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Presentation on theme: "Genitalia."— Presentation transcript:

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 Sexual Activity and contraceptive use STD contact
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 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

10 Transillumination - 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 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

36 Physical Examination

37 Privacy Position Comfort measures Communication Chaperone
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 Risk factors Abnormal bleeding Pap and biopsy
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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