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
hormones

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