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NUR 3069C: Shadow Health Assessment of the Abdomen and Male and Female Genitourinary Systems

NUR 3069C: Shadow Health Assessment of the Abdomen and Male and Female Genitourinary Systems

NUR 3069C: Shadow Health Assessment of the Abdomen and Male and Female Genitourinary Systems

Shadow Health Assessment of the Abdomen and Male and Female Genitourinary Systems Learning Activities:

At the end of today’s session, the student will be able to:

  • Identify the organs and structures of the female genitourinary system.
  • Obtain a complete patient history (review of systems – subjective findings).
  • Conduct a physical assessment.
  • Differentiate normal from abnormal findings.
  • Chart findings.
  • Teach female patients about well-women exams, birth control, and prevention of sexually transmitted infections.
  • Identify the organs and structures of the male genitourinary system.
  • Obtain a complete patient history (review of systems – subjective findings).
  • Conduct a physical assessment.
  • Differentiate normal from abnormal findings.
  • Chart findings.
  • Teach male patients how to perform testicular self-exam.
  • Identify internal abdominal organs based upon external landmarks.
  • Recall the anatomy and physiology of the abdomen.
  • Identify landmarks that guide assessment of the abdomen.
  • Develop questions to be used when completing the focused interview.
  • Explain client preparation for assessment of the abdomen.
  • Differentiate normal from abnormal findings in physical assessment of the abdomen.
  • Describe developmental, psychosocial, cultural, and environmental variations in assessment techniques and findings.

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 Learning Activities:

Watch On-Line Lectures/ Demonstrations

Course Website:

  • Lecture on Abdomen Voice Over Power Point
  • Lecture on Male Genitalia Voice Over Power Point
  • Lecture on Female Genitalia Voice Over Power Point

NUR 3069C: Shadow Health Assessment of the Abdomen and Male and Female Genitourinary Systems

Overview

  1. Genitourinary assessments may be deferred:
    1. Some facilities state that if there is no complaint and it is not their primary diagnosis, genital assessments can be deferred
    2. Defer until performing bed bath or perineal care – so as to preserve the patient’s dignity
    3. Utilize interview-style assessment until it is appropriate to perform physical inspection/assessment

Nursing Points

General

  1. Assessment of:
    1. External genitalia/perineum
    2. Urinary symptoms
    3. Symptoms related to reproductive function

Assessment

  1. MALE
    1. Ask
      1. Any bleeding or discharge
      2. Burning with urination
    2. Inspect
      1. Scrotum
        1. Lesions, masses, hair
        2. Symmetry
          1. Normal for left to be lower than right. NUR 3069C: Shadow Health Assessment of the Abdomen and Male and Female Genitourinary Systems
      2. Penis
        1. Shape
        2. Vasculature
        3. Discharge or bleeding
      3. Inguinal region
        1. Visible mass may indicate hernia
    3. Palpate
      1. Testes
        1. Palpate testes gently between thumb and forefinger.
        2. Should be oval, freely movable, and only slightly tender
      2. Inguinal region
        1. Palpate for hernia/mass
        2. Palpate inguinal lymph nodes
    4. Advanced
      1. Prostate exam
        1. Insert one finger with lubricant into rectum
        2. Palpate anteriorly
        3. Should not be enlarged
        4. Should be no signs of blood on finger
  2. FEMALE
    1. Ask
      1. Any burning with urination
      2. Last menstrual period
      3. Menstrual symptoms
        1. Severity of cramping and bleeding
        2. How many days
        3. How long is average cycle
    2. Inspect
      1. External
        1. Labia majora should be symmetrical and well-formed
        2. Skin color
        3. Hair distribution
        4. Lesions or cysts
      2. Spread labia majora
        1. Clitoris
        2. Labia minora should be symmetrical, dark pink, and moist
      3. Urethral
        1. Note any discharge or redness/swelling
      4. Vaginal canal
        1. Observe any drainage
        2. Note any foul odor
    3. Palpate
      1. Labia majora – should feel no masses or lumps
        1. This may indicate clogged Bartholin’s gland
      2. All actions should be nontender, but may be sensitive
    4. Advanced
      1. Speculum used to inspect cervix and take pap smear
      2. In nulligravida patient, cervical opening should be small and round
      3. In a patient who has been pregnant, cervical opening may be a horizontal slit
      4. Cervix should be midline. NUR 3069C: Shadow Health Assessment of the Abdomen and Male and Female Genitourinary Systems

Nursing Concepts

  1. It is fully appropriate and expected that you will get the patient’s permission before performing these assessments, especially if there are no primary genitourinary complaints.
  2. Utilize a chaperone as requested and appropriate, especially for opposite gender patients
  3. Maintain dignity at all times

Patient Education

  1. Purpose for assessments
  2. Describe everything you will do before you do it

Reference

PHYSICAL ASSESSMENT EXAMINATION STUDY GUIDE
Page 1 of 35
Adapted from the Kentucky Public Health Practice Reference, 2008 and
Jarvis, C, (2011). Physical examination & health assessment. (6th Ed). Elsevier: St. Louis.MO.
by Wright State University on May 28, 2012 for the NLN Assessment Exam for Credit by Exam Test Out – updated November 2012
Nursing Assessment
1. Part of Nursing Process
2. Nurses use physical assessment skills to:
a) Obtain baseline data and expand the data base from which subsequent phases of the
nursing process can evolve
b) To identify and manage a variety of patient problems (actual and potential)
c) Evaluate the effectiveness of nursing care
d) Enhance the nurse-patient relationship
e) Make clinical judgments
Gathering Data
Subjective data – Said by the client (S)
Objective data – Observed by the nurse (O)
Document: SOAPIER
Assessment Techniques:
The order of techniques is as follows (Inspect – Palpation – Percussion – Auscultation) except for the
abdomen which is Inspect – Auscultation – Percuss – Palpate.
A. Inspection – critical observation *always first*
1. Take time to “observe” with eyes, ears, nose (all senses)
2. Use good lighting
3. Look at color, shape, symmetry, position
4. Observe for odors from skin, breath, wound
5. Develop and use nursing instincts
6. Inspection is done alone and in combination with other assessment techniques
B. Palpation – light and deep touch
1. Back of hand (dorsal aspect) to assess skin temperature
2. Fingers to assess texture, moisture, areas of tenderness
3. Assess size, shape, and consistency of lesions and organs
4. Deep = 5-8 cm (2-3”) deep; Light = 1 cm deep
C. Percussion – sounds produced by striking body surface
1. Produces different notes depending on underlying mass (dull, resonant, flat, tympanic)
2. Used to determine size and shape of underlying structures by establishing their borders and
indicates if tissue is air-filled, fluid-filled, or solid
3. Action is performed in the wrist.
D. Auscultation – listening to sounds produced by the body
1. Direct auscultation – sounds are audible without stethoscope
2. Indirect auscultation – uses stethoscope
3. Know how to use stethoscope properly [practice skill]
4. Fine-tune your ears to pick up subtle changes [practice skill]
5. Describe sound characteristics (frequency, pitch intensity, duration, quality) [practice skill]
6. Flat diaphragm picks up high-pitched respiratory sounds best. NUR 3069C: Shadow Health Assessment of the Abdomen and Male and Female Genitourinary Systems.
7. Bell picks up low pitched sounds such as heart murmurs.
8. Practice using BOTH diaphragms