Breast and Genital Special Examinations

Special Examinations Breast Genital Prostate and Rectal 

Healthcare providers must obtain objective and subjective data from the patient before making a diagnosis to ensure that the diagnosis is accurate. They also require past medical and family history, conducting physical assessments, and carrying out diagnostic tests based on the chief complaint and the symptoms. This essay analyses the subjective and objective data for a patient presenting with genitourinary symptoms. The diagnostic tests and possible diagnosis will also be discussed.

Breast and Genital Special Examinations

Additional Subjective Information Required in the Documentation

The additional subjective information that the nurse should include in the documentation consists of menstruation characteristics, the last menses, and the frequency. The nurse should also ask about any other known related disorders. Since the patient states she is sexually active, the nurse should ask about pain during intercourse and any bleeding. The information on sexual history is also important (Toney-Butler & Wendy, 2022). The nurse should ask about the first sexual encounter, the number of sexual partners the patient has had, and whether any contraception is used.

Additional Objective Information Required in the Documentation

The nurse should assess the abdomen for any masses arising from the pelvis. The nurse should also systematically assess the urethra, clitoris, introitus, the labia minora, and the labia majora (Powell, 2021). The nurse should also assess the vaginal mucosa and record its characteristics. Any color changes on the abdomen should also be assessed and recorded. If there is any pain, the nurse should determine and record its type.

Assessment Support by Subjective and Objective Information

The subjective and objective information supports the assessment. The assessment is Chancre. Based on the chief complaint, the patient presented with painless, rough lumps in her genitalia. The subjective data states that the lumps are visible, and the objective data confirm that a lump is noted in the external labia. According to Valladares, Craig & Katz (2021), painless chancres can be a symptom of primary syphilis.

They are formed at the primary stage of syphilis, approximately 21 days after exposure to the bacteria- Treponema pallidum. However, there are also painful chancres that indicate other conditions, such as chancroids. Painless chancres often disappear between 4-8 weeks, even without using any medication. Although rare, painless genital ulcers may also be caused by Chlamydia trachomatis serovars, the causative agent of LVG.

Additional Diagnostic Tests

The only diagnostic test that was taken was HSV to test for Herpes Simplex Virus

Other diagnostic tests that should be taken include:

Pelvic US/CT to diagnose any pelvic abnormalities

Full hemogram for systemic involvement

VDRL or PPR to diagnose syphilis

WBC to diagnose any infection

Diagnostics would be appropriate for this case. The diagnostic test results could be used to make a diagnosis. For instance, the VDRL or PPR test would show the presence of the bacteria that causes syphilis, thus diagnosing the patient with syphilis.

Primary Diagnosis: Chancres

The primary diagnosis is Chancres. I accept the current diagnosis. Chancres are a manifestation of primary syphilis. According to Tudor et al. (2022), painless chancres appear 10-90 days after exposure to the infection at the site of inoculation. HIV patients may have more than one chancers. They disappear on themselves within 2-8 weeks, after which secondary syphilis begins manifesting.

It is important to treat primary and secondary syphilis results in the latent phase of syphilis. The case study’s patient presented with a painless lump. Also, she stated that the lump appeared about a week ago. Therefore, chancres are the primary diagnosis for this patient.

Differential Diagnosis One: Herpes Simplex Virus (HSV-2)

Herpes simplex virus is a viral infection that causes genital herpes. It involves herpes appearing around the genitals and may also appear inside the vagina. The bacteria causing herpes is usually transmitted through genital contact. Some HSV-2 symptoms include painful lumps in the genitals (Looker et al., 2020). Herpes may affect the genitals, causing pain/burning during urination. The patient in this case study presented with lumps, but they are painless, thus ruling out this diagnosis.

Differential Diagnosis Two: Chancroids

Chancroids are sexually transmitted infection transmitted through sexual contact that causes ulcers in the genitals. Chancroids lesions are more visible and roughly felt. Chancroids involve open and draining open sores on the genital area. Chancroid symptoms begin manifesting between 4-7 days after infection.

Females with chancroids develop red bumps on the labia, which eventually become ulcerated and open, causing a burning/painful sensation during urination or sexual intercourse. Patients may also present with swelling in the groin and abdomen. In this case, the patient has red lumps on the labia. However, the lumps are painless; thus, the patient does not present with chancroids.

Differential Diagnosis Three: Donovanosis

Donovanosis, also known as Granuloma inguinalea, is a genital ulcerative condition caused by the bacterium Klebsiella granulomas. The signs and symptoms include having one or more painless lumps in the genitalia and groin. The lumps are usually rough and beefy-red in color. They also get larger, ulcerate, and may bleed with an undesirable smell.

The infection can spread to the pelvis and disseminate to intra-abdominal organs such as the bones. In the case study, the patient presents with a painless lump in the genitals; thus, donovanosis could be the diagnosis. However, it is ruled out since the lump does not appear reddish in color and does not bleed.

Understanding the symptoms and the disease presentations before making a diagnosis is vital in ensuring an accurate diagnosis. It is also essential to compare different differential diagnoses, thus selecting the one that best suits the patient’s symptoms.

References

Looker, K. J., Johnston, C., Welton, N. J., James, C., Vickerman, P., Turner, K. M., & Gottlieb, S. L. (2020). The global and regional burden of genital ulcer disease due to herpes simplex virus: a natural history modeling study. BMJ Global Health5(3), e001875. http://dx.doi.org/10.1136/bmjgh-2019-001875

Morrone, A. (2020). Donovanosis, chancroid, and endemic treponematoses: Clinical features and control. In Sexually Transmitted Infections (pp. 319-335). Springer, Cham. https://doi.org/10.1007/978-3-030-02200-6_16

Powell, K. (2021). Consultation and clinical assessment of the genitourinary system for advanced clinical practitioners. British Journal of Nursing30(22), 1288-1294. https://doi.org/10.12968/bjon.2021.30.22.1288

Toney-Butler, J., Wendy, J. (2022). Nursing Admission Assessment and Examination. In: StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK493211/

Tudor, M. E., Al Aboud, A. M., Leslie, S. W. & Gossman, W. (2022). Syphilis. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK534780/

Valladares, H. C., Craig, E., & Katz, K. A. (2021). Perianal Chancres of Primary Syphilis. JAMA Dermatology157(12), 1496. https://doi.org/10.1001/jamadermatol.2021.3763