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Nursing Health Assessment of the Female Genitourinary ystem

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Nursing Health Assessment of the Female Genitourinary ystem Powered By Docstoc
					Female Genitourinary System

                                 Chapter 26




  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
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            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
           Sex
           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
                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
                Vaginal pool
                Cervical scrape
                Endocervical specimen
                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                                                  Adnexa

           Cervix                                                               Rectovaginal
                                                                                  examination
                Consistency
                                                                                        Rectovaginal septum
                Contour
                                                                                        Posterior uterine wall
                Mobility
                                                                                        Cul-de-sac
           Uterus
                                                                                        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
           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. Ask open-ended questions.
        B. Ask straightforward questions to elicit basic
           facts.
        C. Ask whether the patient feels comfortable
           talking about sex.
        D. 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

				
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