Exam 5
Which of the following documentation statements indicates a normal assessment of the perianal area? "Small round opening in the anal area." "Anus moist, color darker than adjacent tissues. No lesions or discharge. Opening tightly closed." "Anal area dark pink, moist, with 0.5-cm shiny blue skin sac at 5 o'clock." "Anus with flabby skin sac at 7 o'clock."
"Anus moist, color darker than adjacent tissues. No lesions or discharge. Opening tightly closed." Normal findings during inspection of the perianal area include anus moist and hairless, with coarse folded skin that is more pigmented than the perianal skin; anal opening that is tightly closed; and no lesions present. A shiny blue skin sac is a thrombosed hemorrhoid. A flabby skin sac is a hemorrhoid. A small round opening in the anal area is a fistula.
Which of the following questions would be appropriate for the nurse to ask when a patient complains of diarrhea? (Select all that apply.) Select all that apply. "Have you ever had clay-colored stools?" "Have you traveled recently?" "Do you eat breakfast?" "Have you eaten at a restaurant in the past few days?" Have you recently been prescribed antibiotics?"
"Have you traveled recently?" "Have you eaten at a restaurant in the past few days?" Have you recently been prescribed antibiotics?" Noninflammatory diarrhea is associated with travel, foodborne illness, and may be a side effect of antibiotics. Eating breakfast is a question that should be routinely asked as part of the subjective GI assessment. Clay-colored stools indicate absent bile pigment associated with liver disease or gallstones.
Subjective Data
1. Frequency, urgency, and nocturia 2. Dysuria 3. Hesitancy and straining 4. Urine color 5. Past genitourinary history 6. Penis—pain, lesion, discharge 7. Scrotum, self-care behaviors, lump 8. Sexual activity and contraceptive use 9. Sexually transmitted infection (STI) contact
Summary Checklist: Male Genitalia Examination
1. Inspect and palpate the penis. 2. Inspect and palpate the scrotum. 3. If a mass exists, transilluminate it. 4. Palpate for an inguinal hernia. 5. Palpate the inguinal lymph nodes.
Subjective Data
1. Menstrual history 2. Obstetric history 3. Menopause 4. Patient-centered care 5. Acute pelvic pain 6. Urinary symptoms 7. Vaginal discharge 8. Past history 9. Sexual activity 10. Contraceptive use11. Sexually transmitted infection (STI) contact
Subjective Data
1. Usual bowel routine 2. Change in bowel habits 3. Rectal bleeding, blood in the stool 4. Medications (laxatives, stool softeners, iron) 5. Rectal conditions (pruritus, hemorrhoids, fissure, fistula) 6. Family history 7. Patient-centered care (diet of high-fiber foods, most recent examinations)
Scrotum
A loose protective sac, which is a continuation of the abdominal wall. The scrotal skin is deeply pigmented and has large sebaceous follicles. The scrotal wall consists of thin skin lying in folds, or rugae, and the underlying cremaster muscle. The cremaster muscle controls the size of the scrotum by responding to ambient temperature (keep the best temperature for producing sperm). Will raise or lower to maintain temperature In each scrotal half is a testis, which produces sperm. Lubricated by fluid so the testis can slide a little within the scrotum; this helps prevent injury
The Rectum
A short tube at the end of the large intestine where waste material is compressed into a solid form before being eliminated The rectum, which is 12 cm long, is the distal portion of the large intestine. It extends from the sigmoid colon, at the level of the 3rd sacral vertebra, and ends at the anal canal. Just above the anal canal the rectum dilates and turns posteriorly, forming the rectal ampulla. The rectal interior has 3 semilunar transverse folds called the valves of Houston. The peritoneum covers only the upper two-thirds of the rectum
Abnormal Findings: Scrotum
Absent testes, cryptorchidism: failure to distend; a condition in which one or both of the testes fail to descend from the abdomen into the scrotum. Testicular torsion: occurs when a testicle rotates, twisting the spermatic cordthat brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling. Epididymitis: an inflammation of the small, coiled tube at the back of the testicle (epididymis). Signs and symptoms of epididymitis might include: A swollen, red or warm scrotum. Testicle pain and tenderness, usually on one side Testicular tumor: Cancer in the male organs that make male hormones and sperm (testicles). Orchitis: an inflammation of one or both testicles. Bacterial or viral infections can cause orchitis (STI) Scrotal Edema: scrotum swelling; accumulation of fluid, inflammation, or an abnormal growth
What is the most appropriate recommendation to prevent cervical cancer in females? Administration of HPV vaccine around 11 and 12 years old Start birth control if sexually active There is nothing that can prevent cervical cancer. Use barrier protection method during sexual intercourse.
Administration of HPV vaccine around 11 and 12 years old The American Cancer Society recommends HPV vaccine for all boys and girls at 11 and 12 years as HPV causes almost all cervical cancers in addition to other types of cancer. Barrier protection is important to use during intercourse to prevent spread of sexually transmitted infections, but is not the best method to prevent cervical cancer. Use of birth control when sexually active is important to decrease the risk for pregnancy. Studies show that the HPV vaccine at 11 and 12 years old has been linked to steep declines in the presence of HPV which causes almost all cervical cancers in addition to other types of cancer.
Nursing Considerations
Antibiotic Use - Itching, burning (subjective) - Changes in normal flora with antibiotic use Contraception use - Protection, frequency, education of STI - Risk factors: smoking Infertility - classified 1 year of unprotected intercourse prior to seeking medical attention Candidiasis - Yeast infection - White discharge, curdlike
Additional History: Aging Adult
Any difficulty urinating? Have you experienced any hesitancy or straining, a weakened force of stream, dribbling, or incomplete emptying? Do you ever leak water or urine when you don't want to? Do you use pads/tissue to catch urine in your underwear? Do you need to get up at night to urinate? What medications are you taking? What fluids do you drink in the evening?
Sexually Transmitted Infection
Any sexual contact with a partner having an STI, such as gonorrhea, herpes, AIDS, chlamydia, venereal warts, or syphilis - When was this contact? Did you get the disease? - How was it treated> Were there any complications? - Do you use condoms to help prevent STIs? Do you have any questions or concerns about any of these diseases?
In order to obtain accurate subjective assessment data from a female adolescent, what would be the most appropriate action by the nurse? Stand when asking questions. Ask parent/caregiver to step out of the room and return to the lobby. Share what life was like for the nurse at the patient's age. Ask questions such as, "you're not sexually active, right?"
Ask parent/caregiver to step out of the room and return to the lobby. In order to gain trust and provide privacy for the adolescent female, it would be most appropriate to ask the parent/caregiver to step out of the room. The nurse should rarely share personal information especially r/t female genitalia and sexuality. Asking questions in a negatively worded manner does not provide an open environment for the adolescent female to share concerns. Whenever interviewing/talking with patients, the nurse should use therapeutic communication techniques which includes sitting or being at their eye level.
Vaginal lubrication during intercourse is produced by: sebaceous glands. adrenal glands. Bartholin glands. Skene glands.
Bartholin glands. The vestibular (Bartholin) glands secrete clear lubricating mucus during intercourse. Paraurethral (Skene) glands are tiny, multiple glands that surround the urethral meatus. Sebaceous glands are microscopic glands in the skin that secrete an oily/waxy matter, called sebum, to lubricate the skin and hair. The adrenal glands are endocrine glands responsible for releasing hormones in conjunction with stress through the synthesis of corticosteroids and catecholamines.
Transillumination of Scrotum and Testes
By holding a light externally to the scrotum or testes, one can easily determine whether the mass is cystic (light shines through) or solid (light blocked by the mass)
Culture Considerations
Cervical Cancer: Racial/Geographical - Black women still have higher cervical cancer incidence rates and lower relative survival rates than whites. Factors related to these statistics are (1) presenting with cancer at later stages and being less likely to receive the best treatment due to patient refusal, (2) inappropriate physician recommendation, (3) poorer health, and (4) comorbid conditions. - A geographic disparity—incidence rates were highest among non-Hispanic blacks in the South. Also in the South, incidence rates among whites decreased after age 40 years and rates for black women increased with greater age. Thus one population to target to decrease cervical cancer rates and mortality would be older black women living in the Southern United States HPV Vaccine: American Cancer Society Recommends the vaccine for all boys and girls at 11 and 12 years, with late vaccination as soon as possible for those not vaccinated. HPV causes almost all cervical cancers, as well as vulvar, vaginal, anal, and oropharyngeal cancers in females and most oropharyngeal, anal, and penile cancers in males. - The HPV vaccine has been linked to steep declines in the presence of the virus in teenage girls and young women, just 6 years after its introduction—a 64% decrease in quadrivalent HPV types in teens ages 14 to 19 years and a 34% decrease in those ages 20 to 24 years. Female Circumcision (female genital mutilation) or "cutting," is an invasive, coercive surgical procedure performed on girls before puberty. It is a social custom, not a religious practice. This procedure involves removal, partial or total, of the clitoris and is believed to inhibit sexual pleasure. However the procedure can cause severe bleeding, death, sterility, infection, psychological trauma, and have severe consequences during childbirth.
Menopause
Cessation of the menses. Usually this occurs around 48 to 51 years, although a wide variation of age from 35 to 60 years exists. The preceding 1 to 2 years of decline in ovarian function shows irregular menses that gradually become farther apart and produce a lighter flow. Ovaries stop producing progesterone and estrogen. Because cells in the reproductive tract are estrogen dependent, decreased estrogen levels during menopause bring dramatic physical changes. The uterus shrinks in size because of decreased myometrium. The sacral ligaments relax, and the pelvic musculature weakens; thus the uterus droops. The cervix shrinks and looks paler with a thick, glistening epithelium; uterine and ovarian atrophy The vagina becomes shorter, narrower, and less elastic. Without sexual activity the vagina atrophies to one-half its former length and width. The vaginal epithelium atrophies, becoming thinner, drier, and itchy. Decreased vaginal secretions leave the vagina dry and at risk for irritation and pain with intercourse (dyspareunia). The vaginal pH becomes more alkaline, and glycogen content decreases from the decreased estrogen. These factors also increase the risk for vaginitis because they create a suitable medium for pathogens.
Sexual Expression in Later Life
Chronologic age by itself should not mean a halt in sexual activity; physical changes need not interfere with libido and sexual pleasure Older male is capable of sexual function as long as he is in reasonably good health and has an interested, willing partner Danger is in male misinterpreting normal age changes as a sexual failure; once this idea occurs, it may demoralize man and place undue emphasis on performance rather than on pleasure In absence of disease, withdrawal from sexual activity may be due to (any combination of) - loss of spouse, depression, preoccupation with work - marital or family conflicts - side effects of medication, heavy alcohol use - lack of privacy, living with children, or in a nursing home - poor nutrition or fatigue
Culture and Genetics: Circumcision
Circumcision is an elective surgical procedure to remove all or part of the foreskin (prepuce) from the penis. Parents need an unbiased presentation of the risks and benefits of this procedure. Parents make the decision about whether to circumcise their newborn son. Medical benefits of male circumcision include a reduced risk of acquiring HIV infection through heterosexual contact, reduced risk of urinary tract infections in infancy and in adults a reduced risk of STIs such as human papillomavirus (HPV) infection, herpes simplex virus, and genital ulcer disease in men, and a decreased risk of bacterial vaginosis and trichomoniasis in female partners. Religious and cultural, as well as medical indications can influence decisions
The American Academy of Pediatrics recommends newborn male circumcision because of which of the following benefits? Increased risk for HIV Increased risk for sexually transmitted infections Transmission of trichomoniasis Decreased risk for urinary tract infections
Decreased risk for urinary tract infections The American Academy of Pediatrics recommends newborn male circumcision as it shows decreased risk for urinary tract infections. Newborn male circumcision decreases the risk for sexually transmitted infection, transmission of trichomoniasis, and decreased risk for HIV transmission among heterosexual partners.
Developmental Competence: Gender Identity
Do not assume sexual orientation by appearance. Be aware of definition of "sexual minority." Self-identify as gay, lesbian, bisexual, and transgender Provide accepting attitude while providing factual information that is confidential in nature. Identify and provide supportive resources.
A patient tells the examiner that passing stools is painful. What term would the examiner use to document painful bowel movements? Flatulence Encopresis Occult Dyschezia
Dyschezia Dyschezia is the painful passage of stool secondary to a local condition (e.g., hemorrhoids, fissure) or constipation. Occult is a term used to describe blood in the stools that is not visible. Flatulence is the passage of gas from the anus. Encopresis is persistent passing of stools into clothing in a child older than age 4 years, at which age continence would be expected.
Self-Care: Testicular Self-Examination (TSE)
Encourage self-care by teaching every male from 13 to 14 years old through adulthood how to examine his own testicles. Early detection of cancer enhanced if male is familiar with his normal consistency. Points to include during health teaching are: T—timing, once a month S—shower, warm water relaxes scrotal sac E—examine, check for, and report changes immediately Testicular Torsion: emergency situation; occurs when a testicle rotates, twisting the spermatic cordthat brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling Cancer: enlarged testicle or painless lump
Abnormal Findings
Hemorrhoids: also called piles, are swollen veins in your anus and lower rectum, similar to varicose veins. Hemorrhoids can develop inside the rectum (internal hemorrhoids) or under the skin around the anus (external hemorrhoids). Prolapsed rectum: part of the large intestine slips outside the anus. Black tarry stools: a sign of a problem in the upper digestive tract. It most often indicates that there is bleeding in the stomach, small intestine, or right side of the colon. Steatorrhea: Fat in the stools, oily appearance, and floats Pinworms: white, parasitic worms that can live in the large intestine
Testies
In each scrotal half is a testis, which produces sperm. It is suspended vertically by the spermatic cord. The left testis is lower than the right because the left spermatic cord is longer. Each testis is covered by a double layered membrane, the tunica vaginalis, which separates it from the scrotal wall. The two layers are lubricated by fluid so the testis can slide a little within the scrotum; this helps prevent injury Sperm are transported along a series of ducts. First the testis is capped by the epididymis, which is a markedly coiled duct system and the main storage site of sperm. The lower part of the epididymis is continuous with a muscular duct, the vas deferens. This duct approximates with other vessels (arteries and veins, lymphatics, nerves) to form the spermatic cord. The spermatic cord ascends along the posterior border of the testis and runs through the tunnel of the inguinal canal into the abdomen. Here the vas deferens continues back and down behind the bladder, where it joins the duct of the seminal vesicle to form the ejaculatory duct. This duct empties into the urethra.
The Prostate
In the male the prostate gland lies in front of the anterior wall of the rectum and 2 cm behind the symphysis pubis. It surrounds the bladder neck and urethra and has 15 to 30 ducts that open into the urethra. The prostate secretes a thin, milky, alkaline fluid that supports sperm. Most common cancer in men (age, family history, inherited genes) Increased age, the prostate enlarges due to hormonal changes. This benign prostatic hyperplasia (BPH) is present in 80% of men over 60 years. he hyperplasia is an imbalance between cell proliferation and programmed cell death (apoptosis). The prostatic growth creates bladder outlet obstruction because it constricts the urethra. This impedes urine output like putting a clamp on a garden hose.
Which of the following are findings r/t testosterone deficiency? Increased libido Scrotal sac pendulous with less rugae Increased fatigue Decreased penis size
Increased fatigue Depression, fatigue, loss of muscle mass or strength, and decreased libido are common findings in males with testosterone deficiency. Decreased libido is expected with testosterone deficiency. Pendulous scrotal sac with less rugae is a normal expected finding in an older male. Decreased penis size is a normal expected finding in an older male.
Inspection and Palpation: Hernia
Inspect inguinal region for bulge as a person stands and strains down; normally none is present. Palpate inguinal canal: -For right side, ask male to shift his weight onto left leg -Use technique: NAVEL (Nerve, Artery, Vein, Empty space, Lymphatics) Palpate femoral area for a bulge: -Normally you feel none.
Inspection and Palpation: Scrotum
Inspect scrotum as male holds penis out of the way; alternatively alternatively, you hold penis out of the way with back of your hand. Palpate gently each scrotal half between your thumb and first two fingers. Palpate each spermatic cord between your thumb and forefinger, along its length from epididymis up to external inguinal ring. If you find a mass, then provide additional specific information relative to location, size, shape, and ability to reduce. Perform transillumination if mass or swelling is detected.
Inguinal Area (Groin)
Juncture of the lower abdominal wall and the thigh (potential site for hernia development) Its diagonal borders are the anterior superior iliac spine and the symphysis pubis. Between these landmarks lies the inguinal ligament (Poupart ligament). Superior to the ligament lies the inguinal canal, a narrow tunnel passing obliquely between layers of abdominal muscle. It is 4 to 6 cm long in the adult. Its openings are an internal ring and an external ring Inferior to the inguinal ligament is the femoral canal (medial to and parallel with the femoral artery)
Culture and Genetics: Kidney Disease and Bladder Cancer
Kidney Disease: Two main causes of ERSD: hypertension and diabetes Prevalence of diabetes and hypertension is higher in some racial groups: African American, American Indians, and Hispanics are more likely to be affected Contributing factors: low socioeconomic status with higher proportion of at risk behaviors, presence of comorbidities, and limited access to care Bladder Cancer: Fourth Mose common cancer in men with ethnic differences Smoking is the most common risk factor alone with occupational exposure to chemicals Assess for painless hematuria
Developmental Competence
Lesbian and bisexual Access to care Myths and misconceptions - education Risk for cancer cervical screening guidelines Stress incontinence - dribble of urination with coughing, laughing, exercise
Developmental Competence: Adults and Aging Adults
Male does not experience a definite end to fertility as female does Around age 40 years, production of sperm begins to decrease, although it continues into 80s and 90s Testosterone production declines after age 30 but continues very gradually so resulting physical changes are not evident until later in life - Pubic hair decreases and penis size decreases - Due to decreased tone of dartos muscle, scrotal contents hang lower, rugae decrease, and scrotum becomes pendulous - Testes decrease in size and are less firm to palpation - Increased connective tissue is present in tubules, so these become thickened and produce less sperm
Penis
Male reproductive organ Composed of three cylindric columns of erectile tissue: the two corpora cavernosa on the dorsal side and the corpus spongiosum ventrally At the distal end of the shaft the corpus spongiosum expands into a cone of erectile tissue, the glans. The shoulder where the glans joins the shaft is the corona. The urethra is a conduit for both the genital and the urinary systems. It transverses the corpus spongiosum, and its meatus forms a slit at the glans tip. Over the glans, the skin folds in and back on itself, forming a hood or flap. This is the foreskin or prepuce. Often it is surgically removed shortly after birth by circumcision.
An adolescent male is brought to the emergency department with complaints of excruciating pain in his left testicle. Which of the following would be the nurse's most appropriate action? Perform a focused assessment. Notify the emergency department physician immediately. Document pain assessment and notify physician when he or she is available. Tell the adolescent, everything will be fine and there's nothing to worry about.
Notify the emergency department physician immediately. Excruciating unilateral testicle pain of sudden onset are signs of testicular torsion which is considered an emergency. The adolescent needs to have emergency surgery to prevent gangrene which can occur in only a few hours. Symptoms indicate an emergent condition; thus the nurse should notify the physician immediately and allow them to perform the needed assessment. Telling a patient and/or his family there is nothing to worry about is non-therapeutic communication and provides false reassurance.
Palpation of Inguinal Lymph Nodes
Palpate horizontal chain along groin inferior to inguinal ligament and vertical chain along upper inner thigh Normal to palpate an isolated node on occasion; it then feels small, 1 cm, soft, discrete, and movable - Enlarged, hard, matted, fixed nodes are abnormal findings
Which of the following is an expected finding of assessment of the male genitourinary system? Right testes 1.5 cm, Left testes 3 cm. Patient complains of urinary frequency Scrotum enlarged, rugae flattened. Patient states that he urinates 4 to 5 times per day.
Patient states that he urinates 4 to 5 times per day. The adult male typically urinates at least 4 to 5 times per day. An enlarged scrotum with flattened rugae is a sign of edema. Urinary frequency is usually associated with a urinary tract infection. Testes should be equal bilaterally and are freely movable.
External Genitalia Abnormalities
Pediculosis pubis (crab lice): Pubic lice infestations (pthiriasis) are usually spread through sexual contact Herpes simplex virus—type 2 (herpes genitalis): infection is usually transmitted sexually and can cause recurrent, painful genital ulcers Syphilitic chancre: Syphilis spreads from person-to-person by direct contact with a syphilitic sore, known as a chancre. A sore appears at the spot where the bacteria entered your body Red rash—contact dermatitis: Skin contact with allergenic substance in environment, intense pruritus; red, swollen vesicles. HPV warts: Painless watery growths; pink or flesh colored, soft, pointed, moist, warty papules; cauliflower like patch Urethritis and UTI: inflamed urethra and UTI present with dysuria, frequency, urgency, flank, or suprapubic pain. Anterior vaginal wall shows erythema, pain along urethra, maybe purulent drainage. Diagnose with urine culture.
Abnormal Findings
Pelvic Inflammatory Disease: painful inflammation of uterus and pelvic walls Endometriosis: cells similar to the lining of the uterus, or endometrium, grow outside the uterus. Masses, small firm nodules, tender with palpation Uterine Fibroids: Noncancerous growths in the uterus that can develop during a woman's childbearing years. Made up of the muscle and connective tissue from the wall of the uterus. Sharp, stabbing pelvic pain, spotting, positive pregnancy test Ectopic pregnancy: A pregnancy in which the fertilized egg implants outside the uterus; fertilized egg gets stuck on its way to the uterus
Abnormalities: Internal
Pelvic Musculature: - Cystocele: when the wall between the bladder and the vagina weakens; bladder prolapse; feeling of pressure in vagina, stress incontinence - Rectocele: type of prolapse (rectum) where the supportive wall of tissue between a woman's rectum and vaginal wall weakens. Without the support of these pelvic floor muscles and ligaments, the front wall of the rectum sags and bulges into the vagina, and in severe cases, protrudes out of the vaginal opening; feeling of pressure in vagina, possibly constipation - Uterine prolapse: occurs when pelvic floor muscles and ligaments stretch and weaken until they no longer provide enough support for the uterus. As a result, the uterus slips down into or protrudes out of the vagina. Cervix: - Bluish cervix (cyanosis): a bluish discoloration of the cervix, vagina, and vulva (Chadwick sign). Occurs normally with pregnancy or other conditions such as hypoxia or venous congestion (heart failure, pelvic tumor) - Erosion: cervical lips inflamed and eroded, reddened granular surface is superficial inflammation, with nu ulceration (loss of tissue) - HPV (condylomata): affects the cervical epithelium. Warty growth appears as abnormal thickening white epithelium. Must be treated or will turn into cervical cancer. - Polyp: Bright red, soft, pedunculated growth emerges from os (cervical hole). fingerlike growths on the lower part of the uterus that connects with the vagina ( cervix ). Cervical polyps are small fingerlike growths originating from the mucosal surface of the cervix Cervical Cancer: Chronic ulcer and induration are early signs of carcinoma
Abnormal Findings: Penis
Phimosis: the inability to retract the skin (foreskin or prepuce) covering the head (glans) of the penis. Phimosis may appear as a tight ring or "rubber band" of foreskin around the tip of the penis, preventing full retraction. Phimosis is divided into two forms: physiologic and pathologic. Paraphimosis: a common urologic emergency that occurs in uncircumcised males when the foreskin becomes trapped behind the corona of the glans penis. This can lead to strangulation of the glans and painful vascular compromise, distal venous engorgement, edema, and even necrosis. Inability to pull the foreskin forward (stuck) Hypospadias: a birth defect in boys in which the opening of the urethra is not located at the tip of the penis; underside rather than tip Epispadias: a rare birth defect located at the opening of the urethra (top aspect of penis rather than the tip). In this condition, the urethra does not develop into a full tube, and the urine exits the body from an abnormal location. Priapism: prolonged erection of the penis. The full or partial erection continues hours beyond or isn't caused by sexual stimulation. The main types of priapism are ischemic and nonischemic.
Inspection and Palpation: Penis
Skin normally looks wrinkled, hairless, and without lesions; dorsal vein may be apparent. Glans looks smooth and without lesions; ask uncircumcised male to retract foreskin, or you retract it; it should move easily. Some cheesy smegma may have collected under foreskin; after inspection, slide foreskin back to original position. Urethral meatus positioned just about centrally Compress glans anteroposteriorly between your thumb and forefinger; meatus edge should appear pink, smooth, and without discharge.
Rome III criteria for constipation includes which of the following? Straining to have a bowel movement Pain with bowel movement Soft, firm stools Four stools per week
Straining to have a bowel movement Rome III criteria for constipation include: ≤3 stools per week, lumpy or hard stools, incomplete evacuation, and sensation of blockage. Pain is not included in the Rome III criteria for constipation.
Lymphatics
The lymphatics of the penis and scrotal surface drain into the inguinal lymph nodes, whereas those of the testes drain into the abdomen. Abdominal lymph nodes are not accessible to clinical examination.
Male Genitourinary System
The male genital structures include the penis and scrotum externally and the testis, epididymis, and vas deferens internally. Glandular structures accessory to the genital organs (the prostate, seminal vesicles, and bulbourethral glands)
Anal Canal
The outlet of the gastrointestinal (GI) tract Highly vascular: Each anal column contains an artery and a vein. Under conditions of chronic increased venous pressure, the vein may enlarge, forming a hemorrhoid. The anal canal is surrounded by two concentric layers of muscle, the sphincters Internal sphincter is under involuntary control by the autonomic nervous system. The external sphincter surrounds the internal sphincter but also has a small section overriding the tip of the internal sphincter at the opening. It is under voluntary control. Except for the passing of feces and gas, the sphincters keep the anal canal tightly closed. The intersphincteric groove separates the internal and external sphincters and is palpable. Although the rectum contains only autonomic nerves, numerous somatic sensory nerves are present in the anal canal and external skin therefore a person feels sharp pain from any trauma to the anal area.
Focal Assessment
Used in addition to a complete assessment Any area of dysfunction or problem is looked at alone and in greater detail
Female Genitourinary System: Internal Structures
Vagina Cervix Squamocolumnar junction Anterior fornix Posterior fornix Rectouterine pouch, or cul-de-sac of Douglas Uterus Fallopian tubes
Female Genitourinary System: External Structures
Vulva (pudendum): Mons pubis Labia majora Labia minora Frenulum or fourchette Clitoris Vestibule Urethral meatus Skene's glands Vaginal orifice Hymen Bartholin's glands
An anorectal fistula is usually caused by: a tear in the superficial mucosa. a chronically inflamed gastrointestinal tract. daily use of laxatives. trauma from passing hard stools.
a chronically inflamed gastrointestinal tract. An anorectal fistula is caused by a chronically inflamed gastrointestinal tract. Fissures are tears that occur in the superficial mucosa and often result from trauma (e.g., passing a large, hard stool) or from irritant diarrheal stools. Long-term use of laxatives may lead to dependence.
The etiology of a pilonidal cyst is: a congenital disorder. a chronically inflamed gastrointestinal tract. trauma or irritant diarrheal stools. a tear in the superficial mucosa.
a congenital disorder. A pilonidal cyst is a congenital disorder that is first diagnosed between the ages of 15 and 30 years. An anorectal fistula is caused by a chronically inflamed gastrointestinal tract. Fissures are tears that occur in the superficial mucosa and often result from trauma (e.g., passing a large, hard stool) or from irritant diarrheal stools.
A deep recess formed by the peritoneum between the rectum and the cervix is called: a cystocele. the Chadwick sign. a rectouterine pouch. a rectocele.
a rectouterine pouch. The rectouterine pouch (or cul-de-sac of Douglas) is the deep recess between the rectum and the cervix. The cervical mucosa during the second month of pregnancy is blue, which is termed the Chadwick sign. The cervix may also turn blue in any condition causing hypoxia or venous congestion. A cystocele is an abnormality of the pelvic musculature in which the bladder prolapses into the vagina. A rectocele is an abnormality of the pelvic musculature in which the rectum prolapses into the vagina.
A retention cyst in the epididymis filled with milky fluid containing sperm is called: a spermatocele. a prepuce. a varicocele. Peyronie disease.
a spermatocele. A spermatocele is a retention cyst in the epididymis filled with milky fluid containing sperm. A varicocele is a dilated, tortuous varicose vein in the spermatic cord. Peyronie disease is a result of hard, nontender, subcutaneous plaques on the penis that cause a painful bending of the penis during an erection. Over the glans, the skinfolds in and back on itself forming a hood or flap called the foreskin or prepuce.
Orchitis is (are): hard, subcutaneous plaques associated with painful bending of the erect penis. a circumscribed collection of serous fluid in the tunica vaginalis surrounding the testes. an acute inflammation of the testes. a meatus opening on the dorsal side of the glans or shaft.
an acute inflammation of the testes. Orchitis is an acute inflammation of the testes. Epispadias is a meatus opening on the dorsal side of the glans or shaft. Peyronie disease is a result of hard, nontender, subcutaneous plaques on the penis that cause a painful bending of the penis during an erection. A hydrocele is a circumscribed collection of serous fluid in the tunica vaginalis surrounding the testes.
Pruritus is the presence of an itching or burning sensation. a longitudinal tear in the superficial mucosa at the anal margin. blood in the stool. excessive fat in the stool.
an itching or burning sensation. Pruritus is an itching or burning sensation. A fissure is a painful longitudinal tear in the superficial mucosa at the anal margin. Melena, hematochezia, and occult describe blood in the stool. Steatorrhea is excessive fat in the stool.
On palpation the prostate gland is enlarged, nontender, firm, and smooth with a palpable central groove. This assessment finding indicates: a normal prostate gland. prostatitis. prostate carcinoma. benign prostatic hypertrophy.
benign prostatic hypertrophy. In benign prostatic hypertrophy, the prostate gland is enlarged, nontender, firm, and smooth with a palpable central groove. In prostatitis, the prostate gland is swollen and exquisitely tender. In prostatic carcinoma, the prostate gland is stone-hard and irregular with fixed nodules. A normal prostate gland does not protrude more than 1 cm into the rectum; is heart-shaped, with a palpable central groove; is smooth; is elastic, rubbery, and slightly movable; and is nontender to palpation.
Hematuria is a term used for: bleeding after intercourse. bloody discharge. blood in the urine. urine in the blood.
blood in the urine. Hematuria is the term used to describe blood in the urine.
The first sign of puberty in girls is breast and pubic hair development. rapid increase in height. the first menstrual cycle (menarche). axillary hair development.
breast and pubic hair development. The first signs of puberty are breast and pubic hair development, beginning between 8½ and 13 years of age. These signs usually occur together, but it is not abnormal if they do not develop together. This development takes about 3 years to complete. Menarche occurs during the latter half of the sequence of breast and pubic hair development, just after the peak of growth velocity. Coarse curly hairs develop in the pubic area first and then in the axillae.
The most common sexually transmitted infection in the United States is: trichomoniasis. syphilis. gonorrhea. chlamydia.
chlamydia. Chlamydia is the most common sexually transmitted infection in the United States.
Complete Assessment
complete health history & full physical exam. Head to toe assessment describes the current & past health state & forms a baseline.
The first sign of puberty in boys is: enlargement of the testes. pubic hair growth extending up the abdomen. an increase in penis size. the appearance of pubic hair.
enlargement of the testes. The first sign of puberty in boys is enlargement of the testes. Following the enlargement of the testes, pubic hair appears, then penis size increases. Pubic hair growth extending up the abdomen occurs after puberty.
The term rugae refers to: an acute inflammation of the testes. a muscle that controls the size of the scrotum. a corpus spongiosum cone of erectile tissue. folds of thin skin of the scrotal wall.
folds of thin skin of the scrotal wall. The scrotum wall consists of thin skin lying in folds, or rugae, and the underlying cremaster muscle. The penis is composed of three cylindric columns of erectile tissue: two corpora cavernosa on the dorsal side and the corpus spongiosum ventrally. The cremaster muscle controls the size of the scrotum. Orchitis is an acute inflammation of the testes.
Soft, pointed, fleshy papules that occur on the genitalia caused by human papillomavirus (HPV) are known as: chancres. urethritis. genital warts. varicoceles.
genital warts. Genital warts are soft, pointed, fleshy papules that occur on the genitalia and are caused by HPV. Syphilitic chancres are small, solitary, silvery papules that erode to a red, round or oval, superficial ulcer with a yellowish serous discharge. Urethritis is an infection of the urethra; the meatus edges are reddened, everted, and swollen. A varicocele is a dilated, tortuous varicose vein in the spermatic cord.
Toilet training (for bowel movements) in children: may begin when the nerves in the rectal area are fully myelinated. should start after 4 years of age. can be successful as early as 12 months of age. should begin after the gastrocolic reflex disappears.
may begin when the nerves in the rectal area are fully myelinated. Voluntary control of the external anal sphincter cannot occur until the nerves supplying the area have become fully myelinated, usually around 1½ to 2 years of age. Toilet training usually starts after age 2 years. The wave of peristalsis that occurs after eating is the gastrocolic reflex. This reflex is present at birth and does not disappear.
Cessation of menses is known as menopause. menarche. adnexa. salpingitis.
menopause. Menopause is the cessation of menses. Menarche is the age of the first period. Salpingitis is inflammation of the fallopian tube. The adnexa of uterus (or uterine appendages) refers to the structures most closely related structurally and functionally to the uterus; these structures include the ovaries, fallopian tubes, and ligaments.
A patient is taking iron supplements. The patient should expect the stools to be: frothy. clay-colored. tarry and black. nontarry and black.
nontarry and black. Iron medication supplements cause stools to be nontarry and black. Clay-colored stools are caused by the absence of bile pigment. Melena is the term to describe tarry, black stools; this indicates the presence of blood in the stool. Frothy stools have excessive fat from a malabsorption of fat; the term to describe fatty stools is steatorrhea.
Dysmenorrhea is: pain associated with menstruation. pain with urination. pain with defecation. painful intercourse.
pain associated with menstruation. Dysmenorrhea is the abdominal cramping and pain associated with menstruation. Dyspareunia is the term to describe painful intercourse. Dyschezia is pain with bowel movements. Dysuria describes pain or burning with urination.
A caruncle is a(n): hard, painless nodule in the uterine wall. aberrant growth of endometrial tissue. vestibular gland located on either side of the vaginal orifice. small, red mass protruding from the urethral meatus.
small, red mass protruding from the urethral meatus. A caruncle is a small, deep red mass protruding from the urinary meatus. Bartholin glands are vestibular glands located on either side of and posterior to the vaginal orifice. Endometriosis is a disorder caused by aberrant growths of endometrial tissue scattered throughout the pelvis. Myomas (leiomyomas or uterine fibroids) is a disorder in which the uterus is irregularly enlarged, firm, mobile, and nodular with hard, painless nodules in the uterine wall.
Colonoscopy
the direct visual examination of the inner surface of the entire colon from the rectum to the cecum
The ejaculatory duct is: the passage formed by the joining of the vas deferens and the seminal vesicle. a narrow tunnel inferior to the inguinal ligament. a narrow tunnel superior to the inguinal ligament. a muscular duct continuous with the epididymis.
the passage formed by the joining of the vas deferens and the seminal vesicle. The ejaculatory duct is the passage formed by the junction of the duct of the seminal vesicles and the vas deferens through which semen enters the urethra. The muscular duct continuous with the epididymis is the vas deferens. The femoral canal is inferior to the inguinal ligament. The inguinal canal is superior to the inguinal ligament and is a narrow tunnel passing obliquely between layers of abdominal muscle.