GENITALIA

• Femoral canal


  Another potential spot for hernia
• Cremasteric reflex


  Stoking the inside of the thigh will cause ipsilateral testicle to retract in the scrotum, indicating neurologically intact
• Inguinal nodes


  Small, shotty nodes are common, enlarged, tender nodes are often associated with viral STIs or chancroid, enlarged, discrete, firm, rubbery, non-tender, often unilateral nodes are associated with syphilis
• Checking of the secretions of the urethra is the FINAL STEP OF ASSESSMENT
• NOT ALL HERNIA need to be operated, herniorrhaphy is the procedure for correcting hernia

  
• Transillumination should not be performed on normal scrotal contents
• Serous fluid does not transilluminate and shows red glow in hydrocele/spermatocele
• Transillumination – perform this maneuver if you note swelling or mass. Darken room, shine flashlight behind scrotal contents. Do not transilluminate normal scrotal contents
• Serous fluid does not transilluminate and shows red glow


  Hydrocele /spermatocele
• Solid tissue and blood do not transilluminate

  Hernia, epididymitis, tumor
• Nursing history for prostate gland


  • Changes in bowel function
  • Anal discomfort
  • Rectal bleeding
  • Changes in urinary function (males)
• Past health history for prostate gland


  • Hemorrhoids
  • Spinal cord injury (SCI)
  • Prostate hypertrophy or cancer (males)
  • Cancer, episiotomy/lacerations (females)
  • Risk factors for colorectal cancer
• Normal findings on palpation


  • Assess the urethra and skene's glands with gloved finger
  • Assess vagina - gently milk the urethra by applying pressure up and out
  • Assess Bartholin's glands with index inside and thumb outside
  • Assess pelvic muscles - perineum should feel thick, smooth, and muscular in nulliparous women and thin and rigid in multiparous women, ask woman to squeeze vaginal opening around fingers - should feel tight in nulliparous, separate the vaginal orifice and ask patient to strain down - no bulging of vaginal walls or urinary incontinence
• Speculum examination


  1. Select proper-sized speculum - Grave's speculum or Pederson speculum

  2. Warm and lubricate speculum under warm running water - avoid gel lubricant

  3. Insert by asking woman to bear down - relaxed perineal muscles and opens introitus

  4. Insert speculum at 45-degree angle downward towards the small of woman's back

  5. After blades are fully inserted, open them by squeezing handles together

  6. Cervix should be in full view

  7. Try closing blades by tightening the thumbscrew
• Normal findings on inspection of cervix and its os


  • Color - normally pink and even, blue in color in 2nd month of pregnancy, pale past menopause
  • Position - midline, anterior, or posterior, projects 1cm to 3cm into vagina
  • Size - diameter is 2cm to 5cm (1in)
  • OS - small and round in nulliparous, horizontal irregular slit, may show healed / laceration on sides
  • Surface - smooth, eversion or ectropion, past vaginal delivery; endocervical canal everted or rolled out; red, beefy halo inside the pink cervix surrounding OS
  • Consistency - smooth, firm, tip of the nose; softens, feels velvety at 5 to 6 weeks of gestation (Goodell's sign)
  • Mobility - with finger on either side, move cervix gently from side to side; no pain
• Normal findings on inspection of vaginal wall


  • Pink, deeply rugated, moist, smooth, normal discharge must be thing, clear, opaque, stringy, and odorless
• Normal findings on palpation of pelvic organs


  • Palpate uterus with intravaginal fingers in anterior fornix. Palpate with abdominal hand midway between umbilicus and symphysis - firm, smooth, with contour of fundus rounded, freely movable, non-tender
  • Palpate adnexa on lower quadrant inside anterior iliac spine with intravaginal fingers in lateral fornix. May not be palpable
• Bimanual examination of the vaginal wall


  1. Lithotomy position

  2. Lubricate fingers of gloved hand

  3. Insert fingers into vagina posteriorly

  4. Use both hands to palpate internal genitalia to assess location, size, and mobility, screen for tenderness or mass

  5. One hand is on the abdomen and the other into the vagina

  6. Palpate the vaginal wall - should feel smooth and no area of induration or tenderness

  7. Locate cervix in midline - palpate using palmar surface of fingers note for consistency
• Retrovaginal exam


  1. Use this technique when assessing rectovaginal septum, posterior uterine wall, cul-de-sac, and rectum

  2. Change gloves - avoids spreading of infection

  3. Lubricate first two fingers

  4. Instruct patient to position properly to avoid feeling of discomfort

  5. Ask patient to bear down as fingers are inserted into vagina, middle finger is gently inserted into rectum, while pushing with abdominal hand

  6. Note - rectovaginal septum must be smooth, firm, thin, and pliable

  7. Rectovaginal pouch (Cul-de-sac) - not palpated

  8. Rotate intrarectal finger to check rectal wall and anal sphincter tone

  9. Give patient tissue to wipe area and help her up. Remind her to slide hips back from edge before sitting up
• Graves Vaginal Speculum

  Gynecological instrument used for performing pelvic examinations, Pap Smears, and examining the cervix
• Pederson speculum (gravida)

  Used if the client has had intercourse or is sexually active but hasn't given birth
• Anuria

  Absence of urine
• Nocturia

  Bed wetting at night
• Oliguria

  Urinary output less than 400 ml per day or less than 20 ml per hour
• Hematuria


  Pee with blood
• Polyuria


  Pees more than 2.5 liters per day
• Dysuria


  Sensation of pain and/or burning, stinging, or itching of the urethra or urethral meatus associated with urination
• Enuresis


  Medical term for wetting the bed, child urinates without meaning to
• Premature ejaculation


  Usually side effect of anti-depressant use
• Orchitis

  Inflammation of scrotum
• Orchiectomy


  Removal of scrotum
• Indirect inguinal hernia


  Most common type of hernia, common in children due to latent processus vaginalis
• Direct inguinal hernia


  Mga nag bubuhat buhat
• Femoral hernia


  Sa babae
• Inguinal area


  Diyan lumalabas intestine
• Examination of inguinal hernia


  1. Inspection

  2. Palpation

  3. Ask client to bear down and cough

  4. Palpate inguinal lymph nodes
• Positive lymphadenopathy


  Enlarged lymph node
• Coitarche


  First sexual experience of a client
• Myritiform caruncle


  Fate of hymen, like ng bikers nawawala hymen
• Prolonged estrogen exposure


  Higher the risk of cervical cancer