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NURS 6512 Lab Assignment: Assessing the Genitalia and Rectum

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

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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

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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.
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

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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.

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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/

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