Weber Ch 23 & 24 Male & Female Genitalia

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cswett
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Weber Ch 23 & 24 Male & Female Genitalia
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2011-11-28 10:12:48
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Weber 23 24 Male Female Genitalia
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Weber Ch 23 & 24 Male & Female Genitalia
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  1. Health History: Chief Complaints
    •Menstrual cycle/problems

    • –Dysmenorrhea
    • = painful menses
    • Menorrhagia = heavy bleeding/menses

    •Lower abdominal or pelvic pain

    •Discharge (vaginal), pain, masses, itching, or lymphedema


    •Genital lesions or rashes

    •Changes in urination (burning or incontinence)

    •Menopausal symptoms

    •Lump or swelling in breast
  2. Past Health History
    • •Problems with uterus/ovaries, or reproduction? Describe.
    • •Surgery—what kind, when, why; how affected you?
    • •Past history of cancer (ovarian, endometrial or colon)?
    • •Chronic illness? (DM, endocrine disorders)
    • •Menstruation time period (menarche to menopause)
    • •Pregnancies – reproductive history
    • –how many times
    • –number of babies
    • –miscarriages, abortions, stillborn

    • Gravida = # pregnancies
    • Para
    • = # pregnancies > 20 wks. (usually as # preterm births & # term births)
    • #
    • abortions (spontaneous miscarriages or therapeutic pregnancy terminations)

    Last Pap smear, results? - papaniocolaou

    • PAP smears q 1yrs after sexually active or age 21
    • q2-3 yrs. If 3 in a row normal if > 30 yrs.
    • Old
    • > 70 yrs. Old can stop PAP tests if not had
    • hysterectomy for cancer (ex. 90 y/o nun getting PAP’s)



    • Gravida = # pregnancies
    • Para
    • = # pregnancies > 20 wks. (usually as # preterm births & # term births)
    • #
    • abortions (spontaneous miscarriages or therapeutic pregnancy terminations)
  3. Female Exam: Procedures & Techniques
    • •External genitalia
    • –Inspect pubic hair—distribution, nits
    • –Inspect skin mons pubis/inguinal area—surface characteristics
    • –Inspect labia majora/minora—pigmentation/surface
    • characteristics
    • –Inspect urethral meatus, vaginal introitus/entrance,
    • perineum—positioning/surface characteristics

    Inspect anus—color, surface characteristics
  4. Breast Tissue
    • •Breasts: paired mammary glands
    • –Lie over muscles, anterior chest wall - anterior to: pectoralis major, serratus anterior
    • –Extend: horizontally:2nd to 6th rib; vertically:sternum to midaxillary line
    • –Functions of female breasts:
    • •Production & storage of milk for newborn
    • •Sexual stimulation
    • •Breasts with 3 types of tissue:
    • –3 types of tissue:
    • •Glandular
    • •Fibrous
    • •Fatty

    •Breasts: divided into 4 quadrants intersecting at nipple

    •Tail of Spence: upper outer quadrant; extends to axillary area; location of most frequent occurrences of breast tumors
  5. Beast Exam
    • •Inspect breast for size, shape, contour, & symmetry
    • •Inspect skin of breast for color, pigmentation, vascularity , surface characteristics & lesions
    • •Inspect areola for color & surface characteristics
    • Inspect nipples for position, symmetry, lesion, or discharge

    • Notes:
    • Male with same exam (can have gynecomastia/bilat enlarged or breast CA/unilat. hard painless lump)
    • Inspect in various positions (hands over head, hands on hips, hands squeezed together & leaning forward)
    • Breasts slightly asymmetrical without dimpling, retractions or bulges (malignancy)
    • Breast color & vascularity

    • Smooth, evenly pigmented & slightly lighter than other skin exposed to sun
    • Bilateral venous pattern of obese or pregnant
    • women; increased circulation with malignancy
    • Peau d’orange = rough, tough thickened skin due to edema /blocked lymphatic drainage (orange peal skin)
    • No erythema/redness or heat (inflammation)
    • Areola color varies pink to black yet bilateral with Montgomery tubercles (raised bumps)
    • Nipples normally may be flat, protrude, or inverted as long as not recent change (malignancy)
    • Supernumerary nipple line from axilla to groin along milk
    • line
    • Discharge – only normal = serous/yellow; all others abnormal
    • Clear/watery with pharmacologic causes (hormones)
    • Serosanguineous (straw) = CA
    • Sanguineous (bloody) = CA
    • Milky = galactorrhea (inappropriate lactation in 20 – 25% women; pituitary tumor with HA & vision problems, hypothyroid, Cushings,
    • Tricyclic antidepressants, histamines, antihypertensives)
    • Purulent = infectious process
    • Multicolored (green, gray, brown) = fibrocystic process/disease
  6. Breast Exam Procedure cont
    • •Inspect breasts in various postures for bilateral equal pull
    • •Inspect & palpate axilla for rashes, lesions or masses
    • •Palpate breast for tissue characteristics (tender, temp., mass)
    • Palpate nipples for surface characteristics & discharge
  7. Age Variations: Female Elderly
    • •Breasts atrophy beginning at age 40
    • •Decrease in estrogen so clitoris smaller & difficult to palpate ovaries
    • •Thinning of pubic hair
    • •Drying of mucosa with itching of labia & vagina (atrophy)with dyspareunia

    • •Pelvic muscles with less elasticity leads to urinary
    • incontinence
    • •Vagina & cervix smaller & pale
    • •Still do breast exams & PAP smears even if mastectomy or hysterectomy, if for cancer
  8. Breast Cancer
    • •Age > 50 yrs. (77%)
    • •Family history
    • •Genetics (BRCA1 or BRCA2 genes 10%)
    • •Early menarche (before 12)
    • •Late menopause (after 50)
    • Nulliparous or first child after age 30
    • •Caucasian > Black
    • •High fat diet, obesity
    • •oral contraceptive use
    • •Radiation exposure
    • •Presence of other cancer
    • •Dense breast tissue
    • •HRT > 5 yrs.
    • •Alcohol (more than 2 drinks per day)
  9. Signs & Symptoms of Breast Canter
    • •Asymptomatic, diagnose by mammogram
    • •Nontender lump/thickening in breast UOQ
    • •Burning, stinging, or pricking (not pain)
    • •Abnormal nipple discharge
    • •Rash around nipple
    • •Nipple retraction
    • •Dimpling of skin or nipple off position
    • •Lump under arm or above collar bone
    • •Peau d’orange
  10. Female Nursing Diagnoses
    • •Readiness for enhanced health management RT female
    • reproductive system
    • •Health seeking behavior: request information on STD’s, birth control, or HRT
    • •Risk for infection RT STD’s
    • •Disturbed body image RT perceived feminine role &
    • sexuality AEB mastectomy
    • •Fear of cancer (CA) of reproductive system
    • •Acute pain RT dyspareunia (painful intercourse)
    • •Ineffective sexuality pattern RT decreased libido &
    • menopause
    • Anticipatory grieving RT cervical/uterine/ ovarian CA
  11. Male Chief Complaint
    • •Pain or itching
    • •Lumps or swelling in groin, testicles or scrotum
    • •Penile lesion or discharge
    • •Urinary problems
    • •Change in bowel function
    • •Rectal bleeding
    • Erectile dysfunction
  12. Make preventative exam
    • Hydrocele = fluid accumulation in scrotum
    • Variocele = dilation & tortuosity of veins of spermatic cord
    • Spermatocele = cystic mass in epididymis or spermatic cord filled with sperm & seminal fluid
    • Preventative Exams (Amer. Cancer Society recommends):
    • Testicular exam by MD q 3yrs. Ages 30 – 39
    • then q 1yr. > age 40 (self exams q month in shower)
    • PSA screenings q 1 yr. > age 50 yet younger
    • if + family history or Afr. American (age 40-45)
    • DRE q 1 yr. > age 40 Digital rectal exam
  13. Male Exam
    • •Inspect & palpate:
    • –Penis
    • –Scrotum
    • –Inguinal areas
    • Perform rectal exam & palpate prostate
  14. Procedure - Male Exam
    • •Pubic hair
    • –Inspect for distribution, general characteristics, & nits
    • •Penis
    • –Inspect and palpate for surface characteristics, color,
    • tenderness, and discharge
    • •Circumcised—variable foreskin, uncircumcised – foreskin folded over glans (ask to retract);
    • phimosis =tight foreskin, unable to retract
    • paraphimosis
    • =unable to return foreskin over glans
    • •If discharge or smegma present, obtain specimen
    • •Palpate glans anteroposteriorly to open distal end of urethra
    • –Slit like opening at distal tip of glans (central)
    • »Epispadias
    • =Urethra opens on upper penis
    • »Hypospadias=urethra opens onto lower penis
    • •Palpate shaft of penis (non-tender)—semi-firm consistency without nodules

    • •Scrotum and testes:
    • –Inspect scrotum for color, texture, surface characteristics, position
    • •Left side lower; deeply pigmented with sebaceous cysts
    • •Appearance affected by temperature
    • –Palpate scrotum—surface characteristics and tenderness
    • •Scrotum should be nontender

    • –Palpate testes, epididymides, vas deferens—location, consistency, tenderness, and nodules
    • •Should be smooth and tender
    • •Cryptorchidism
    • •Transilluminate
    • •Teach testicular self-exam
    • –Inspect inguinal & femoral areas for bulges while client bears down
  15. Male anal and rectal exam
    • –Inspect perianal area & anus for pigmentation
    • & surface characteristics
    • –Palpate anus for sphincter tone (hypo or hypertonic tone)
    • –Palpate anal canal & rectum for surface characteristics
    • (AP)
    • –Palpate anterior rectal surface to evaluate prostate (AP)
    • –Examine & test stool for presence of occult blood
  16. Age variations - Older Male
    • •Sexual activity declines in frequency
    • •Erection develops more slowly; ejaculation less intense
    • •Hyperplasia of prostate (rubbery) is major change (BPH)
    • •If excessive prostate enlargement , decrease or obstruction of urinary flow will occur
    • •Decreased sperm viability
    • •Less abundant & finer pubic hair
    • •Elongated scrotal sac & softer testes
    • •Internal sphincter less responsive so stool retention
    • •External sphincter with less control so fecal incontinence
  17. Male Nursing Diagnosis
    • •Health seeking behavior : request information on colorectal exams
    • •Risk for ineffective health maintenance RT testicular self
    • exams
    • •Risk for injury RT hernia due to poor lifting technique
    • •Ineffective sexuality pattern RT decreased libido with aging
    • •Fear RT prostate cancer
    • •Acute pain RT dysuria from STD
    • •Disturbed body image RT hernia
    • •Anxiety RT prostate surgery/cancer
    • •Anticipatory grieving RT testicular cancer

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