Assignment: Lab Assignment: Assessing the Genitalia and Rectum NURS 6512N-32

Assignment: Lab Assignment: Assessing the Genitalia and Rectum NURS 6512N-32

Assignment: Lab Assignment: Assessing the Genitalia and Rectum NURS 6512N-32

Assessing the Genitalia and Rectum

Assessment of the genitalia and rectum is vital in depicting genitourinary and gastrointestinal abnormalities respectively. A rectal examination is necessary to complete an abdominal exam. Meanwhile, assessment of the genitalia is usually sensitive and must be done in the presence of a chaperone. The purpose of this paper is to explore the potential history, physical exam, and differential diagnosis based on a case scenario of T.S. a 32-year-old woman who presents with dysuria, frequency, and urgency for two days. She is sexually active and has had a new partner for the past three months.

Subjective

A triad of urgency, frequency, and dysuria characterizes a pathology that is most likely in the urinary tract. Consequently, it is essential to inquire about associated symptoms such as hematuria, fever, and malaise. Association with malaise and fever is common in urinary tract infections. Similarly, it is important to inquire about the presence of any abnormal vaginal discharge, and burning sensation during urination since she is sexually active and a sexually transmitted infection might be the cause of her symptoms. Likewise, changes in the smell and color of the urine must be elicited as well as associated suprapubic pain. Related to sexually transmitted infections, it is crucial to inquire about the number of sexual partners if similar symptoms have manifested in her partner or the use of protection during intercourse (Garcia & Wray, 2022).

Similarly, her last menstrual period must be known to determine if pregnant as this will impact the management (Bono et al., 2022). Additionally, a history of medication use, alcohol, smoking, and use of illicit drugs must be elicited. A history of contact with an individual with a chronic cough or TB prior to the occurrence of the previous symptoms must be elicited as urogenital TB may present similarly. Finally, it is crucial to inquire about any history of trauma or recent urethral catheterization as these are common risk factors for urinary tract infections.

Objective

The vital signs are mandatory in this patient as it is a pelvic exam. In the general exam, the mental and nutrition status of the patient must be noted. Additionally, a complete abdominal exam must be conducted as the patient has flank pain and suprapubic tenderness. Palpation of the abdomen for any masses and percussion of the flank for costovertebral angle tenderness must be done (Bono et al., 2022). Similarly, complete respiratory and cardiovascular exams must be conducted as a routine during the assessment of any patient. Finally, a digital rectal examination must be performed to exclude associated rectal abnormalities.

Assessment

In addition to urinalysis, STI, and pap smear testing, a complete blood count and urine culture must be conducted as the patient presents with signs of infection. Similarly, a pregnancy test must be conducted as this may complicate urinary tract infections. Additionally, she has no appetite and therefore a random blood sugar must be done to exclude hypoglycemia. Similarly, urea, creatinine, and electrolyte must be conducted to check the renal function as the patient has flank pain. Finally, Inflammatory markers such as ESR and CRP as well as blood cultures must be done as the patient has flank pain which may indicate pyelonephritis (Bono et al., 2022). Imaging tests are not necessary for the diagnosis of lower UTI. However, the patient has flank pain, and therefore, a CT scan of the abdomen and pelvis with or without IV contrast as well as an ultrasound of the kidneys and bladder must be done to identify any pathologies and outline the architecture of the kidney and bladder (Belyayeva & Jeong, 2022)

The possible diagnoses include a urinary tract infection and a sexually-transmitted infection. Urinary tract infections refer to the infection of the bladder, urethra, ureters, or kidneys (Bono et al., 2022). UTIs are more common in women, a consequence of a short urethra and proximity of the anal and genital regions (Bono et al., 2022). A triad of frequency, dysuria, and urgency collectively defines the irritative lower urinary tract symptoms (Bono et al., 2022). Similarly, suprapubic tenderness is a key feature of lower urinary tract infections. However, the patient is also feverish and has flank pain which also denotes the potential for involvement of the upper urinary tract (Bono et al., 2022). T.S is also sexually active, a risk factor for urinary tract infection.

A sexually transmitted infection is another possible diagnosis. T.S is sexually active and she has had her new partner for the last three months which is a key risk factor for this condition (Garcia & Wray, 2022). Most STIs present with suprapubic pain. Most STIs are asymptomatic and if symptomatic manifests with urethral discharge, vaginal discharge, pruritus, and pain (Garcia & Wray, 2022). T.S was negative for the aforementioned features.

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Other differential diagnoses include pyelonephritis, interstitial cystitis, and urethritis due to an STI. Pyelonephritis is of the renal pelvis and parenchyma (Belyayeva & Jeong, 2022). It is usually a complication of ascending bacterial infection of the bladder and manifests principally with frequency, dysuria, urgency, fever, malaise, flank pain, and suprapubic pain (Belyayeva & Jeong, 2022). Interstitial cystitis is a chronic noninfectious idiopathic cystitis associated with recurrent suprapubic pain (Daniels et al., 2018). It presents with urgency, frequency, suprapubic discomfort, and pain relieved by voiding. T.S has some of these features although the gradual onset of symptomatology and a duration of more than six weeks is required for the diagnosis of this condition (Daniels et al., 2018). Finally, urethritis secondary to an STI may present in females with only frequency, urgency, and dysuria with minimal or no vaginal discharge (Young et al., 2022).

Conclusion

Assessment of the genitalia and rectum is sensitive and may help identify abnormalities of the rectum and genitourinary tract. Most abnormalities of the genitourinary system particularly UTIs and STIs can be diagnosed clinically. Consequently, a comprehensive history and physical examination are mandatory. Most UTIs are common in females. Pregnancy must always be excluded in a patient presenting with features suggestive of a UTI.

References

Belyayeva, M., & Jeong, J. M. (2022). Acute Pyelonephritis. https://pubmed.ncbi.nlm.nih.gov/30137822/

Bono, M. J., Leslie, S. W., & Reygaert, W. C. (2022). Urinary Tract Infection. https://pubmed.ncbi.nlm.nih.gov/29261874/

Daniels, A. M., Schulte, A. R., & Herndon, C. M. (2018). Interstitial cystitis: An update on the disease process and treatment. Journal of Pain & Palliative Care Pharmacotherapy, 32(1), 49–58. https://doi.org/10.1080/15360288.2018.1476433

Garcia, M. R., & Wray, A. A. (2022). Sexually Transmitted Infections. https://pubmed.ncbi.nlm.nih.gov/32809643/

Young, A., Toncar, A., & Wray, A. A. (2022). Urethritis. https://pubmed.ncbi.nlm.nih.gov/30725967/

Assignment: Lab Assignment: Assessing

the Genitalia and Rectum

Patients are frequently uncomfortable discussing with healthcare professional’s issues
that involve the genitalia and rectum; however, gathering an adequate history and
properly conducting a physical exam are vital. Examining case studies of genital and rectal abnormalities can help prepare advanced practice nurses to accurately assess
patients with problems in these areas.
In this Lab Assignment, you will analyze an Episodic note case study that describes
abnormal findings in patients seen in a clinical setting. You will consider what history
should be collected from the patients, as well as which physical exams and diagnostic
tests should be conducted. You will also formulate a differential diagnosis with several
possible conditions.
To Prepare
 Review the Episodic note case study your instructor provides you for this week’s
Assignment. Please see the “Course Announcements” section of the classroom for your
Episodic note case study.
 Based on the Episodic note case study:
o Review this week’s Learning Resources, and consider the insights they provide about
the case study. Refer to Chapter 3 of the Sullivan resource to guide you as you
complete your Lab Assignment.
o Search the Walden library or the Internet for evidence-based resources to support your
answers to the questions provided.
o Consider what history would be necessary to collect from the patient in the case study.
o Consider what physical exams and diagnostic tests would be appropriate to gather
more information about the patient’s condition. How would the results be used to make
a diagnosis?
o Identify at least five possible conditions that may be considered in a differential
diagnosis for the patient.
The Lab Assignment
Using evidence-based resources from your search, answer the following questions and
support your answers using current evidence from the literature.
 Analyze the subjective portion of the note. List additional information that should be
included in the documentation.
 Analyze the objective portion of the note. List additional information that should be
included in the documentation.
 Is the assessment supported by the subjective and objective information? Why or why
not?
 Would diagnostics be appropriate for this case, and how would the results be used to
make a diagnosis?
 Would you reject/accept the current diagnosis? Why or why not? Identify three possible
conditions that may be considered as a differential diagnosis for this patient. Explain
your reasoning using at least three different references from current evidence-based
literature.

By Day 7 of Week 10

Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
 Please save your Assignment using the naming convention “WK10Assgn+last
name+first initial.(extension)” as the name.
 Click the Week 10 Assignment Rubric to review the Grading Criteria for the
Assignment.

 Click the Week 10 Assignment link. You will also be able to “View Rubric” for grading
criteria from this area.
 Next, from the Attach File area, click on the Browse My Computer button. Find the
document you saved as “WK10Assgn+last name+first initial.(extension)” and
click Open.
 If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit
my paper(s) to the Global Reference Database.
 Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Week 10 Assignment Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 10 Assignment draft and review the originality report.
Submit Your Assignment by Day 7 of Week 10
To participate in this Assignment:
Week 10 Assignment

What's Coming Up in Module 4?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
Next week, you will consider how evidence-based practice guidelines and ethical
considerations factor into health assessments. You specifically explore evidence-based
practice guidelines and ethical considerations for specific scenarios.
Week 11 Final Exam
Photo Credit: [DirtyDog_Creative]/[Vetta]/Getty Images
Next week, you take your Final Exam, which will cover the topics and resources from
Weeks 7, 8, 9, and 10 for this course. Please take the time to review and plan your time
accordingly so that you may be better prepared for your exam.
Next Module
To go to the next Module:
Module 4

 Chapter 17, “Breasts and Axillae”
This chapter focuses on examining the breasts and axillae. The authors
describe the examination procedures and the anatomy and physiology of
breasts.

 Chapter 19, “Female Genitalia”
In this chapter, the authors explain how to conduct an examination of
female genitalia. The chapter also describes the form and function of
female genitalia.

 Chapter 20, “Male Genitalia”
The authors explain the biology of the penis, testicles, epididymides,
scrotum, prostate gland, and seminal vesicles. Additionally, the chapter
explains how to perform an exam of these areas.

 Chapter 21, “Anus, Rectum, and Prostate”
This chapter focuses on performing an exam of the anus, rectum, and
prostate. The authors also explain the anatomy and physiology of the
anus, rectum, and prostate.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health
assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO:
Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., &
Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
Chapter 5, “Amenorrhea”
Amenorrhea, or the absence of menstruation, is the focus of this chapter.
The authors include key questions to ask patients during history taking and explain what to look for during the physical exam.
Breast Lumps and Nipple Discharge, Chapter 6
This chapter addresses the critical issue of breast lumps and nipple discharge. Because breast cancer is the most common type of cancer in women, an accurate diagnosis is critical. The chapter contains information such as key questions to ask and what to look for during a physical exam.
Chapter 7, “Breast Pain”
Determining the cause of breast pain can be difficult. This chapter
examines how to determine the likely cause of the pain through diagnostic
tests, physical examination, and careful analysis of a patient’s health
history.
Chapter 27, “Penile Discharge”
The focus of this chapter is on how to diagnose the causes of penile
discharge. The authors include specific questions to ask when gathering a
patient’s history to narrow down the likely diagnosis. They also give advice
on performing a focused physical exam.
Chapter 36, “Vaginal Bleeding”
In this chapter, the causes of vaginal bleeding are explored. The authors
focus on symptoms outside the regular menstrual cycle. The authors
discuss key questions to ask the patient as well as specific physical
examination procedures and laboratory studies that may be useful in
reaching a diagnosis.
Chapter 37, “Vaginal Discharge and Itching”
This chapter examines the process of identifying causes of vaginal

discharge and itching. The authors include questions on the
characteristics of the discharge, the possibility of the issues being the
result of a sexually transmitted infection, and how often the discharge
occurs. A chart highlights potential diagnoses based on patient history,
physical findings, and diagnostic studies.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.).
Philadelphia, PA: F. A. Davis.

This article describes the benefits of new technology and
guidelines for pelvic exams. The authors also detail which
guidelines and technology may become obsolete.

Centers for Disease Control and Prevention. (2019). Sexually transmitted
diseases (STDs). Retrieved from http://www.cdc.gov/std/#

This section of the CDC website provides a range of information on
sexually transmitted diseases (STDs). The website includes reports on
STDs, related projects and initiatives, treatment information, and program
tools.
Document: Final Exam Review (Word document)

Optional Resource
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s
diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.

 Chapter 8, “The Chest: Chest Wall, Pulmonary, and Cardiovascular
Systems; The Breasts” (Section 2, “The Breasts,” pp. 434–444)
Section 2 of this chapter focuses on the anatomy and physiology of
breasts. The section provides descriptions of breast examinations and
common breast conditions.

 Chapter 11, “The Female Genitalia and Reproductive System” (pp.
541–562)
In this chapter, the authors provide an overview of the female reproductive
system. The authors also describe symptoms of disorders in the
reproductive system.

 Chapter 12, “The Male Genitalia and Reproductive System” (pp. 563–584)
The authors of this chapter detail the anatomy of the male reproductive
system. Additionally, the authors describe how to conduct an exam of the
male reproductive system.

 Review of Chapter 9, “The Abdomen, Perineum, Anus, and Rectosigmoid”
(pp. 445–527)
Required Media (click to expand/reduce)
Online media for Seidel's Guide to Physical Examination
It is highly recommended that you access and view the resources included with
the course text, Seidel's Guide to Physical Examination. Focus on the videos and
animations in Chapters 16 and 18–20 that relate to special examinations,
including breast, genital, prostate, and rectal. Refer to the Week 4 Learning
Resources area for access instructions on https://evolve.elsevier.com/

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