Ch 23:Male genitalia and rectal exam Flashcards
Because of the intimacy of the genital exam what are 3 things you want to do for the patient
- Provide privacy
2. Remain culturally sensitive - Have a chaperone if requested
During a physical exam (of male genitalia) when there is an educational opportunity what do you want to teach
Teach health promotion and risk reduction.
(I.e: testicular self examination )
What are the two functions of a penis
1.urine excretion
- Penetration for intercourse

Locate:
- Root
- Shaft
- Glans
Route: deep within perineum
Shaft: body; the skin that we see
Glands: head
What are the three distensible (Extendable) structures
What is the function of the bulb
- 2 Corpoa carnivosa
- forms the sides of the penis - Dorsum= TOP
- Corpus spongiosum
- forms bulb
Bulb: for erection and ejaculation
Give the other name for the prepuce
What is the prepuce
Prepuce = foreskin
Hood (light-skinned) covers glans 
Give the definition of the scrotum
Give the three parts of the sacs
What happens to the sack
- with increased temperature
- with decreased temperature
Wrinkled pouch with two sacs containing  1. Testes 2. Epididymis 3. Spermatic cord
Hot temp: sac relaxes
Cold temp: sac rise is closer to body
What is the term for the development of sperm
What is the optimal temperature for the development of sperm
Spermatogenesis = development of sperm
Optimal temperature: 2 to 5° below body temp
Give the description of what phimosis is
When does it typically occur
What can cause
phimosis
-inability to retract for skin
Typically occurs first 6 years of life
Can cause obstructed urinary flow
What do the testes produce
What are normal testicular findings
Testes produce sperm and testosterone
Normal:
- egg shaped
- rubbery
- firm
Within the ducts:
What is the function of the epididymides
Other name for vas deferens + function
Where does sperm come from
Epididymides:
-storage and maturation of sperm
Vas deferens (ductus deferens): -transports sperm
Sperm comes out from the ejaculatory duct

Give the definition of semen and what it is needed for
What does the prostate emit
Semen:
-provides alkaline medium needed for sperm motility and survival
 Prosty emits majority of ejaculatiry fluid 
What is the meatus
Give to abnormal findings
During the physical assessment how do you assess the meatus
Meatus: opening of urethra
 abnormal findings:
1. Hypospadias: Opening of urethra located ventrally ( BOTTOM)
2.epidspadias: opening of urethra located dorsally (TOP)
A sesame aegis but I have a patient compress glans 
What do you note if a patient has a urethral stricture
What causes a urethral stricture
In a urethra structure you note:
- scar tissue
- construction of urethra ***
Urethral stricture is caused by STDs
What are two common developments after 40
Give signs and symptoms for BPH
What do you wanna do to assess prostate cancer
To common developments after 40:
- BPH
- prostate cancer
BPH signs and symptoms:
- straining to void
- Hesitancy
- nocturia
- dribbling
When assessing for prostate cancer do
A digital rectal exam and PSA
When a man gets a vasectomy what is cut in removed
When getting a vasectomy the VAS DEFERENS is cut and removed
 What makes up the terminal end of the G.I. tract And how long is it
What do the rectal valves support
The rectum and anus make up the terminal end of the G.I. tract, about 5 inches
Rectal valves support feces well flatus (farts) arr being expelled 
Where do the anal canal and Anus extend from ->to
Anal canal and anus extend from anorectal junction to anus
What is another name for the rectal columns
what are they
what happens when they are destrnded 
Rectal columns a.k.a. “Internal hemorrhoidal plexus”
Rectal columns are complex system of veins and arteries
Rectal columns when distended create hemorrhoids
What does voluntary control for defication relax?
What does the sensation to poop mean and what does it cause
Voluntary control when pooping relaxes the external sphincters
Sensation to poop means the rectum is filling with stool and it relaxes internal sphincters
Describe the anal canal pain perception
(Upper and lower)
Anal canal pain perception:
- upper: insensitive to stimuli
- Lower- sensitive to stimuli
What are common lifespan considerations for your newborns
1st poop
Control
Stool
In newborns:
-newborn‘s first poop (meconium) within 24 hours of birth
- have involuntary control of internal/external sphincters
- have a stool every feeding until 12-18 months
For your newborns what are the benefits of circumcision
Circumcision Decrease his risk of UTI
Circumcision Decrease risk of HIV
 Through tanner scale how do the male genitalia develop
Using Tanner scale:
-Scrotal skin begins Finn then become more Pendulous active and secrete Testosterone
Give lifespan considerations for your older adult
Incontinence Hormone Libido Pendulous What increases(Two) give percentages
Stool incontinence
-Due to loss of sphincter control
⬇️testosterone, libido, sex function
⬆️ BPH, ED
-ED: 50% = 50’s//75% = 70’s
What is vital to remain in cultural considerations
It is vital to remain non-judge mental about cultural considerations like practices and beliefs
What has been noted as a rise in the last 10 years
How do you want to address this rise
An increase in genital piercings and tattoos have increased in the last 10 years
If genital piercings/tattoos teach:
—Piercing care: S & S of infection
What is Vital you want to teach about the Prince Albert piercing
Prince Albert piercing can cause loss of sensation because of Nerve damage to penis
Among urgent assessments
what do you assume if a patient complains of scrotal pain
What kind of assessment is this
What can this lead to
If patient complains of scrotal pain always assume testicular torsion!!!
 testicular torsion = emergency assessment
To see what ocean can lead to a cute ischemia causing gangrene to testicles
What is a Epididymitis
What assessment type is epididymitis
Give signs and symptoms of epididymitis
Epididymitis is the information of the epididymis
Epididymitis = emergency assessment  Signs and symptoms: -fever - redness -Swelling
What are UTIs most closely associated with in men
UTIs most commonly associated with indwelling Foley catheters in men
What are signs of symptoms a man may have rectal bleeding
What along with rectal bleeding can cause the hospitalization of a patient
Signs and symptoms amen me have a rectal bleed:
- shortness of breath
- extreme fatigue
- laboratory anemia
When a man has a rectal bleed and is on anticoagulance they may need hospitalizations
What kind of assessment is a strangulated hernia briefly describe it
Strangulated hernia = emergency assessment
Strangulated hernia is one small intestine pushes through the muscle and then the muscle clamped down cutting off blood
Give the major differences between to Testicular torsion and epididymitis
Testicular torsion
- acute pain
- RARE fever but 50% N/V
-  Requires surgery
- elevating does not help
- rare urethral symptoms
Epididymitis
- gradual pain
- no N/V but FEVER 50%
- requires antibiotics
- elevating help reduce
- Most common presents with urethralsymptoms
Describe the difference between hypospadias and epispadias
Describe phimosis
Hypospadias: BOTTOM meatus opening venntral
Epispadias: TOP Meatus opening dorsal
Phimosis is the inability to retract foreskin
-commonly occurs during first 6 years
In relation to subjective data what is relevant personal history you should collect
Any chronic illness CA surgeries STI/UTI DM
When collecting medical and surgical history what is vital for subjective data
What is orchiopexy
Any circumcision, vasectomy, orchiopexy
Orchiopexy: surgical procedure to remove undescended testicle (Cryptorchidism) and method for resolving testicular torsion
When obtaining sexual history what is vital to collect

Sexual history:
-unprotected sex 🚹🚹 or 🚹🚺
-Types of sex (route)
- 5 P’s
1. Partners
2. Practices
3. Protection
4. Past STI
5. Prevention of pregnancy
Give the 5 P’s to assess when assessing sexual history
5 P’s
- Partners
- Practices
- Protection
- Past STI
- Prevention of pregnancy
What are medication’s collected during the subjective data that can cause ED
Cardiac meds/HTN RX/diuretics
Hypoglycemics
What are the risk factors for testicular cancer
20-34 YOA***
Caucasian***
Hx of cryptorchidism
personal/familial Hx CA
What are health goals related to male genitalia and rectal assessments
Decreased prostate cancer cases
Increase family planning especially male involvement in preventing pregnancy

Decrease injury to genitalia
Decrease STI
How do you teach your patient the testicular self exam
-optimal time/where
-technique
-Normal findings
-what to do if abnormal finding

Testicular self exam
- Best post warm shower/front of mirror 
- using 2hands with one test at a time palpate between thumbs and first index and middle fingers
- norm: egg shaped, rubbery, firm
If abnormal finding (Lump) make appointment with urologist
Give the signs and symptoms of bladder cancer (same for mail in women)
#1 S&S: hematuria without pain
Give common signs and symptoms Related to the male genitalia and rectal Assessment
Pain difficulties with urination :BPH ED penile lesions discharge scrotal enlargement
Within penile pain what are a few conditions men may develop
- testicular torsion
- Epididymitis
-  hydrocele: fluid in scrotum
- chlamydia/gonorrhea
- Orchitis: bacterial infection
Impatient with ED what signs with a illicit
No erection
Erection without simulation
Curvature
Priapism: prolong painful erections

In relation to penile lesions what is
- chancre
- How does herpes II present on the penis
Lesions:
Chancre: =Syphilis painless lesions
Herpes II presents with vesicles/warts along penis/glans
What disease causes discharge to be omitted from the penis
-what does discharge look like what are other signs and symptoms
Gonorrhea causes discharge to be admitted from penis
-Thick yellow urine discharge rectal pain and rash
What is the main cause of Scrotal enlargement what does it feel like
One of the main causes of scrotum enlargement is Hydrocele
Feels like a dull aching in the groin
What does flank pain with microscopic hematuria indicate
What do you do as an assessment
Flank pain with microscopic hematuria could indicate renal calculi do CVA
Give lesbian considerations for your older adults  Rectal reflex Urine changes ED
Older adults have
Rectal reflexed reduced
BPH present
Changes in sexual function leading to more cases of ED
What cultural consideration group has the highest incidence of prostate cancer
African-Americans have the highest incidence of prostate cancer
What cultural consideration group has the highest incidence of testicular cancer
Caucasians have the highest incidence of testicular cancer
Upon doing Genital and rectal assessment
what do you always want to ask for
What do you examine last
Exam changes for a child
Exam changes for adolescence
During a genital and rectal exam
- always ask for permission
- examine genitalia last
- have parent present if child
- Give the option to have parent present if adolescent

When noting the penis during the comprehensive physical assessment what is a common finding in those who are uncircumcised
During assessment in those who are uncircumcised look for
Smegma
-White cheesy substance usually present after retracting foreskin (around corona)
What do you want to assess for when looking at a glans and meatus
When assessing glans and meatus access for epispadias or hypospadias
Where do you assess for hernias
Assess for hernias in the inguinal ans femoral regions
when doing a perianal and rectal exam how do you position
- a healthy patient
- an older patient
Give the technique
Give what you are assessing for
Position healthy patient bent over table
Position older patient in Sims position
Technique:
Spread buttocks
Have patient bear down
Assess for any tenderness, swelling/redness, warts, fishers (tears) any masses
What is the normal finding in testicles
Testicles egg shaped, rubbery, firm
What is the normal finding in the vas deferens
The vas deferens is smooth and cord like
When conducting the prostate exam what is a secondary test you want to conduct with the stool
Post prostate exam conduct Hemoccult (guaiac) test
Give a technique for the Hemoccult guaiac test
Guve abnorm findings
Dab stool into two boxes put two drops of solution in each box wait 30 to 60 seconds
Abnormal findings blue discoloration indicating colorectal disease
What may cause a false negative Hemoccult guaiac test
Vitamin C
What are pubic changes associated with your older adults
In your older adults pubic hair thins turns gray
Testes smaller, softer
sac presents with less Rugae
Who has a darker scrotum and anal area in relation to cultural considerations
African-Americans have darker scrotum an anal Areas
What are risks associated with with men who have sex with men
What do you always want to offer Gay men
Men who have sex with men have an increased risk of :
-HIV and genital herpes
Always offer STI screenings at annual visits
When doing the assessment what do you perform first
When doing Gen and rectal assessments always perform least invasive procedure first
What are a few diagnostic/lab tests conducted during the chin at all and recto assessments
What test Is conducted if patient has known infection
UA, culture and sensitivity, CVA, sonograms
If patient has known infection catch a clean catch/midstream urine for culture and sensitivity
What are signs and symptoms of a UTI in a man
Uti:
- fever/chills
- CVA pain
- Dysuria/frequency
Give nursing outcomes related to male genitalia and rectal assessments
Patient will remain free of infection
patient will be continent of urine
Give nursing interventions related to male genital and rectal assessments
Teach to care for infection prone sites
teach pelvic floor strengthening exercises
-Incontinence
Give the nursing diagnosis associated with male Genitalia and rectal assessments
 ineffective sexuality pattern
Risk for infection
Urinary retention
