Genitals and Rectum

Page 654 - 662

Dyana M. M. Saplan, RN, MAN

Female Genitals
Examination of the genitals and the reproductive tract includes:
Assessment of the inguinal lymph nodes and Inspection and palpation of the external genitals

In most settings - Generalist nurses perform only inspection of the external genitals and palpation of inguinal lymph nodes
Dyana M. M. Saplan, RN, MAN

For sexually active adolescent and adult women:

Papanicolaou test (Pap test) is used to detect cancer of the cervix If there is ed or abnormal vaginal discharge
Specimens should be taken to check for sexually transmitted infections (STI)

Dyana M. M. Saplan, RN, MAN

Female Genitals and Inguinal area

Usually creates uncertainty and apprehension Lithotomy position can cause embarassment
Nurse must explain each part of the examination in advance Perform in an objective, supportive and efficient manner

Dyana M. M. Saplan, RN, MAN

Assessing Female Genitals

Planning
Equipment:
clean gloves, drape, supplemental lighting (if needed)

Dyana M. M. Saplan, RN, MAN

Implementation
Inquire regarding the following:
Menarche LMP Regularity of cycle Duration, amount of daily flow Dysmenorhea (painful menstruation) Pain during intercourse Vaginal discharge Obstetrical history Urgency and frequency of urination @ night Blood in urine; pain; incontinence Hx of STI, past and present
Dyana M. M. Saplan, RN, MAN

Assessment:
Inspect distribution, amount, and characteristics of pubic hair
N: varies; generally kinky in adult, thinner and straighter after menopause; inverse triangle D: scant pubic hair (hormonal problem)

Inspect the skin of pubic area for parasites, inflammation, swelling and lesions. To assess adequately separate labia
Dyana M. M. Saplan, RN, MAN

Assessment
Inspect clitoris, urethral orifice, and vaginal orifice when separating labia minora
N: clitoris does not exceed 1 cm in width and 2 cm length; urethral orifice appears as a small slit and same color as surrounding tissues; No inflammation, swelling, or discharge

Dyana M. M. Saplan, RN, MAN

Assessment of inguinal area

Palpate inguinal lymph nodes Use pads of fingers in a rotary motion, noting any enlargement or tenderness
Dyana M. M. Saplan, RN, MAN

Lifespan Considerations
Infants can be held in a supine position on the parents lap with the knees supported in a flexed position and separated In newborns, because of maternal estrogen labia and clitoris may be edematous and enlarged, and there may be small amount of white or bloody vaginal discharge. Assess the mons and inguinal area for swelling or tenderness that may indicate presence of an inguinal hernia

Dyana M. M. Saplan, RN, MAN

Children
Ensure that you have the parent or guardians approval to perform the examination and then tell the child what you are going to do. Pre-school children are taught not to allow others to touch their private parts Assessment of adolescent girls is limited to inspection of the external genitals, unless the girl is sexually active. the exam should be conducted with the parent out of the room. Girls should have a papanicolau (Pap) test done if sexually active, or by age 18 years
Dyana M. M. Saplan, RN, MAN

Elders
Labia are atrophied and flatter in older females. Clitoris is a potential site for cancerous lesions in older females The vulva atrophies as a result of a reduction in vascularity, elasticity, adipose tissue and estrogen levels. Because the vulva is more easily irritated.
Dyana M. M. Saplan, RN, MAN

Elders
The vaginal environment becomes drier and more alkaline, resulting in an alteration of the type of flora present and predisposed to vaginitis Dyspareunia (difficult or painful intercourse) is also a common occurrence The cervix and uterus decrease in size The fallopian tubes and ovaries atrophy

Dyana M. M. Saplan, RN, MAN

Elders
Vaginal bleeding unrelated to estrogen therapy is abnormal in older women Prolapse of the uterus can occur in older females, especially those who have had multiple pregnancies. Older females may be arthritic and find the examination position uncomfortable
Dyana M. M. Saplan, RN, MAN

Internal Genitals
In many agencies - only nurse practitioners examine the internal genitals Examination of internal genitals involves:
Palpating Skenes and Bartholins glands Assessing pelvic musculature Inserting vaginal speculum to inspect the cervix and vagina, and Obtaining a Papanicolaou smear
Dyana M. M. Saplan, RN, MAN

Vaginal speculum
Speculum examination involves insertion of a plastic or metal that consists of 2 blades and an adjustable thumb screw May be lubricated w/ water-soluble lubricant if specimens are not being collected
Most examiners lubricate w/ warm water

Dyana M. M. Saplan, RN, MAN

Vaginal speculums

Dyana M. M. Saplan, RN, MAN

Speculum examination

Dyana M. M. Saplan, RN, MAN

Nurses Responsibilities:
Assembling equipment
Drapes, gloves, warm water/lubricant, supplies for culture studies

Preparing client
Advise not to douche prior to procedure Explain procedure Assist to a lithotomy position Drape appropriately

Dyana M. M. Saplan, RN, MAN

Nurses Responsibilities:
Supporting client during the procedure
Encouraging to take deep breaths relax pelvic muscles

Monitoring and assisting client after procedure

Perineal care, as needed

Documenting procedure
Date, time performed, name of examiner, any nursing assessments and interventions
Dyana M. M. Saplan, RN, MAN

Male Genitals and Inguinal Area

Page 657- 660

Dyana M. M. Saplan, RN, MAN

Complete examination includes:

Adult males:
Assessment of external genitals Presence of any hernias, and Prostate glands

Reproductive and urinary systems share the urethra

Passageway for both urine semen

Dyana M. M. Saplan, RN, MAN

Assessment
All males shd be screened for presence of inguinal or femoral hernias
Protrusion of the intestine through the inguinal wall or canal

CA of the prostate gland most common cancer in adult males

Occurs primarily in men over age 50

Examination of prostate gland is performed w/ examination of the rectum and anus

Dyana M. M. Saplan, RN, MAN

Dyana M. M. Saplan, RN, MAN

Inguinal hernia

Dyana M. M. Saplan, RN, MAN

Femoral hernia

Dyana M. M. Saplan, RN, MAN

Assessment
Testicular CA
Much rarer Occurs primarily in young men ages 15 35 Commonly found on the anterior and lateral surfaces of the testes Testicular self-examination should be conducted monthly

Dyana M. M. Saplan, RN, MAN

Abnormal findings

Hypospadias
Dyana M. M. Saplan, RN, MAN

Hypospadias

Dyana M. M. Saplan, RN, MAN

Epispadias

Dyana M. M. Saplan, RN, MAN

Scrotal edema

Dyana M. M. Saplan, RN, MAN

Rectum and Anus

Page 657- 660

Dyana M. M. Saplan, RN, MAN

Position
Adults:
Left lateral or Sims

Females:
Dorsal recumbent w/ hips externally rotated and knees flexed, or Lithotomy

Males examining prostate gland

Standing position while client bends over the examining table

Dyana M. M. Saplan, RN, MAN

Digital exam of Prostate

Dyana M. M. Saplan, RN, MAN

Abnormal Findings

Dyana M. M. Saplan, RN, MAN

Anal fissure

Dyana M. M. Saplan, RN, MAN

External Hemorrhoids

Dyana M. M. Saplan, RN, MAN

Imperforate anus

Dyana M. M. Saplan, RN, MAN

Temporary mgt. of imperforate anus

Dyana M. M. Saplan, RN, MAN

Rectal prolapse

Dyana M. M. Saplan, RN, MAN