3Clinical ObjectivesDemonstrate knowledge of the S&S related to the male genitalia by obtaining a pertinent health history.Inspect and palpate the penis and scrotumTeach TSERecord the history and PE accurately, assess, develop a plan of care.
4How does a nurse create an environment that will be conducive for examination?
5Subjective Data for Male PrivacyReason for seeking care? Problem usually identified as “Personal” (not a diagnostic statement)How do you gather information?
6Did you identify all these areas? Frequency, urgency, nocturiaPolyuriaOliguria (< 400mls/24yrs)DysuriaHesitancy and strainingUrine colorPast genitourinary historyPenisPain, lesion, discharge, bleeding
7Sexual Activity and contraceptive use STD contact ScrotumTSESexual Activity and contraceptive useSTD contact
8After the client history in nonurgent cases …..What next? Remember you are doing Physical Assessment
9Male Genitalia Inspect and Palpate Wash Hands before and after examinationWear GlovesDischargeIf a scrotal mass is suspected, what will you check for ?PainLocationReduceAuscultate
10Transillumination - performed if scrotol swelling or mass. Darken room Transillumination - performed if scrotol swelling or mass. Darken room. Shine flashlight from behind the sac.Normal contents do not transilluminateSerous fld does = red glow (hydrccele, spermatocele)Solid tissue and bld do not transilluminate
11Normal Scrotal Findings Contents should slide easilyTestes feel oval, firm, rubbery, smooth, = bilaterallyFreely movable,Slightly tender to moderate pressureLeft testicle lower than right
12Inguinal 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
14TSE 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 symptomsEarly detection by palpation and Rx = almost 100% cureProthesis
15PQRST (U) P: provocative or palliative Q: Quality or Quantity R: Region or RadiationS: Severity Scale.T: Timing
16“U” is Holistically important Understand Patient’s Perception ask “What do you think it means?”
17Documentation 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.
25Palpate Anus and Rectum Anal sphincterAnal CanalRectal WallProstate GlandSize, shape, surface, consistency, mobility, tendernessCervix
26Examination of Stool Visual Occult Blood – ( a false + may occur if the person has ingested significant amts. Of red meat in the last 3 days.
27DocumentationNo 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)
28Concerns Carcinoma A rectal malignant neoplasm is asymptomatic. Irregular cauliflower shape, fixed, stone hardAbout ½ of rectal lesions are malignant
29Abnormalities of Prostate Gland BPH – Benign Prostatic HypertrophySymptoms - urinarySymmetric, nontender enlargementProstate surface feels smooth, rubbery, or firm with the median sulcus obliterated
30Prostatitis Symptoms – infection, urinary, perineal and rectal pain Tender enlargement with acute inflammationSwollen, asymmetric gland, tender to palpationChronic inflammation = tender enlargement, boggy feel or firm isolated areas or normal feel.
31CarcinomaSymptoms = urinary, continuous pain lower back, pelvis, thighsOften 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
33Clinical ObjectivesDemonstrate knowledge of the S & S related to the female genitalia by obtaining health historyDemonstrate knowledge of infection control precautions before, during and after the examination.Inspect and palpate the external genitaliaDocumentation
34Health History LMP Pregnancies Periods/ menopause Pap test Urinary symptomsVaginal dischargeGenital sores / lesions
35Sexual relationships Birth control STDs/ precautions Medications hormones
41Bimanual ExaminationObstetric Hand position intravaginal other hand on the abdomenVaginal Wall - smoothCervix –Consistency = tip of noseContour = evenly roundedMovable side to side , no painUterusAdnexa – ovaries, fallopian tubes (often not palpable)Rectovaginal – change gloves
42DocumentationExternal 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.
43Abnormalities External Genitalia Pediculosis Pubis (crab lice) Genital WartsBartholin CystCystocele – bladder prolapse into vaginaUterine prolapseRectocele – prolapse into vagina
44Cervical Carcinoma Risk factors Abnormal bleeding Pap and biopsy Intercourse at early age+ sex partnersSmokingSTDs
45Adnexal Enlargement PID Ectopic Pregnancy Ovarian Cyst Ovarian Cancer Usually asymptomatic.Abd. enlargement from fld.Malignancy = heavy, solid, fixed, poorly defined mass