Assessing the Genitalia and Rectum
Assignment 1: Lab Assignment: Assessing the Genitalia and Rectum
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Patients are frequently uncomfortable discussing with healthcare 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 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.
To Prepare
Review the Episodic note case study your instructor provides you for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your Episodic note case study.
Based on the Episodic note case study:
Review this week’s Learning Resources, and consider the insights they provide about the case study. Refer to Chapter 3 of the Sullivan resource to guide you as you complete your Lab Assignment.
Search the Walden library or the Internet for evidence-based resources to support your answers to the questions provided.
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.
The Lab Assignment
Using evidence-based resources from your search, 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 three different references from current evidence-based literature. CORE SKILL: conducting a sensitive exam and building a differential from focused GU/rectal findings. Two competencies are graded — the CLINICAL and the COMMUNICATIVE.
THE COMMUNICATION LAYER (frequently under-weighted by students, heavily weighted by rubrics): normalize before you ask (“I ask all my patients about…”), use the ubiquity technique, avoid assumptions about sexual orientation, partners, or practices — ask about SEXUAL BEHAVIOR rather than identity (“do you have sex with men, women, or both?”). The 5 P’s structure the sexual history: Partners, Practices, Protection from STIs, Past history of STIs, Prevention of pregnancy. Explain each maneuver BEFORE performing it; offer a chaperone and DOCUMENT the offer; drape appropriately; do not carry on a conversation about unrelated matters mid-exam.
MALE EXAM: inspection and palpation of penis, scrotum, testes, epididymis, spermatic cord; hernia check (ask the patient to bear down); DRE for prostate — size, symmetry, nodularity, tenderness. KEY DIFFERENTIALS to know cold: TESTICULAR TORSION (acute, severe, absent cremasteric reflex, high-riding transverse testis — a SURGICAL EMERGENCY with a ~6-hour window; never anchor on epididymitis in a young man with acute severe pain) vs. EPIDIDYMITIS (gradual onset, positive Prehn’s sign — relief with elevation, often infectious) vs. varicocele (“bag of worms,” left-sided, and a NEW right-sided varicocele demands abdominal imaging for a mass) vs. hydrocele (transilluminates) vs. testicular cancer (painless, firm, does not transilluminate).
FEMALE EXAM: external inspection, speculum exam (cervix — color, discharge, lesions), bimanual (uterine size/position/mobility, adnexal masses, CERVICAL MOTION TENDERNESS — the “chandelier sign” pointing to PID).
PROSTATE: know the difference between BPH (smooth, symmetric, rubbery enlargement, obstructive urinary symptoms) and PROSTATE CANCER (hard, irregular, asymmetric nodule) and prostatitis (boggy, exquisitely tender — do NOT vigorously massage, risk of bacteremia).
FOR THE SOAP NOTE: whatever findings you’re given, discipline yourself to write pertinent NEGATIVES. “No CVA tenderness, no urethral discharge, cremasteric reflex intact” is what demonstrates you actually did the reasoning. Then 3–5 differentials, each with the finding that supports it AND the finding that argues against it.
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