Assignment: Assessing the Genitalia and Rectum

Assignment: Assessing the Genitalia and Rectum

Assignment  Assessing the Genitalia and Rectum

Subjective Data

CC: “I have bumps on my bottom which I would like to be checked out.”

HPI: AB, a college student 21 years old WF came to the hospital complaining of external bumps on her genital area. She claims that the pumps feel rough and they are painless. She confirms being sexually active with multiple partners especially in the past years. She first encountered a sexual experience when she was 18 years old. She is quite not sure when the bumps started appearing but, she, however, came to notice them about a week before visiting the hospital. The last time she had a pap smear was three years ago, and the doctors did not find any dysplasia, as her results turned out to be normal. She, however, confirms only one sexually transmitted infection, chlamydia. She completed her treatment for chlamydia just as prescribed.

PMH: Asthma.

Medications: 160/4.5 mcg Symbicort

Allergies: No known drug or food allergies.

FH: She denies having a history of cervical or breast cancer. Her father had a history of HTN as well as her mother, together with GERD.

Social Hx: She denies ever using tobacco, but confirms using alcohol occasionally. She is married with three kids, I girl, and two boys.

Objective Data

VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs

Heart: no murmurs, RRR

Lungs: CTA, symmetrical chest wall.

Genitalia: Hair distribution is normal around her genitalia with no swelling or masses. The urethral meatus is normal with no discharge or erythema. The perineum is normal, with a healed scare from her past episiotomy. Her vaginal mucosa is moist and pink with rugae present, pos for firm, small, round, and painless ulcer spotted on the external labia.

Abdominal: Normoactive bowel sounds, soft, neg murphy’s, neg rebound, neg McBurney.

Diagnostic: HSV specimen was obtained.

Assessment: Chancre.

Information Missing on the Subjective Data:

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            For a substantial diagnosis, it is important for the nurse to gather as much subjective information as possible for a better understanding of the patient’s condition. For an instant, the history of presenting illness must also include a characteristic of the

pumps that the patient is complaining about, in terms of color, size and pattern (In Passos, 2018). Whether they have been the same or changing ever since she noticed them. Moreover, whether she has done anything to try and get rid of them. Consequently, given that her condition is situated around the genitalia, and she was previously diagnosed of chlamydia, it is important to find out whether the patient has ever experienced symptoms of eczema and psoriasis in the past (In Passos, 2018). Her immunization status is also vital as part of the subjective data. The nurse must also get information from the patient regarding her past surgical history and her hospitalization status, and the reason for hospitalization if any. The past medical history should also include the drugs that the patient took to manage her chlamydia. The patient social history should include information such as whether she uses any contraceptives or sexual protection. The subjective portion should also include a review of system with information regarding weight gain weight loss, HEENT, skin assessment, breast assessment, genitourinary, cardiovascular, respiratory, musculoskeletal, hematological and neurological assessments.

Information Missing on the Objective Data

            The objective portion is the most crucial part of a patient’s history as it reports the findings upon physical examination. It should start with the vital signs of the patient, which have been included. However, BMI is missing. General information such as the patient’s conduct, alertness, grooming, and cleanliness should also be included. The HEENT portion should include information regarding her throat, tonsils, edema, drainage and whether there are lesions (In Passos, 2018). The neck should also be assessed for nodal tenderness or goiter. The chest region should be examined for non-labored breathing, nipple tenderness, and presence of breast nodules. The heart and the lung are also essential and information regarding whether the patient is experiencing wheezing, nasal flaring or retraction and heart rate, hear sounds, arrhythmias, and chest crackles should also be provided (In Passos, 2018). The genitourinary assessment should also include information regarding vaginal bleeding, vaginal discharge, frequency of the discharge and amount, and any abnormalities noted. The nurse should also conduct a rectal examination to check for lesions or masses.

Missing Diagnostic Tests

            The patient needs to have a full pelvic examination, which includes biopsy and pap smear for the nurse to be able to rule out other sexually transmitted infections. Enzyme immunoassay test should also be done to check for indications of syphilis and herpes. Her blood should also be screened for HIV. A urinalysis and HCG tests are also necessary given that the patient has an STD, and if pregnant, might affect the baby. An acetic acid test is also necessary to rule out genital warts (Kedar, Mukhi, Waghulkar, & Goyal, 2015). This test will also be able to rule out underlying reasons for HPV given that this woman has multiple sexual partners.

Assessment

            Both the subjective and objective data have supported the patient data assessment. For instance, from the subjective data, the nurse was able to know the patient’s presenting condition, the duration, past medical history, and other symptoms which are crucial to make a diagnosis. The objective data provides the results of physical information to confirm and more weight to the subjective data, hence being able to have an opinion of what the patient might be suffering from (In Passos, 2018). However, without the lab tests provided above, a final diagnosis cannot be made. For instance, chancroid is confirmed by the presence of painful open sores around the genital, whereas the patient complained of painless bumps, overruling it as a preferential diagnosis.

Differential Diagnosis

1. Syphilis: This is a sexually transmitted infection that is characterized by the presence of painless cores (chancre) around the genitalia in acute stages, which the patient is positive for. The infection can lie dormant in the patient’s body for several years. Syphilis mainly occurs in three stages; in the first stage, the patient will complain of having painful sore around her genital area, mouth or the bottom area, within the first ten days to three months of infection. The sores may get bigger with time. If untreated, the infection will progress to the second stage where the sores will disappear, and the patient might get rashes on her body, mostly on the palms of the hand and the soles of her feet. This stage is also accompanied by fever, headache, weight loss, hair loss and skin growth around the vulva (Klein, McLaud, & Rogers, 2015). The infection will then proceed to a latent stage before the third stage kicks in. The third stage is chronic infection where the condition might cause damage to the brain, nervous system and the heart.
2. Genital Herpes: This is a sexually transmitted disease that is normally caused by the herpes simplex virus. It is characterized by a cracked, raw and red area around the genitals which is usually painless. Other symptoms include itching and small blisters that break open with time causing pain, headache, backaches, painful urination and flue like symptoms (OʼByrne, MacPherson, Kitson, & Bourgault, 2019). It is usually asymptomatic among most patients at first. However, upon an early treatment, the patient will recover within a short time of medical therapy.
3. Genital Warts: This condition is sexually transmitted and mainly caused by certain types of HPV. They always appear on the skin around the genital area. This condition is mainly characterized by whitish or skin colored bumps on the vagina, vulva, cervix or the anus (OʼByrne, MacPherson, Kitson, & Bourgault, 2019). The bumps can either be big or small, one or numerous and sometimes painful or painless. Sometimes the patient might experience itchiness and bleeding from the genital area.
4. Molluscum Contagion: This is a common viral infection of the skin especially on the genitalia. Elevated, pearl-like nodules or papules characterize it. The papules are usually painless with no itchy feeling just like in the patient above. This condition does not leave scars (OʼByrne, MacPherson, Kitson, & Bourgault, 2019). Most of the time, this condition resolves on itself even without treatment.
5. Contact dermatitis: It is an allergic reaction that causes itchiness and redness of the skin; as a result to contact with an allergen. It is presented with symptoms such as red rash around the genitalia, dry, cracked and scaly skin, bumps and blisters that sometimes oozes, and swelling or burning sensation (Mowad et al., 2016).

May use https://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/index.html

see class rules
cite scholarly resources including peer-review journals and current practice guidelines
 Please, all bullets points, bold, red and highlighted area must be attended to.
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The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

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Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

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Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

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Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed
• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• Student paper example
• Citing Sources
• The Writing Center is a great resource