wordpress-seo domain was triggered too early. This is usually an indicator for some code in the plugin or theme running too early. Translations should be loaded at the init action or later. Please see Debugging in WordPress for more information. (This message was added in version 6.7.0.) in /home/intelligentwr/nursingassignmentcrackers/wp-includes/functions.php on line 6114Patients are frequently uncomfortable discussing with healthcare professional\u2019s 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.<\/p>\n
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.<\/p>\n
Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature.<\/p>\n
Submit<\/strong> your Assignment.<\/p>\n Submission and Grading Information<\/strong><\/p>\n To submit your completed Assignment for review and grading, do the following:<\/strong><\/p>\n Genitourinary problems are among the public health concerns globally. Nurses and other healthcare providers adopt evidence-based interventions that would optimize patient outcomes in the treatment of these conditions. Subjective and objective data help nurses to formulate diagnoses and treatment plans. Therefore, this essay examines TS\u2019s case study. TS has presented to the hospital complaining of dysuria, urgency, and frequency for the last two days. The essay focuses on topics that include additional subjective and objective information that should be obtained from the patient, if subjective and objective data supports the assessment, appropriate diagnostics, accepting or rejecting the diagnosis, and differential diagnoses to be considered for the patient.<\/p>\n Additional subjective information should be obtained from TS. Firstly, information about the character of her urine should be obtained. This includes information such as the smell and color of the urine. Bloodstained urine could indicate bladder problems while urine with a strong smell could imply that TS has a urinary tract infection. The nurse should also ask for information about the presence or absence of abnormal vaginal discharge. For instance, yellow or purulent vaginal discharge would indicate sexually transmitted infections. The character of TS\u2019s symptoms should also be obtained. This includes seeking information on the factors that precipitate or alleviate her urinary symptoms. She should be asked about any activity that worsens or relieves her symptoms (Kaur & Kaur, 2021). The nurse should also assess her current level of pain using the pain rating scale. Pain rating could indicate the severity of her condition.<\/p>\n The nurse should also ask TS about her sexual habits. This includes sexual preferences and the use of protection when engaging in sexual intercourse. The information would help the nurse rule out causes such as sexually transmitted infections. Additional sexual-related information that should be obtained includes the use of contraceptives, the last menstrual period, and menstrual cycle problems. The nurse should also obtain information about any history of recurrent urinary tract infections. This would help determine if she has chronic urinary tract infections. Similarly, information about the history of sexually transmitted infections should be obtained to rule them out in her case. Information about her partner\u2019s history of sexually transmitted infections and testing should also be obtained to rule out a risk of STD transmission. Information about TS\u2019s social history is also needed. This includes data about smoking, dietary practices, and alcohol use (Bono et al., 2024). The nurse should also rule out the potential of heredity of TS\u2019s problem. Information about a family history of health problems such as kidney disease or symptoms that TS has should be obtained.<\/p>\n Additional objective information should be obtained in TS\u2019s case to guide the development of an accurate diagnosis and treatment plan. Firstly, the nurse should provide information about TS\u2019s general appearance. Information such as her overall grooming, weight changes, presence or absence of chills or fatigue should be included in the objective portion. Abdominal assessment should provide information about the presence or absence of organomegaly, or abnormal pulsations. The case study should also provide detailed information about urine description (Bono et al., 2024). This includes urine color, smell, and the presence or absence of pus or blood in the urine.<\/p>\n The nurse should also provide information about the assessment of the genitourinary system. Information such as the presence or absence of vaginal discharge, lesions, or trauma should be documented to rule out causes such as sexually transmitted infections and intimate partner violence. The nurse should also assess TS\u2019s level of pain. She should use a pain rating scale to determine the severity of her pain and prioritize the treatment plan accordingly (Boon et al., 2021). Pain assessment should also include TS\u2019s experiences of pain on abdominal palpation.<\/p>\n Subjective and objective information support TS\u2019s assessment. Nurses obtain subjective information by asking patients questions that relate to their health problems and different body systems. The subjective data helps the nurse determine the severity of a health problem and its impact on the client\u2019s health and overall well-being. TS\u2019s case study has subjective information. They include her chief complaints, history of her presenting illness, surgical history, past medical history, medication use, allergies, and social history. Nurses obtain objective data from their patients by using methods such as inspection, palpation, auscultation, and percussion. The objective data validates subjective claims by the patient. The case study has objective information. They include TS\u2019s vital signs, abdominal assessment, and diagnostics ordered.<\/p>\n Some diagnostic and laboratory investigations should be ordered in TS\u2019s case study to guide develop an accurate diagnosis and treatment plan. Firstly, a urinalysis test should be performed to rule out urinary tract infections. A diagnosis of urinary tract infection will be made should her urine test reveal the presence of leucocytes and nitrites. The presence of proteins in urine will indicate cardiovascular problems such as hypertension while the presence of glucose would imply that TS has diabetes. The presence of ketones will indicate the possibility of dehydration. TS should also be tested for sexually transmitted infections. Blood tests, vaginal swabs, and urine samples should be taken to rule out sexually transmitted infections such as gonorrhea and chlamydia infections. An abdominal CT scan should also be performed to rule out causes such as kidney stones. MRI might also be needed to rule out kidney stones and other renal pathologies that could be associated with TS\u2019s problems (Kaur & Kaur, 2021). Lastly, cervical screening for cervical cancer should be done. Cervical screening would also help rule out other causes such as vaginosis in TS\u2019s case.<\/p>\n I would accept the current diagnosis. TS\u2019s complaints align with those seen in patients with urinary tract infections and sexually transmitted infections. Often, patients with these conditions experience dysuria, urgency, frequency, and fever, which are present in TS\u2019s case (Bono et al., 2024). Therefore, additional diagnostic and laboratory tests will help determine if TS is suffering from STDs or UTIs. TS\u2019s history of engaging in unprotected sex with her new partner makes STDs among the probable diagnoses to be considered.<\/p>\n One of the differential diagnoses that should be considered for TS is perinephric abscess. Perinephric access is a condition that develops from the spread of infections from other regions of the genitourinary tract to the kidneys (Okafor & Onyeaso, 2024). The infections result in the development of abscesses. Patients experience symptoms that include fever, chills, nausea, vomiting, flank pain, and fatigue (Adams et al., 2020). Unlike urinary tract infections or STDs, patients with perinephric abscesses might not experience symptoms such as urinary frequency or dysuria.<\/p>\n The other differential diagnosis that should be considered for TS is urethral syndrome. Urethral syndrome is a genitourinary condition characterized by urinary frequency, urgency, suprapubic pain, and dysuria. It develops from any condition that causes urethral irritation and inflammation. The urethral syndrome can develop due to sexually transmitted infections, urinary tract infections, or the use of foods that irritate the urethra (Sell et al., 2021). A confirmed diagnosis of either UTI or STD might indicate its co-existence with urethral syndrome.<\/p>\n The last differential diagnosis that should be considered for TS is kidney stones. Kidney stones develop from crystal deposition in the kidneys. Factors such as dehydration, intake of diets rich in salt, and overweight or obesity predispose individuals to kidney stones. Patients experience symptoms such as severe, sharp back or flank pain, pain radiating to the groin or lower abdominal regions, and dysuria. Patients might also report passing red or brown urine, foul-smelling and cloudy urine, frequency, nausea and vomiting, chills, and fever (Thongprayoon et al., 2020; Wang et al., 2021). The absence of red or brown-colored urine and sharp pain show that kidney stones are not the cause of TS\u2019s complaints.<\/p>\n Overall, additional subjective and objective information should be obtained in the case study. Subjective and objective data support the assessment. Additional diagnostics and laboratory investigations should be ordered to develop an accurate diagnosis and treatment plan. I accept the current diagnosis based on TS\u2019s symptoms. The three differential diagnoses that should be considered in TS\u2019s case study include kidney stones, urethral syndrome, and perinephric abscess.<\/p>\n \u00a0<\/strong><\/p>\n Adams, M., Bouzigard, R., Al-Obaidi, M., & Zangeneh, T. T. (2020). Perinephric abscess in a renal transplant recipient due to Mycoplasma hominis: Case report and review of the literature. Transplant Infectious Disease<\/em>, 22<\/em>(5), e13308. https:\/\/doi.org\/10.1111\/tid.13308<\/a><\/p>\n Bono, M. J., Leslie, S. W., & Reygaert, W. C. (2024). Uncomplicated Urinary Tract Infections. In StatPearls<\/em>. StatPearls Publishing. http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK470195\/<\/a><\/p>\n Boon, H. A., Bruel, A. V. den, Struyf, T., Gillemot, A., Bullens, D., & Verbakel, J. Y. (2021). Clinical Features for the Diagnosis of Pediatric Urinary Tract Infections: Systematic Review and Meta-Analysis. The Annals of Family Medicine<\/em>, 19<\/em>(5), 437\u2013446. https:\/\/doi.org\/10.1370\/afm.2684<\/a><\/p>\n Kaur, R., & Kaur, R. (2021). Symptoms, risk factors, diagnosis and treatment of urinary tract infections. Postgraduate Medical Journal<\/em>, 97<\/em>(1154), 803\u2013812. https:\/\/doi.org\/10.1136\/postgradmedj-2020-139090<\/a><\/p>\n Okafor, C. N., & Onyeaso, E. E. (2024). Perinephric Abscess. In StatPearls<\/em>. StatPearls Publishing. http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK536936\/<\/a><\/p>\n Sell, J., Nasir, M., & Courchesne, C. (2021). Urethritis: Rapid Evidence Review. American Family Physician<\/em>, 103<\/em>(9), 553\u2013558.<\/p>\n Thongprayoon, C., Krambeck, A. E., & Rule, A. D. (2020). Determining the true burden of kidney stone disease. Nature Reviews Nephrology<\/em>, 16<\/em>(12), Article 12. https:\/\/doi.org\/10.1038\/s41581-020-0320-7<\/a><\/p>\n Wang, Z., Zhang, Y., Zhang, J., Deng, Q., & Liang, H. (2021). Recent advances on the mechanisms of kidney stone formation (Review). International Journal of Molecular Medicine<\/em>, 48<\/em>(2), 1\u201310. https:\/\/doi.org\/10.3892\/ijmm.2021.4982<\/a><\/p>\n<\/header>\n 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. In the subsequent paragraphs, potential history, physical exam, and differential diagnosis shall be explored 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.<\/p>\n 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).<\/p>\n 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 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.<\/p>\n 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.<\/p>\n 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 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)<\/p>\n 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.<\/p>\n 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.<\/p>\n 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 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).<\/p>\n 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.<\/p>\n Belyayeva, M., & Jeong, J. M. (2022).\u00a0Acute Pyelonephritis<\/em>. https:\/\/pubmed.ncbi.nlm.nih.gov\/30137822\/<\/a><\/p>\n Bono, M. J., Leslie, S. W., & Reygaert, W. C. (2022).\u00a0Urinary Tract Infection<\/em>. https:\/\/pubmed.ncbi.nlm.nih.gov\/29261874\/<\/a><\/p>\n Daniels, A. M., Schulte, A. R., & Herndon, C. M. (2018). Interstitial cystitis: An update on the disease process and treatment.\u00a0Journal of Pain & Palliative Care Pharmacotherapy<\/em>,\u00a032<\/em>(1), 49\u201358. https:\/\/doi.org\/10.1080\/15360288.2018.1476433<\/a><\/p>\n Garcia, M. R., & Wray, A. A. (2022).\u00a0Sexually Transmitted Infections<\/em>. https:\/\/pubmed.ncbi.nlm.nih.gov\/32809643\/<\/a><\/p>\n Young, A., Toncar, A., & Wray, A. A. (2022).\u00a0Urethritis<\/em>. https:\/\/pubmed.ncbi.nlm.nih.gov\/30725967\/<\/a><\/p>\n<\/header>\n\n
A Sample Answer For the Assignment: NURS 6512 Week 10 Assignment Assessing the Genitalia and Rectum<\/strong><\/h2>\n
Title: <\/strong> NURS 6512 Week 10 Assignment Assessing the Genitalia and Rectum<\/strong><\/h2>\n
Additional Subjective Information<\/strong><\/h2>\n
Additional Objective Information<\/strong><\/h2>\n
If the Assessment is Supported by Subjective and Objective Information<\/strong><\/h2>\n
Appropriate Diagnostics for the Case<\/strong><\/h2>\n
Accepting or Rejecting Current Diagnosis Differential Diagnoses<\/strong><\/h2>\n
Conclusion<\/strong><\/h2>\n
References<\/strong><\/h2>\n
A Sample Answer 2 For the Assignment: NURS 6512 Week 10 Assignment Assessing the Genitalia and Rectum<\/strong><\/h2>\n
Title: <\/strong> NURS 6512 Week 10 Assignment Assessing the Genitalia and Rectum<\/strong><\/h2>\n
Subjective<\/strong><\/h2>\n
Objective<\/strong><\/h2>\n
Assessment<\/strong><\/h2>\n
Conclusion<\/strong><\/h2>\n
References<\/strong><\/h2>\n