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Dillon Ch 16/18/19

Assessing the Breasts & Assessing Male/Female Genitourinary Systems

Tanner's stages - when is onset of breast buds 9 - 13.5 years
Where are most common areas for breast lumps Tail of Spence---upper outer quadrant
When does pubic hair normally appear 2-6 months after breast buds
When does menarche usually commence 2 years after first signs of breast buds---normal range from 10.5 - 15 years
What position is helpful in detecting dimpling or retraction of breast tissue hands over head, hands pressed on hips----large breasted women = sitting, leaning forward position.
How do you examine for breast reconstruction? press firmly inward at edges of implant to feel ribs beneath
What is one factor (non-genetic) that increases risk of breast cancer age is a risk factor
Post-menopausal women should conduct their BSE (breast self exam) when at the same time every month
most common site for breast cancer in men the areola
which area best for assessing central lymph nodes high in middle of axilla
where is best spot for assessing lateral lymph nodes high in axilla on inner aspect of humerus
which characteristic is associated with a fibrocystic breast disease tenderness
In general, how is the Tanner Stages of pubertal development used for males/females They look at the pictures relating to Stages I-V and tell practitioner which most resembles what their body looks like
whole process of breast development takes how long 1.5 - 6 years
whole process of testicular development takes how long 2-5 years
The clitoris serves as a landmark for which orifice the urethra, which helps in locating foley catheter placement
is it uncommon for the internal labia to be larger than the external? No, there is a wide variation here. This is a normal variation.
a vaginal hematoma would be a normal finding under what circumstance would be normal (requiring follow-up) finding in post-partum
current protocol for pelvic exams is how frequent Every 3 years, even if on oral contraceptives (also depending on age and past personal history)
when do we start assessing genitalia start at newborn (descending testes, etc) through the lifespan
Is there a medical reason for routine circumcision? no, now most insurance companies won't pay for it.
should we ever force retraction of foreskin? no, there may be atrophy or disease, so don't force it
what is hypospadias Urethral meatus opens on the ventral (under) side of penis (not at the end/tip); an abnormal finding
what is most common cancer in 15-34 year-old males testicular cancer most common. Men should do self-exams as part of pt. education
What is USPTF resource that we should know for the rest of our careers U.S. Preventative Services Task Force - source of many guidelines
According to APA, is transgender a medical disorder no - not unless it causes significant distress or disability
not every lesion is herpes, another type folliculitis from shaving often appears as herpes
scabies, often found in homeless, transitional housing, is generally sexually transmitted and are visible/invisible to eye invisible - they burrow under skin, with 3-4 week latency period
pubic lice or 'crabs' are visible/invisible to eye they are visible, through sexual contact with 5 day latency period
1 in 4 Americans contract Herpes Simplex 1 or 2; is this usually a symptomatic or asymptomatic infection? 3/4 of infected are asymptomatic
pearly penile papules are benign/malignant? benign - only treat cosmetically
Clear penile discharge could indicate chlamydia - which is the most common STD in U.S.
HPV virus has over 40 strains, how many of these cause cervical cancer only 1 strain is linked to cancer ---others cause genital warts (I don't think this is right)
Believe it or not, the USPTF recommends for/against SBE against, but doesn't account for individuals who benefit from BSE
Reasons for assessing genitalia -STD sx's -Foley catheter -Female in labor -Pt complaining of pain/discomfort in that area -Part of a well visit
How is the tanner's stages of sexual development used? To determine if the pt is at their appropriate sexual development stage for their age.
What are the first changes for males, according to the Tanner's stages Testicular enlargement, color changes and enlargement of the scrotum
At what age does the onset of sexual changes begin for males? 9 1/2 - 14 years
At what age would a male be considered "delayed" developmentally, if no changes have occurred in the testes or scrotum? 13 1/2 - 14 years; or changes not completed within 4 years after start of the testicular enlargement.
What are you looking for/at when assessing the female genitalia? Pubic hair distribution, lesions, swollen lymph nodes (Mons Pubis and inner aspect of thigh), clitoris (presence, piercing, discharge, landmark to find urethra), vestibule (urethra and vagina), and the perineal area. Patency of vaginal and anus area.
How should you, as a nurse, approach a physical genitalia exam? With respect, openness, compassion, and professionalism.
If the vagina or anus are not patent, should we force them open to inspect? No! Surgery will probably be needed.
Is douching a recommended practice? Why or why not? No, douching strips the vagina of its normal flora/bacteria and is the major cause of bacterial vaginosis.
What percentage of American males are circumcised? 50%
What is female circumcision? Removal of all or part of the clitoris, labia minora, and labia majora, usually in early childhood or early adolescence. This practice is widespread in many African countries and among some Muslim groups. (page 632)
When assessing a (male) patient, post-circumcision, what are you assessing for? Is the area healing well (tend to look raw and irritated), excessive bleeding, excessive discharge/sign of infection, is the infant/patient in pain.
Does protocol allow for pain meds to be given to an infant post-circumcision?: Yes, as a nurse you will be responsible for assessing the infant and ensuring that they are being well medicated to control pain.
What is epispadias? Urethral meatus opens on dorsal (upper) side of penis; this is an abnormal fielding.
What is the annual incidence rate of testicular cancer? 5.4 cases per 100,000 males, testicular cancer is relatively rare compared with other type of cancer
What might you suspect a pt is dealing with who presents with genital lesions all over the genital area and it is clear that the pt has been shaving in their genital area (you ask about shaving). Folliculitis
What might you suspect a pt is dealing with who presents with clustered genital lesions that look like blisters, acute pain, and have had unprotected sex within the past 2 weeks? STD (possibly Herpes)
What is important in assessing a pt with a genital lesion? Taking a good history; knowing if the has recently had unprotected sex, for example, or if they have recently stayed in a homeless shelter, will give you valuable information about what the pt may be dealing with.
What would yellow or green vaginal discharge in women be a sign of? Chlamydia infection (would not be able to assess externally)
What is a normal consistency finding of the testes? Normally, the testes are about 5 cm by 2.5 cm, firm, and rubbery in consistency.
The health hx is helpful in identifying risk factors for testicular cancer. Which childhood medical problem increases the risk for testicular cancer? Undescended testicles has been identified as a risk factor for testicular cancer.
The PSA test is a screening for PSA is a screening test for prostate cancer
Thick, yellow penile discharge is often associated with Gonorrhea, caused by Neisseria gonorrhoeae, typically causes urinary sx's and produces a thick, yellow penile discharge
On examination of the external genitalia, you note a painless, white, wartlike lesion. The lesion described is A condylomata acuuminatum - a painless, white, wartlike lesion caused by HPV. It is sometime referred to as venereal warts.
Sickle cell anemia increases the risk for developing Priapism - a painful, sustained erection, without sexual desire.
What is the recommended age for prostate screening? Age 50
Created by: MEPN 2013