Sample Answer for NURS 6512 Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal Included After Question
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.
In final preparation for this week’s head-to-toe physical examination, 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
- Assess health conditions based on a head-to-toe physical examination
Photo Credit: Jose Luis Pelaez Inc/Blend Images/Getty Images
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
- Chapter 16, “Breasts and Axillae” (pp. 350-369)
This chapter focuses on examining the breasts and axillae. The authors describe the examination procedures and the anatomy and physiology of breasts.
- Chapter 18, “Female Genitalia” (pp. 416-465)
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 19, “Male Genitalia” (pp. 466-484)
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 20, “Anus, Rectum, and Prostate” (pp. 485-500)
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. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.
- Chapter 5, “Amenorrhea” (pp. 47-60)
Amenorrhea, or the absence of menstruation, is the focus of this chapter. The authors include key questions to ask patients when taking histories and explain what to look for in the physical exam.
- Chapter 6, “Breast Lumps and Nipple Discharge” (pp. 61-72)
This chapter focuses on the important topic of breast lumps and nipple discharge. Because breast cancer is the most common type of cancer in women, it is important to get an accurate diagnosis. Information in the chapter includes key questions to ask and what to look for in the physical exam.
- Chapter 7, “Breast Pain” (pp. 73-80)
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” (pp. 318-324)
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” (pp. 419-433)
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” (pp. 434-445)
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.
- Chapter 3, “Adult Preventative Care Visits” (“Gender Specific Screenings”; p. 137)
Note: Download the Physical Examination Objective Data Checklist to use as you complete the Head-to-Toe Physical Assessment Video assignment.
Sabbagh, C., Mauvis, F., Vecten, A., Ainseba, N., Cosse, C., Diouf, M., & Regimbeau, J. M. (2014). What is the best position for analyzing the lower and middle rectum and sphincter function in a digital rectal examination? A randomized, controlled study in men. Digestive and Liver Disease, 46(12), 1082–1085. doi:10.1016/j.dld.2014.08.045
Retrieved from the Walden Library Databases.
Westhoff, C. L., Jones, H. E., & Guiahi, M. (2011). Do new guidelines and technology make the routine pelvic examination obsolete? Journal of Women’s Health, 20(1), 5–10.
Retrieved from the Walden Library databases.
This article describes the benefits of new technology and guidelines for pelvic exams. The authors also detail which guidelines and technology may become obsolete.
Required Media
Online media for Seidel’s Guide to Physical Examination
Optional Resources
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)
A Sample Answer For the Assignment: NURS 6512 Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal
Title: NURS 6512 Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal
Patients are frequently uncomfortable discussing with health care 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 assignment, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.
In this assignment, you will analyze a SOAP 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.
GENITALIA ASSESSMENT
Subjective:
- CC: “I have bumps on my bottom that I want to have checked out.”
- HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner over the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.
- PMH: Asthma
- Medications: Symbicort 160/4.5mcg
- Allergies: NKDA
- FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD
- Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)
Objective:
- VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs
- Heart: RRR, no murmurs
- Lungs: CTA, chest wall symmetrical
- Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact with a healed episiotomy scar present. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia
- Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney
- Diagnostics: HSV specimen obtained
Assessment:
- Chancre
- PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.
To prepare:
With regard to the SOAP note case study provided:
- Review this week’s Learning Resources, and consider the insights they provide about the case study.
- 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 five possible conditions that may be considered in a differential diagnosis for the patient.
To complete:
Refer to Chapter 5 of the Sullivan text. Analyze the SOAP note case study. Using evidence based resources, 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 3 different references from current evidence based literature.
By Day 7
This Assignment is due.
Grading Criteria
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
Assignment 2: Head-to-Toe Physical Assessment Video
Throughout this course, you were encouraged to practice conducting various physical assessments on multiple areas of the body, ranging from the head to the toes. Each of these assessments, however, was conducted independently of one another. For this Assignment, you connect the knowledge and skills you gained from each individual assessment to perform a comprehensive head-to-toe physical examination on a volunteer “patient.”
To prepare:
- Arrange an appropriate time and setting with your volunteer “patient” to perform a head-to-toe physical examination. Note: Your volunteer’s Video Release Form must be submitted prior to the exam. Refer to the Week 1 Looking Ahead for release form details.
- Download and review the Physical Examination Objective Data Checklist from this week’s Learning Resources.
- Ensure that you have the appropriate lighting and equipment to perform the examination.
To complete:
- Record yourself performing the head-to-toe physical examination. Be sure to cover all of the areas listed in the checklist and to use any equipment appropriately.
By Day 7
This Assignment is due. Submit your video using the Kaltura Mashup tool accessible through the Assignment submission link provided.
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
Submit Your Assignment by Day 7
Week in Review
This week, you culminated the knowledge and skills you gained from each individual assessment of multiple areas of the body to perform a comprehensive head-to-toe examine on your ‘patient’ while recording yourself using Kaltura.
Next week, you will consider how evidence-based practice guidelines and ethical considerations factor into health assessments. In addition, you will evaluate health assessment concepts related to sports physicals and well-child and well-woman examinations.
A Sample Answer 2 For the Assignment: NURS 6512 Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal
Title: NURS 6512 Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal
Initials: RD Age: 21 Sex: Female Race: Black
S:
“ I have bumps on my bottom that I here for them to be examined”.
HPI:
This is 21 years old Black female who presented to the clinical today, because of bumps on her external genital. RD stated that texture of the bumps is rough, but she is not experiencing any pain in the area. The patient is currently sexually active and has been this was 18 years old. The reported several partners with the last year. The patient denies having any discharge from the vagina. The patient was unable to verbalize how long the bumps have been on her vagina but stated that she just observed that they were there approximately one week ago. The patient has annual pap smear exams which were all normal. The patient mentioned being diagnosed with the sexually transmitted disease chlamydia two years and did receive treatment which she completed.
PMHx: Asthma
Medications: Symbicort 160/4.5mcg
Allergies: NKA
FMHx: Denies any family history of cancer, including breast and cervical, Father has a history of hypertension and mother history of hypertension and gastroesophageal reflux disease.
Social: non-smoker, states moderate alcohol use, married, and 3 children ( 1girl and two boys)
O:
Vital signs: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs
Heart: RRR, no murmurs
Lungs: Clear to auscultation, chest wall symmetrical
Skin: intact, no lesions or urticaria
Abdomen: soft, hyperactive bowel sounds, positive for pain in LLQ on palpitation
Genital: No foul odor, no drainage, the pattern of hair growth is normal, and distributed evenly, no swelling and redness. Old scar noted from an episiotomy. Pumps that are round in shape noted and painless noted on the outside of the labia.
Diagnostics: HSV specimen obtained
Assessment: Chancre
Additional Subjective Information.
Prior to making any diagnose there are several questions that the student would like to ask. There is a lot that can be learned by doing a sexual history. What is your sexual preference, men, women, or both? Can you recall how many past sex partners you had? Were your past relationships monogamous? Have you experienced physical, sexual, or emotional violence from a partner? What kinds of sex are you having? (for example, oral sex, vaginal sex, anal sex, sharing sex toys) What do you do to protect yourself from HIV and STDs? Tell me about when you use condoms. Did you use protection the last time you had intercourse? What do you know about your partner(s)’ past or other sexual activities? Do you have any concerns about your sex life?
The patient is alert, awake and oriented x4. The patient is obese.
General: The patient is alert, awake and oriented x 4. He considered being obese.
HEENT:
Neck: Normal range of motion
Breasts: Denies any pain and discomfort in the pectoralis area
Respiratory: Normal and effortless, no signs of respiratory distress
Cardiovascular/Peripheral Vascular: denies any pain in the chest,
Gastrointestinal: Denies any abdominal pain and discomfort, no nausea, no vomiting
Genitourinary: painless bumps located on the external vagina
Musculoskeletal: Normal range of motion
Psychiatric: Speech is normal, and behaviors normal, denies any memory deficits. Mood and affect anxious.
Neurological: He is alert, awake and oriented to person, place time and day. No signs of cranial nerve deficits
Skin: Skin is warm to touch and moist
Hematologic: denies any bruising, and bleeding problems
Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs, BMI 30.82 kg/m2/ SpO2 100%
Additional Subjective Data
The patient reported seeing rough painless bumps on her genital for one week but is unsure for how long they have been there. According to (Martin, 2018) bumps on the vagina is normally the initial sign that women contracted a sexually transmitted disease. There are several sexually transmitted diseases that could be responsible for the bumps that are located on the patient’s external labia. According to (Martin, 2018) genital herpes, human papillomavirus (HPV), and molluscum contagiosum can all cause various types of bumps on the vagina.
Diagnostic Tests
A provider might order. A physical examination can help determine the cause of female genital sores. A pelvic exam is performed, and sexual history is taken. Tests, such as blood work or culture of the sore, to determine the cause. A culture involves taking a swab sample from the affected area and testing it for the presence of bacteria (Henao-Martínez, & Johnson, 2014). Rapid plasmin reagin (RPR test) if negative Repeat screening at 6 and 12 weeks. Confirmation test for syphilis: Treponemal antibody test (e.g. enzyme immunoassay, T. pallidum particle agglutination or chemiluminescent assay (Henao-Martínez, & Johnson, 2014).
Acceptance or Rejection of Current Diagnoses
The current diagnoses would be rejected based on the fact that a thorough assessment was not done in order to gather more information to increase the odds of making a more accurate diagnosis. This is necessary because there are several conditions that could be responsible for the bumps on the patient’s vagina. According to the Center for Disease Control (2015) in order, the diagnose of chancroid to be made there are certain criteria’s that must be met. This includes the patient having more painful ulcers that are located in the genital area, this is not the case with the patient, she reported painless rough bumps. Secondly, there must be a clinical appearance and presentation of the genital ulcers with swollen lymph nodes indicating a bacterial or viral infection. Once more there was no information provided about if the patient experienced enlarge lymph nodes., this must be present because according to the (CDC, 2015) this is a typical sign for chancroid. Thirdly, the patient must not have any presence of T. pallidum infection when the darkfield microscopy test is completed on by darkfield examination the fluid from the ulcer is done or by a “serologic test for syphilis performed at least 7 days after onset of ulcers”, (CDC, 2015). And Fourthly “ HSV PCR test or HSV culture performed on the ulcer exudate is negative” (CDC, 2015).
There are several sexually transmitted disorders that could possibly be responsible for the painless bumps that are located on the patient’s genital area. Therefore, a sexual history should be done on the patient seeing that she has already been diagnosed with another previous sexual transmitted disease. This is history is important in order to make an accurate diagnose and provide the clinician with an opportunity to educate the patient about safe sexual practice in order to avoid contracting some uncurable sexually transmitted disease. The sexual history will also aide with creating a more accurate treatment plan.
Differential diagnosis
Condylomata Acuminata: Is considered to be a common sexually transmitted disease that can cause warts that are either flat or raised with rough appearance (Carusi, Barbieri and Eckler, 2015). These warts are normally located on the labia on and around or inside the anus (Carusi et al., 2015). The warts are small and can have a pink color appearance (Carusi, et al., 2015). This kind of sexually transmitted disease is found in both males and females, but more females are impacted by it (Carusi et al., 2015). Even though women may have condylomata acuminata they sometimes do not experience any symptoms (Carusi, et al., 2015). Some occurring symptoms that women may, or may not experience be itching, itching, burning, or tenderness in the genital area (Carusi et al., 2015).
Molluscum Contagiosum- Is referred to as water warts, it is a benign skin disease that is caused by poxvirus. This condition is characterized by a single lesion or multiple lesions that can appear on any part of the body or mucous membranes; however, the most commonly affected areas are the trunk, skin folds, axillae and genitalia (Center for Disease Control- CDC, 2017). The virus is spread via physical contact and shaving and scratching areas with infected lesions may also result in inoculation of the virus (CDC, 2017). Much like herpes, the virus may lie dormant in the body for an extended period of time but may reappear at a later time (CDC, 2017). The incidence of molluscum contagiosum has increased significantly in the United States since the 1960’s and the prevalence in sexually active individual’s ages 15-29 years of age is well documented (CDC, 2017).
Herpes simplex virus 2 (HSV2): Is considered to be a highly contagious viral infection (Kaye 2018). There would be internal blister in the genital and the anal area. In females, these blisters normally are seen in the internal area of the vagina or the cervix (Kaye, 2018). Blisters would develop within 4-7 days of being exposed (Kaye, 2018). These blisters are often times painful.
lymphogranuloma venereum-This disease oftentimes is overlooked because blisters are normally quickly healed (Morris, 2018). There are three stages; in the first stage, painless blisters developed in the vagina that heals and is not noticed (Morris, 2018). In the second lymph nodes that are located in the groin would become enlarged and tender and would breakdown be causing drainage. In the last, the sores that are developed from the blisters are healed and scars are formed (Morris, 2018).
Vulvar Cancer- Is a form of cancer that arises from the malignant cell in the clitoris, the labia or from the Bartholin glands (Alkatout, Schubert, Garbrecht, Weigel, Jonat, Mundhenke and Gunther (2015). Vulvar cancer can be classified into two categories, human papillomavirus (HPV), which is responsible for approximately half of the reported vulvar cancers (CDC, 2017). Symptoms of vulvar carcinoma included but not limited to the following; itching, pain, and tenderness, discharge and vulvar pain and bleeding. Diagnosis of vulvar cancer is made by physical examination and biopsy.
References
Alkatout, I., Schubert, M., Garbrecht, N., Weigel, M. T., Jonat, W., Mundhenke, C., & Günther, V. (2015). Vulvar cancer: epidemiology, clinical presentation, and management options. International journal of women’s health, 7, 305-13. doi:10.2147/IJWH.S68979
Center for Disease Control (2017). Inside knowledge about gynecologic cancer. Retrieved from.
htpps://www.cdc.gov/cancer/knowledge/provider -education/vaginal-vulvar/epidemiology
Center for Disease Control (2017). Molluscum contagiosum. Retrieved from
https://www.cdc.gov/poxvirus/molluscum-contagiosum/index.html
Center for Disease Control (2015). Chancroid. Retrieved from
https://www.cdc.gov/std/tg2015/chancroid.htm
Carusi, A. D., Barbieri, L., R. and Eckler, K.(2015). Genital warts in women – beyond the basics.
Retrieved from https://www.uptodate.com/contents/genital-warts-in-women-beyond-the-basics
Henao-Martínez, A. F., & Johnson, S. C. (2014). Diagnostic tests for syphilis: New tests and new
algorithms. Neurology. Clinical practice, 4(2), 114-122.
Kaye, M. K (2018). Herpes simplex virus (HSV) infection. Retrieved from
Martin, F. J.(2018). STD- symptoms vaginal bumps. Retrieved from
https://www.stdcheck.com/std-symptoms-vaginal-bumps.php
Morris, R. S. (2018). Lymphogranuloma venereum (LGV). Retrieved from
https://www.merckmanuals.com/home/infections/sexually-transmitted-diseases-
stds/lymphogranuloma-venereum-lgv