urinary, perineal and rectal pain Tender enlargement with acute inflammation Tender enlargement with acute inflammation Swollen, asymmetric gland, tender to palpation Swollen, asymmetric gland, tender to palpation Chronic inflammation = tender enlargement, boggy feel or firm isolated areas or normal feel. Chronic inflammation = tender enlargement, boggy feel or firm isolated areas or normal feel.

31 Carcinoma Carcinoma Symptoms = urinary, continuous pain lower back, pelvis, thighs 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 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 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

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

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

36 Physical Examination

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

38 Inspect External Genitalia

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

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

41 Bimanual Examination Obstetric Hand position intravaginal other hand on the abdomen Obstetric Hand position intravaginal other hand on the abdomen Vaginal Wall - smooth Vaginal Wall - smooth Cervix – Cervix – Consistency = tip of nose Consistency = tip of nose Contour = evenly rounded Contour = evenly rounded Movable side to side, no pain Movable side to side, no pain Uterus Uterus Adnexa – ovaries, fallopian tubes (often not palpable) Adnexa – ovaries, fallopian tubes (often not palpable) Rectovaginal – change gloves 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. 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 External Genitalia Pediculosis Pubis (crab lice) Pediculosis Pubis (crab lice) Genital Warts Genital Warts Bartholin Cyst Bartholin Cyst Cystocele – bladder prolapse into vagina Cystocele – bladder prolapse into vagina Uterine prolapse Uterine prolapse Rectocele – prolapse into vagina Rectocele – prolapse into vagina

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

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


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