Reproductive system pt 2

Inspection of External Genitalia

• Purpose of Inspection

  • Importance in peri-care and routine examinations

  • Identification of abnormal discharge or fluids

• Explanation of the Procedure

  • Explain to the patient what will be done to prevent surprise

  • Ensure privacy through closed doors, pulling curtains, and draping

  • Encourage patient to use the bathroom if allowed

Patient Positioning

• Recommended Position

  • Lithotomy position with legs in stirrups (if available)

  • Different settings may require adjustments (e.g., emergency department)

Preliminary Observations

• Key Areas of Inspection

  • Hair distribution, swelling, redness, ulcerations, odors

  • Discharges, rashes, lesions, signs of trauma, itching

• Specific Observations

  • Scar tissue may indicate prior childbirth or episiotomy

  • Look for trauma, drainage, and inflammation

Practices for Cleaning

• Best Practices

  • Clean front to back to minimize infection risk

  • Avoid reusing wipes or cleaning materials

Internal Palpation and Examination

• Role of the Provider

  • Generally performed by a qualified provider rather than nursing staff

• Techniques of Palpation

  • Palpation of skin glands surrounding the urethra

  • Method involves one finger in and one finger out to check for inflammation

  • Attention to Bartholin glands for pain or lesions

  • STDs may present in glands; identification aids treatment

Use of Speculum

• Tool Description

  • Speculum used to pry open the vaginal cavity for inspection of cervix

• Procedure

  • Ensure proper sizing and proper insertion

  • Open slowly to visualize cervix

• Expected Normal Findings

  • Cervix should be midline, with pink or bluish coloration depending on pregnancy

Cervical Inspection

• Important Features

  • Shape of the os (opening of cervix):

  • Normal for nulliparous (never had a baby) cervix

  • Changes in shape with childbirth (e.g., lacerated cervix, everted cervix, eroded cervix)

  • Presence of cysts

• Pap Smear Procedure

  • Scraping of cervical tissue for analysis

• Bimanual Examination

  • Assessing uterus and ovaries through abdominal and vaginal palpation

Common Conditions of the Female Anatomy

• Cystocele

  • Herniation of bladder through anterior wall of vagina

  • Leads to urinary incontinence

• Rectocele

  • Herniation of rectum into posterior vaginal wall

• Bartholin Gland Inflammation

  • Swelling indicates possible gonorrhea infection, requiring testing and treatment

• STDs and Symptoms

  • Herpes type 2 presents as small red vesicles

  • Genital warts removable but may recur

  • Asymptomatic nature of STDs in males emphasizes the need for partner testing and treatment

Male Reproductive System Overview

• Anatomy and Functionality

  • Penis: excretes urine and sperm

  • Scrotum: containing the testes, involved in temperature regulation

• Urethra

  • Functions in urinary drainage and sperm exit

• Testicle Function

  • Spermatogenesis and testosterone production

• Vas Deferens

  • Transport of sperm; cut during vasectomy

Vasectomy Details

• Fertility Implications

  • Impacts sperm transport; potential for unexpected pregnancies

Changes with Age

• Older Adults

  • Continued sexual activity leads to increased risk for STDs

  • Fertility potential persists indefinitely in males

  • Age-related changes: smaller and softer testes, sparse gray pubic hair

Patient Care Considerations

• Important Protocols

  • Ensure privacy and proper methods of communication

  • Acknowledge cultural sensitivity and gain patient trust

• Consent and Understanding

  • Importance of patient understanding before procedures

  • Need to allow for questions

Inspection Details for Male Patients

• General Observations

  • Hair growth, ulcerations, rashes, swelling on penis and scrotum

• Circumcised vs. Uncircumcised Considerations

  • Cleaning technique for uncircumcised penis, presence of smegma

Testicular Examination

• Procedure

  • Patient should hold the penis to the side; palpation by the examiner

• Cancer Prevalence

  • Testicular cancer more common in younger men; prostate cancer in older men

  • Emphasize regular self-exams, especially post-shower

Diagnosing Hernias

• Types of Hernias

  • Inguinal hernias; implications from weight lifting

  • Surgical repair required for painful, straining-related hernias

Common Male Conditions

• Genital Infections

  • Balanitis due to improper cleaning

  • Herpes, syphilis, and their presentations

• Hydrocele

  • Fluid-filled mass in the scrotum; non-tender

• Epididymitis

  • Inflammation related to STDs or UTIs

• Testicular Torsion

  • Life-threatening situation requiring prompt intervention

Conclusion and Patient Care Approach

• Importance of Providing Privacy and Confidentiality

  • Ensure comfort for patients, particularly those with trauma histories

• The need for clear communication regarding procedures and expectations

• Focus on culturally sensitive practice

Inspection of External Genitalia

• Purpose of Inspection - Importance in comprehensive peri-care and routine physical examinations for early detection of potential health issues.

  • Timely Identification of abnormal discharge or fluids - This can indicate infections (e.g., bacterial vaginosis, candidiasis, STDs), inflammation, or other pathologies requiring further investigation.

Explanation of the Procedure

• Explain to the patient what will be done - Clearly communicate each step of the examination, including the purpose and expected sensations, using simple, respectful language to alleviate anxiety and prevent surprise.

  • Ensure privacy - This is paramount; close all doors, pull curtains completely around the examination area, and utilize adequate draping to cover all non-examined body parts. Verbalize these steps to the patient.

  • Encourage patient readiness - Ask the patient to use the bathroom to empty their bladder and/or bowels before the exam, if allowed and appropriate, as this can improve comfort and visualization.

Patient Positioning

• Recommended Position - Lithotomy position, where the patient lies on their back with hips and knees flexed and feet supported in stirrups. This position provides optimal exposure of the perineal and genital areas.

  • Different settings may require adjustments - In acute care settings like the emergency department or for patients with mobility limitations, modifications such as frog-leg position or supine with knees bent may be necessary, prioritizing patient comfort and safety.

Preliminary Observations

• Key Areas of Inspection - Systematically observe the mons pubis, labia majora and minora, clitoris, urethral meatus, vaginal introitus (opening), perineum, and anus.

  • Hair distribution and characteristics - Note the amount, pattern (e.g., inverted triangle in females, diamond shape in males), and any lesions or parasites within the pubic hair.

  • Skin integrity - Look for swelling, redness (erythema), ulcerations, rashes, lesions (e.g., vesicles, papules, pustules), or signs of trauma (e.g., bruising, lacerations).

  • Odors - Note any foul or unusual odors, which can be indicative of infection (e.g., a "fishy" odor with bacterial vaginosis).

  • Discharges - Characterize any visible discharge by color, consistency, and amount (e.g., thin and gray, thick and white, yellow-green and frothy).

  • Itching (pruritus) - Inquire about or observe signs of scratching.

• Specific Observations - Scar tissue, particularly in the perineal area, may indicate prior childbirth (especially if an episiotomy was performed) or previous surgical procedures.

  • Trauma - Assess for any signs of recent or old injuries, which may require further investigation regarding their cause.

  • Drainage - Differentiate between normal physiological discharge and abnormal exudates.

  • Inflammation - Look for signs such as redness, swelling, warmth, and tenderness.

Practices for Cleaning

• Best Practices - Always clean from front to back (from the urethral meatus/vaginal opening towards the anus) to prevent the transfer of fecal bacteria into the urinary tract or vagina, which can cause urinary tract infections (UTIs) or other infections.

  • Avoid reusing wipes or cleaning materials - Use a single wipe or section of a cloth for each stroke, and then discard or move to a clean section to prevent cross-contamination.

Internal Palpation and Examination

• Role of the Provider - While nurses often assist and prepare the patient, internal pelvic examinations, including palpation and speculum use, are generally performed by qualified healthcare providers such as physicians, nurse practitioners, or physician assistants with specialized training.

• Techniques of Palpation - Palpation of the skin glands surrounding the urethra (e.g., Skene's glands).

  • Method for checking urethra and vestibule - Involves inserting one gloved finger into the vagina while applying pressure anteriorly and laterally to milk the urethra and observe for any discharge or tenderness. This technique helps assess for inflammation or infection of the Skene's glands.

  • Attention to Bartholin glands - These glands, located posterolateral to the vaginal opening, are palpated for pain, swelling, tenderness, or lesions. Inflammation (Bartholinitis) or abscess formation can be painful and indicate infection, sometimes an STD.

  • Identification aids treatment - Abnormal findings during palpation, especially in the glands, are crucial for diagnosing STDs, which often manifest as inflammation, pain, or discharge from these structures, guiding appropriate testing and treatment.

Use of Speculum

• Tool Description - A speculum is an instrument used to gently pry open the vaginal cavity, allowing for direct visualization of the vaginal walls and the cervix.

• Procedure - Ensure proper sizing of the speculum (appropriate for parity, age, and sexual history) and proper insertion technique, often angled downwards and then rotated.

  • Open slowly - Once fully inserted, the speculum blades are opened slowly to visualize the cervix fully, avoiding rapid movements that can cause discomfort.

  • Systematic visualization - Observe the vaginal walls as the speculum is inserted and withdrawn, noting rugae, color, lesions, or discharge.

• Expected Normal Findings - The cervix should be centered (midline) in the vaginal vault, with a smooth surface. Its coloration can vary from pink in non-pregnant individuals to a bluish hue (Chadwick's sign) in early pregnancy due to increased vascularity.

Cervical Inspection

• Important Features - Observe the shape and characteristics of the os (the external opening of the cervix):

  • Normal for nulliparous cervix - Typically appears as a small, round, or oval opening (nulliparous os).

  • Changes in shape with childbirth - After vaginal childbirth, the os often becomes a horizontal slit (lacerated cervix), reflecting the stretching and tearing during delivery. Other changes can include an everted cervix (endocervical columnar epithelium exposed to the vaginal environment) or an eroded cervix (often referring to an area of eversion).

  • Presence of cysts - Nabothian cysts (retention cysts from blocked endocervical glands) are common benign findings.

• Pap Smear Procedure - Involves scraping or brushing cells from the ectocervix and endocervix for cytological analysis (Papanicolaou test) to screen for cervical dysplasia or cancer.

• Bimanual Examination - After speculum removal, this examination involves inserting two fingers into the vagina and placing the other hand on the patient's abdomen to palpate and assess the size, shape, consistency, mobility, and tenderness of the uterus and ovaries.

Common Conditions of the Female Anatomy

• Cystocele - A herniation of the bladder through a weakened anterior vaginal wall, causing the bladder to bulge into the vagina. This weakening can lead to urinary incontinence, pressure, or a sensation of a