Week 11 Weekly Quiz

Steps to use bladder scanner

1. Position 2. Locate symphysis pubis 3. Apply ultrasound gel 4. Place scanner head on gel 5. Press scan button

Axillae skin color and condition expected variations

A client with a history of mastectomy may have lymphedema due to procedure disrupting the normal pathways of lymph drainage from the breast area

Male genitourinary system inspection of scrotum and testes expected variations

Adolescent: testes and scrotum enlarge to adult size Older adult: testes decrease in size, scrotal sac becomes pendulous

Female genitourinary system inspection of mons pubis expected variations

Adolescents: varied from soft straight sparse hair that covers the vulva to coarse curly hair that densely covers the mons pubis, vulva, and inguinal folds Older adults: sparse pubic hair with dry skin and mucous membranes and atrophy of mons pubis, labia, and clitoris

Clients should be familiar with own breast tissue

All clients should be encouraged to inspect and palpate their breast tissue so as to become familiar with their own breasts Any noted changes should be reported to provider

Present health condition for Breast and lymphatics

Any pain, swelling, or changes in appearance of breast, axillae, or nipples? Any nipple discharge? Any breast changes related to menstrual cycle? Enlarged lymph nodes?

Past health conditions for breast and lymphatics

Any previous breast disease (cancer or fibrocystic breast disease)? Any breast trauma, surgery, or biopsies? Any breast examinations?

Breast shape and size expected findings

Approximately the same size Smooth contour- unchanged as the client moves

Areolas and nipples skin condition expected findings

Areola round or oval shaped with small bumps visible Nipple protrudes Flat or inverted nipples present since puberty Skin smooth and intact- no open areas, crusting, rash, or drainage present

Genitourinary present health

Assess urinary system (pain, urine characteristics, difficulty urinating, discharge, lesions, or edema) Anus: Any pain, itching, burning, Stool color and characteristic Reproductive system: Gender identity and sexual practices, frequency of provider genitalia exams

Human Papillomavirus (HPV) Vaccine

Associated with cancer of cervix, penis, and anus- virus is transmitted by skin to skin contact and often does not have any manifestations Three immunizations over 6 months beginning at age 11 for all genders Most beneficial if administered prior to becoming sexually active

Routine examinations: Females

Average risk, sexually active, age 21-65 years: yearly pelvic exam, Pap smear every 3 years Cease pelvic exams and Pap smears if cervix removed or client is older than 65 years

Safe sexual practice

Be mindful of client's lifestyle, presences, and cultural and religious beliefs Some methods prevent conception but not STI

Breast skin color and condition expected variations

Bilateral vein visibility in obesity and pregnancy- should be visible bilaterally Striae- appear as pale linear marks Inflammation on underside of large breasts- due to skin friction

Breast self-exam expected findings

Breasts approximately same size and shape with smooth contour Absence of dimpling, rashes, edema, lumps, or tenderness in breast or axilla Clients who have large breasts may not a firm ridge of tissue along lower portion or breast due to tissue compression

Genitourinary present health unexpected findings

Burning, urgency, frequency- signs of potential infection Older adults: UTI can cause disorientation and confusion Incontinence- a condition that creates an inability to control the urine while sneezing or coughing. Can occur as a result of giving birth, or from a neuromuscular condition that interrupts the brain's ability to send appropriate signals that control the flow of urine Suprapubic pain

Manifestations of breast cancer

Change in breast size, shape, or contour Unilateral superficial vein dilation, inflammation, or edema of the breast or axillae Nipple discharge Enlarged lymph nodes Change in presentation or orientation of nipple Rash on nipple or areola Dimpled or retracted area in the breast tissue Visible or palpable lump in the breast tissue

Areolas and nipples symmetry, alignment, and orientation unexpected findings

Change in nipple presentation or orientation- can indicate the presence of a benign or cancerous mass in the breast

Breast self-exam unexpected findings

Changes in breast appearance or texture Presence of tenderness, nipple drainage, or inflammation

Intervention needed: Bladder distention indicating urinary retention

Client reports difficulty with voiding requires further assessment

Clients with increased risk of breast cancer should begin screenings earlier

Clients should follow their provider's recommendations for mammogram screenings based upon their risk for developing breast cancer

Anal and perianal area inspection expected variations

Decreased control of the anal opening is an expected variation in older adults due to weakened perineal muscles

Areolas and nipples skin condition unexpected findings

Dry scaling rash on nipple and areola- associated with form of breast cancer Discharge from nipple is client who is not lactating- can indicate the presence of an infection or certain types of breast cancer

Axillae skin color and condition unexpected findings

Edema in axilla or arm- can be related to infection in the breast, arm, or hand Rash- can indicate the presence of and infection of the sweat glands or an irritation from shaving or antiperspirant use Deeply pigmented, very smooth skin- suggests the presence of other diseases (diabetes, polycystic ovary disease) Lymphedema after mastectomy

Male genitourinary system inspection of scrotum and testes unexpected findings

Edema, redness, tenderness Nodules or masses Small, soft testes (less than 3.5 cm) Absent testes

Female genitourinary system inspection of mons pubis expected findings

Even distribution of hair in an inverted triangle pattern Clear skin with even color

Routine examinations: Colorectal cancer screening

Every client beginning at age 50, positive family history increases risk of developing colorectal cancer Screening options: fecal occult blood once per year, flexible sigmoidoscopy and digital rectal exam every 5 years, double contrast barium enema and digital rectal exam every 5 years, colonoscopy and digital rectal exam every 10 years

Female genitourinary system inspection of labia, vestibule, and perineum

Gently spread the labia major to inspect the inner aspects of the labia major, labia minora, vestibule, meatus, and perineum

Genital herpes

Groups of small painful fluid filled vesicles that break and become superficial ulcers

Male genitourinary system inspection of inguinal and femoral areas unexpected findings

Hernias, bulbes, swelling, pain

Family history for breast and lymphatics

History of breast cancer?

Male genitourinary system inspection of urethral meatus unexpected findings

Hypospadias- a meatus located on the ventral side of the glans or penis shaft Epispadias- occurs when the meatus is located on the dorsal side of the glans or penis shaft Discharge, redness, swelling

Intervention needed: Bladder distention indicating urinary retention additional actions/interventions

If bladder distention is present evaluate amount of urine. To measure post void bladder residual urine volume perform scan within 10 minutes of emptying bladder

Expected findings residual volume

If greater than 100 mL, notify provider of assessment findings Compare clients intake and output Position that promotes voiding Sensory stimulation techniques- Hearing the sound of running water or placing the clients hand in warm water

Intervention needed: Bladder distention indicating urinary retention palpation

If the bladder will be palpable above the symphysis pipes along the midline of the abdomen if bladder distention is suspected. Gently palpate, bladder distention can be felt as a smooth, rounded mass

Male genitourinary system inspection of penis unexpected findings

Inflammation Lesions or ulcerations Nodules Pubic lice Phimosis- a condition in which the prepuce is not able to be retracted

Female genitourinary system inspection of labia, vestibule, and perineum unexpected findings

Inflammation, edema, ulceration, and excoriation Discolored or malodorous vaginal discharge Tenderness, pain, or bruising Leukoplakia- white patches Lesions, lumps, or nodules Cervix appearing at vaginal opening- can occur when weakened pelvis muscles enable the uterus to prolapse into the vagina Bartholin gland abscess- a fluid-filled pocket with overlaying red and stinky skin that is painful and causes the labia to swell

Anal and perianal area inspection unexpected findings

Inflammation, lesions, scars, skin tags Fissures- a tear in the mucosal wall of the anus External hemorrhoids- dilated veins on the exposed portion of the anus. Appears as tissue flaps that are painless unless they become irritated of thrombosed (lack blood flow due to blood clot) Thrombosed hemorrhoid- appears bluish-purple, shiny, and full. Can report pain, itchiness, and bleeding during bowel movement Rectal prolapse- Involves partial or complete protrusion of the rectal wall through the anal opening. A bulging, moist, red, ring-shaped membrane is seen at the anal opening Stool color: Bright red blood- can indicate hemorrhoids or bleeding from the rectum, tarry black stools- can be from too much iron or blood from further up in the intestinal tract, gray stool- the client may have an obstructed biliary tract

Female genitourinary system inspection of labia, vestibule, and perineum expect findings

Inside of labia major and minora are darker than overall skin tone Labia majora: no vaginal birth- labia appear full with labia meeting midline, after vaginal birth- labia have open wrinkled appearance Labia minora: symmetrical and smooth Clitoris: smooth, moist, round, and located between labia minora folds Urethral opening: midline and star or slit-shaped Vaginal introitus- slit or larger opening, may have uneven edges due to remnants of hymen membrane Perineum- smooth

Male genitourinary system inspection

Inspect all sides of the penis, including the dorsal surface, ventral surface, and base Note hair distribution around the base of the penis The glans is the tip of the penis and it is visible in a circumcised penis with the prepuce (foreskin) removed. For a client whose foreskin is intact, ask them to retract the prepuce to allow inspection of the glans

Male genitourinary system inspection of inguinal and femoral areas

Inspect for bulges, located on either side of the shaft below the area of the symphysis pubis

Breast skin color and condition

Inspect the color and condition of the clients breast tissue with the client's arms relaxed at their sides

Intervention needed: Bladder distention indicating urinary retention inspection

Inspect the suprapubic (bladder) area for distention. Bladder distention related to urine retention is caused by an inability to empty the bladder during urination. This could be related to an obstruction, weak bladder muscles, medications, or neurologic condition

Male genitourinary system inspection of urethral meatus expected findings

Located midline in center of glans Smooth and similar in color to surrounding area

Breast self-exam process

Look at breasts in front of a mirror with hands placed on hips Inspect for any changes in color, shape, contour, dimpling in the skin, or presence of a rash or drainage Lie down and place the arm closest to the breast to be examined behind the head and palpate for lumps Clients should palpate each breast using the pads of the three middle fingers. Make overlapping dime sized circular motions with the finger pads to assess each area of the breast for the presence of lumps

Breast tests

Mammogram recommendations vary based upon client's risk for breast cancer Client who have low risk: screening mammogram ever 1-2 years beginning at age 45 Clients who have increased risk: screening mammogram at age of 40 Continue with screenings until 75 or longer if client's life expectancy is at least 10 yrs

Breast self-exam

Menstruating clients should palpate breasts 4 to 7 days after start of menstrual cycle- the breast tissue will be less full and tender as compared to other days of the month Clients who have had breast augmentation should follow same procedures for breast examination

Contraception

Natural methods: withdrawal, fertility tracking, periodic abstinence Barrier methods: condoms, diaphragms, sponges (use a physical device that acts a barrier to prevent sperm from reaching an egg Pharmacological methods: oral hormone and injectable hormone contraceptives, vaginal spermicides (medication to prevent pregnancy) Surgical interventions: vasectomies and tubal ligation

Areolas and nipples symmetry, alignment, and orientation expected findings

Nipples symmetric and positioned in same plane of breast and oriented in same direction

Intervention needed: Genital lesions and discharge inspection

Note appearance, clusters, location, and size Note color, odor, and consistency of discharge Additional actions: document and notify provider

Female genitourinary system inspection of mons pubis

Note the presence of pubic hair and general skin surface characteristics

Areolas and nipples skin condition

Observe the color, shape, and skin characteristics of the nipple and areola. The color can vary from pink to black and is based on hormones and ethnicity

Female genitourinary system inspection of labia, vestibule, and perineum expected variations

Perineum may have scar from childbirth- if the client had an episiotomy during vaginal birth Older adults: postmenopausal changes of atrophy and dryness- from decreased hormone levels after menopause

Anal and perianal area prepare

Position the client on their side with the hip and knee bent, will allow for visualization of the perineal area

Female genitourinary system preperation

Positioning- ask the client to lie in the supine position with their knees bent and feet placed on the bed. Cover their abdomen with a sheet for modesty, and instruct the client to drop their knees outward so that you can inspect the external genitalia Improve client comfort- void prior to exam, elevate HOB for eye contact, stirrup positioning, explain step prior to performing, gentle but firm touch, talk to client throughout exam

Male genitourinary system preparation

Positioning- either supine or standing position

STI prevention and screening: Behavioral counseling for adolescents and adults about STI

Prevalence Transmission Condoms to reduce transmission HIV screening- high risk- yearly, low risk- one-time screening Chlamydia and gonorrhea annual screening- sexually active clients younger than 25, multiple sexual partners or possible exposure

Routine examinations: Males

Prostate and genitalia examination: yearly to detect cancer lesions Palpation of prostate: Older adults- may experience benign enlargement of prostate, changes in frequency and urgency of urination, Prostate-specific antigen (PSA) screening/digital rectal exam (DRE), Average risk- begin PSA screenings and optional DRE at age 50, Abstain from ejaculation for 2 days prior to PSA, discontinue at age 70 or if life expectancy less than 10 years, High risk- Begin PSA screening and optional DRE at age 40 or 45 Testicular self-examination: annual by provider, monthly by client

Breast shape and size expected variations

Scars from breast surgeries Gynecomastia in adolescents or weight gain- certain disease and medication can cause condition Older adults: gynecomastia in males, female breast flattened and pendulous- menopause related hormonal changes and breast tissue atrophy lead to flattening and pendulous

Male genitourinary system inspection of scrotum and testes expected findings

Scrotal skin darker coloring than overall skin tone Left testicle hangs slightly lower than the right- due to longer length of the left spermatic cord Equal in size Freely moveable

Breast shape and size unexpected findings

Significant differences in size or presence of a mass- associated with breast cancer Difference in contour- associated with breast cancer Dimpling or retraction- associated with breast cancer Change in contour with movement- can indicate the presence of mass within the breast

Syphilitic chancre

Single silver colored raised patch that develops into a superficial ulcer with yellow serous discharge

Male genitourinary system inspection of penis expected findings

Skin slightly wrinkled Pubic hair can be present in the surrounding genital area, but the penis should be hairless Large dorsal vein visible on shaft of penis Glans smooth: Circumcised, intact

Genital warts

Small painless fleshy growth that may appear singularly or in cluster

Breast skin color and condition expected findings

Smooth and consistent coloring

Axillae skin color and condition expected findings

Smooth and intact- no areas of discoloration, edema, or rash

Hepatitis B Vaccine

Spread through contact with infected blood, some, and other body fluids Recommended for client in high risk settings, health care workers, HBV endemic area, chronic liver diseases, HIV infection, and clients who have had exposure to blood

Areolas and nipples symmetry, alignment, and orientation expected variations

Supernumerary nipple- extra nipple, they are typically pink or brown and appear along the embryonic milk line that runs from the breast to the groin area, often mistaken for moles

Female genitourinary system inspection of mons pubis unexpected findings

Swelling or redness Patchy or complete hair loss Lesions or ulcerations Pubic lice

Male genitourinary system inspection of inguinal and femoral areas expected findings

Symmetrical and flat

Chlamydia

Symptom free or may present with yellow purulent discharge from the meatus and painful, frequent urination

Anal and perianal area inspection expected findings

The anal and perineal skin should be intact without any noticeable protrusion or lesions The anal skin will be coarse and more darkly pigmented than the overall skin tone The area will appear moist and hairless The anus should remain closed when the client is relaxed

Breast skin color and condition unexpected findings

Unilateral rash, skin thickening, dimpling, venous distention, or edema- associated with breast cancer Peau d'orange appearance- when the breast tissue resembles the skin of an orange. Caused by edema, which dilates the hair follicles. Associated with breast cancer Inflammation or edema- can indicate the presence of an infection in the breast tissue

Genitourinary past health

Urinary system: history of UTI, personal or family history of prostate or kidney problems Anus: history of anal problems, rectal or anal surgery Reproductive system: personal or family history of cancer of reproductive tract, surgery of reproductive tract. Women: child bearing age, menstrual history- menarche, last menstrual period, cycle, excessive bleeding or cramping, obstetrical history- pregnancies, abortions, living children, pregnancy complication, contraceptives, over age 40, menopausal manifestations, hormone replacement therapy. Men: testicular changes- lumps, bulges, swelling, or changes

Intervention needed: Genital lesions and discharge subjective data

When did lesions appear? Any exposure to STIs? Any genital discharge? Pain or feelings of abdominal fullness

Gonorrhea

Yellow or green discharge from meatus along with abdominal or pelvic pain and dysuria

Male genitourinary system inspection of scrotum and testes

You might need to lift them up to inspect the underside, and you can ask the client to hold their penis out of the way

Breast shape and size

observe the client at rest and with arm movement