Assessment of the Female Genitourinary System Health Assessment

Assessment of the Female Genitourinary System Health Assessment Across the Lifespan NRS 102 Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Chapter 26: Female Genitourinary System Structure and Function Subjective Data—Health History Questions Objective Data— Physical Exam Abnormal Findings Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -2

Chapter 26: Female Genitourinary System Structure and Function External Genitalia or Vulva Mons pubis Labia majora Labia minora Frenulum Clitoris Urethral meatus Paraurethral (Skene’s) glands Vaginal orifice Hymen Vestibular (Bartholin’s) glands Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -3

Chapter 26: Female Genitourinary System Structure and Function (cont. ) Internal Genitalia Vagina Cervix Squamocolumnar junction Anterior fornix and posterior fornix Rectouterine pouch or cul-de-sac of Douglas Uterus Fallopian tubes Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -4

Chapter 26: Female Genitourinary System Structure and Function (cont. ) Developmental care Infants and adolescents Pregnant female Aging female Cross-cultural care Exposure of genitalia Infibulation (female genital mutilation) Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -5

Chapter 26: Female Genitourinary System Subjective Data— Health History Questions Menstrual history Obstetric history Menopause Self-care behaviors Urinary symptoms Vaginal discharge Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -6

Chapter 26: Female Genitourinary System Subjective Data— Health History Questions (cont. ) History Sexual activity Contraceptive use Sexually transmitted disease (STD) contact STD risk reduction Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -7

Chapter 26: Female Genitourinary System Subjective Data— Health History Questions (cont. ) Additional history for infants and children Urination Perineal hygiene Sexual abuse Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -8

Chapter 26: Female Genitourinary System Subjective Data— Health History Questions (cont. ) Additional history for preadolescents and adolescents Start of period Sexually transmitted disease Sexual abuse Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -9

Chapter 26: Female Genitourinary System Subjective Data— Health History Questions (cont. ) Additional history for the aging adult Postmenopausal bleeding Atrophic vaginitis Uterine prolapse Sexual satisfaction Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -10

Chapter 26: Female Genitourinary System Objective Data— Physical Exam Preparation Lithotomy position and draping Measures to enhance comfort during exam Mirror pelvic examination Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -11

Chapter 26: Female Genitourinary System Objective Data— Physical Exam (cont. ) Equipment Gloves Protective clothing for examiner Goose-necked lamp with a strong light Vaginal speculum of appropriate size Large cotton-tipped applicators (rectal swabs) Materials for cytologic study Lubricant Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -12

Chapter 26: Female Genitourinary System Objective Data— Physical Exam (cont. ) External genitalia—Inspection Skin color Hair distribution Labia majora Any lesions Clitoris Labia minora Urethral opening Vaginal opening Perineum Anus Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -13

Chapter 26: Female Genitourinary System Objective Data— Physical Exam (cont. ) External genitalia—Palpation Skene’s glands Bartholin’s glands Support of pelvic musculature Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -14

Chapter 26: Female Genitourinary System Objective Data— Physical Exam (cont. ) Internal genitalia— Speculum examination Insertion technique Cervix and os Ø Ø Ø Ø Color Position Size Os Surface Any Nabothian cysts Cervical secretions Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -15

Chapter 26: Female Genitourinary System Objective Data— Physical Exam (cont. ) Obtain cervical smears and cultures Ø Vaginal pool Ø Cervical scrape Ø Endocervical specimen Ø Data to include for the laboratory Inspect vaginal wall Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -16

Chapter 26: Female Genitourinary System Objective Data— Physical Exam (cont. ) Internal genitalia—Bimanual Examination Palpation technique Cervix Ø Consistency Ø Contour Ø Mobility Uterus Adnexa Rectovaginal examination Ø Rectovaginal septum Ø Posterior uterine wall Ø Cul-de-sac Ø Rectum Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -17

Chapter 26: Female Genitourinary System Objective Data— Physical Exam (cont. ) Developmental care Infants and children Adolescent Pregnant female Aging adult Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -18

Chapter 26: Female Genitourinary System Sample Charting Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -19

Chapter 26: Female Genitourinary System Sample Charting (cont. ) Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -20

Chapter 26: Female Genitourinary System Sample Charting (cont. ) Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -21

Chapter 26: Female Genitourinary System Abnormal Findings Abnormalities of the External Genitalia Pediculosis pubis (crab lice) Syphilitic chancre Herpes simplex virus—type 2 (herpes genitalis) Red rash—contact dermatitis Human papillomavirus (HPV) warts Urethritis Abscess of Bartholin’s gland Urethral caruncle Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -22

Chapter 26: Female Genitourinary System Abnormal Findings (cont. ) Abnormalities of the Pelvic Musculature Cystocele Uterine prolapse Rectocele Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -23

Chapter 26: Female Genitourinary System Abnormal Findings (cont. ) Abnormalities of the Cervix Bluish cervix—cyanosis Human papillomavirus (HPV, condylomata) Diethylstilbestrol (DES) syndrome Erosion Polyp Carcinoma Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -24

Chapter 26: Female Genitourinary System Abnormal Findings (cont. ) Vulvovaginal Inflammation Atrophic vaginitis Candidiasis (moniliasis) Trichomoniasis Chlamydia Bacterial vaginosis Gonorrhea Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -25

Chapter 26: Female Genitourinary System Abnormal Findings (cont. ) Conditions of Uterine Enlargement Pregnancy Myomas (leiomyomas, uterine fibroids) Carcinoma of endometrium Endometriosis Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -26

Chapter 26: Female Genitourinary System Abnormal Findings (cont. ) Adnexal Enlargement Fallopian tube mass—acute salpingitis (pelvic inflammatory disease or PID) Fallopian tube mass—ectopic pregnancy Fluctuant ovarian mass—ovarian cyst Solid ovarian mass—ovarian cancer Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -27

Chapter 26: Female Genitourinary System Abnormal Findings (cont. ) Abnormalities in the Pediatric Genitalia Ambiguous genitalia Vulvovaginitis in child Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -28

Chapter 26: Female Genitourinary System Which subject is most appropriate for the start of the health history? A. Menstrual history B. Self-care behaviors C. Sexual activity D. Obstetric history Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -29

Chapter 26: Female Genitourinary System Which would be the most appropriate way to start asking about sexual activity? A. B. C. D. Ask open-ended questions. Ask straightforward questions to elicit basic facts. Ask whether the patient feels comfortable talking about sex. Ask the patient whether she is currently in a sexual relationship. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 26 -30