NURS 6512 Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal Paper
Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal Paper
Thorough focused history and physical examination are required to make diagnoses and care plans for patients. The case provided is of a 21-year-old white female who complains of painless bumps in the genital area. On examination, a firm round painless ulcer is reported in the genital labia. Therefore, this paper will explain the missing aspects of the history and physical examination while giving the possible differential diagnoses.
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Subjective Data
The significant systems of concern in this case study are mainly the genitourinary, integumentary, and reproductive systems. The history should provide complete significant negatives and positives of the patient (Sullivan, 2019). The general constitutional complaints such as weight loss, night sweats, and fever are missing from the SOAP note. These aspects are always important when classifying the patient’s illness into infectious, neoplastic, or other classes.
In the genitourinary system, the bump ought to be described further. The characteristics of dermatological conditions of the genitalia and perineum, such as itchiness, were missing from the provided history. For proper diagnosis, we need to rule out urinary pathology in the patient. The reproductive infection symptoms may usually occur together with urinary symptoms. Therefore, to be sure that there are no underlying urinary pathologies, the urinary symptoms of dysuria, dark urine, hesitancy, and incontinence would be included.
The patient is a female, and therefore, the gynecologic history must be included. There are a few elements of gynecologic reports. However, a comprehensive description of her menstruation is missing in the above history. Sometimes inflammatory conditions in the reproductive system can cause interruption of the menstrual patterns presentations. The presence of intermenstrual bleeding, irregular menses, and other menstruation abnormalities are missing from the provided history. Fortunately, the information about the Pap smear and STIs are reported. Sexual history is presented. However, the 5 P’s of sexual history is incomplete.
The aspect of Practices, Protection, and Pregnancy protection are not included. The provided history does not document the information about the specific sexual practices, methods of birth control, and protection against STIs. In the given sexual history, the findings on postcoital symptoms are missing. If present, such findings can be used to infer the presence or absence of cervicitis of possible cervical cancer because her last pap spear was three years ago. The component of HPV vaccination is not clear from the history provided.
Objective Data
A physical examination would majorly focus on the genital examination. The genital exam consists of the examination of the external genitalia, speculum examination of the external genitalia, bimanual examination, and rectovaginal examination (Ball et al., 2019). Specific to this case, the external genitalia examination and a rectovaginal exam are critical. The external genitalia examination reported is missing the results of any lesions in the anus. Some lesions that affect the labia can affect the anus, such as warts and herpetic lesions. The rectovaginal exam findings are missing in the patient. In this patient, it would be appropriate to do a rectovaginal exam to rule out anal pathologies that share the same etiologies with labial infectious diseases. Internal genitalia examination and bimanual examination would not be mandatory, considering the history given lacks the symptoms of internal reproductive organ pathologies.
Another component of the physical exam that was missing was the examination of the lymphadenopathy. Inguinal lymph nodes drain the labia and perineal skin. Inguinal lymphadenopathy would signify that some infectious conditions are present, or the condition is metastatic cancer from the draining regions. It was, therefore, essential to report on the inguinal lymphadenopathy.
Diagnostics
In this case, appropriate diagnostic tests would include the Venereal Disease Research Lab (Chandrasekar & Bronze, 2017), antibody test for HSV, fluorescent treponemal antibody-absorption (FTA-ABS), and darkfield examination of ulcer swab. The results of these tests would confirm or rule out the presence of treponema species and HSV. The absence of treponemes and HSV would be used to make a diagnosis of chancroid (Buensalido et al., 2019). The diagnosis of chancroid will be supported by a thorough physical examination of the ulcer and the patient’s travel history.
Assessment
I would not entirely disagree with the assessment provided, although it is nonspecific. Chancre can arise from syphilis or chancroid. Both are infectious conditions that are caused by different agents. The description of the lesions can be clinically used to distinguish between the two conditions. In most cases, the syphilitic chancre is painless, while the chancre in chancroid is painful (Buensalido et al., 2019). Therefore, my priority differential diagnosis would be a syphilitic chancre. Syphilitic chancre develops with primary syphilis. They are painless, round, punched out with rolled edges. On infrequent occasions, these lesions can be painful (Demir et al., 2016). The chancre develops within the first three to six weeks of incubation. In this patient, it is not clear when the symptoms first appeared. Other differential diagnoses that I would consider are chancroid, herpes simplex, psoriasis, and Behcet’s syndrome.
Herpes simplex infection presents with open ulcers on the labia and the anal region. The ulcers, blisters, or sores are usually multiple (Grove & Ramus, 2020). I would consider the possibility of genital herpes in this patient because of the lesions’ labial location, reproductive age, and since herpes is the commonest cause of genital ulcers in the US. However, herpetic genital ulcers are painful. Chancroid would be a consideration in this case study; however, it is not common, and the presentations in this patient are typical except for the painless ulcers. Psoriasis and Behcet’s syndrome are likely differential diagnosis. Alongside mouth ulcers, Behcet’s syndrome presents with genital ulcers too. However, the presented data is insufficient to consider these differential diagnoses rather than the earlier mentioned diagnoses.
References for Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal Paper
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Buensalido, J., Chandrasekar, P., & Sandejas, J. (2019). Chancroid Differential Diagnoses. Emedicine.medscape.com. Retrieved 3 November 2020, from https://emedicine.medscape.com/article/214737-differential?src=mbl_msp_android&ref=share.
Chandrasekar, P., & Bronze, M. (2017). Syphilis Workup: Approach Considerations, Imaging Studies, Lumbar Puncture. Emedicine.medscape.com. Retrieved 3 November 2020, from https://emedicine.medscape.com/article/229461-workup.
Demir, F., Salaeva, K., Altunay, I., & Yalcın, O. (2016). An extraordinary case of syphilis presenting with a labial ulcer. Saudi Medical Journal, 37(11), 1261-1264. https://doi.org/10.15537/smj.2016.11.15674
Grove, M., & Ramus, R. (2020). Genital Herpes in Pregnancy: Practice Essentials, Genital HSV Infections, Perinatal Transmission of HSV. Emedicine.medscape.com. Retrieved 3 November 2020, from https://emedicine.medscape.com/article/274874-overview?src=mbl_msp_android&ref=share#a2.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
NURS 6512 Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal Instructions
One critical element of any physical exam is the ability of the examiner to put the patient at ease. By putting the patient at ease, nurses are more likely to glean quality, meaningful information that will help the patient get the best care possible. When someone feels safe, listened to, and cared about, exams often go more smoothly. This is especially true when dealing with issues concerning breasts, genitals, prostates, and rectums, which are subjects that many patients find difficult to talk about. As a result, it is important to gain a firm understanding of how to gain vital information and perform the necessary assessment techniques in as non-invasive a manner as possible.
For this week, you explore how to assess problems with the breasts, genitalia, rectum, and prostate.
Learning Objectives
Students will:
- Evaluate abnormal findings on the genitalia and rectum
- Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the breasts, genitalia, prostate, and rectum
Learning Resources
Required Readings (click to expand/reduce)
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
- 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.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
- Chapter 3, “SOAP Notes” (Previously read in Week 8)
This article describes the benefits of new technology and guidelines for pelvic exams. The authors also detail which guidelines and technology may become obsolete.
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/
Assignment: Lab Assignment: Assessing the Genitalia and Rectum
Photo Credit: Getty Images
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:
- 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.
- Search the Walden library or the Internet for evidence-based resources to support your answers to the questions provided.
- Consider what history would be necessary to collect from the patient in the case study.
- 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?
- Identify at least fivepossible 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
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