Ch 24: Female genitalia and rectal assessment Flashcards
Where is the location of the mons pubis and what does it act as
What is its placement also known as
Mons pubis located directly over pubic bone
Access cushion the protects pelvic bone during intercourse
Most anterior
Where do the labia majora and labia menorah extend from and to
Labia majora and minora extend from mons pubis to perineum
What structure of the vagina is the homologue to the penis and how does it
Respond
The clitoris is the female homologue to the penis
It responds in erectile function with stimuli “ pleasure feeling” 
Where is the vaginal introitus located
 where is the perineum located
Vaginal introitus located posterior to urethra anterior to hymen
Vaginal perineum located Between the vaginal enteritis and rectum
What is the function of the Skenes gland
what is the function of the Bartholin gland
together what is the main function of the skins and Bartholin’s gland
Skenes gland produces clear lube during sex
Bartholin’s gland secrete mucus into vaginal introitus during sex
Together the skins and Bartholin gland function to prevent friction during intercourse
Where is the vestibule
Vestaview between labia menorah bound anteriorly by clitoris posteriorly by perineum
What is the vagina considered to be and where does it extends from
Vagina considered to be a muscular tube of tissue extending from vaginal introitus to uterus
What does uterus accept and do
Where is the uterus located
What happens if the uterus is not fertilized every month
Uterus accepts an implants ovum
Uterus located between bladder and rectum
If not fertilized each month the uterus will shed its endometrium
 What is the cervix what kind of opening does it have and what does the opening resemble
The cervix is the opening of the uterus
Cervix has an (OS) opening resembling a doughnut with a small hole at the center
What is the function of the fallopian tube
what are it’s three parts and where does fertilization occur
Fallopian tube function : transport ovum from ovaries to uterus
Three parts:
Isthmus
Ampulla-fertilization
Fimbre
When does the ovary develop
when does it shrink
what does it secrete
what does it provide
Ovary develops post puberty
Ovary shrinks post menopause
Over secretes estrogen/progesterone
Ovary provide ovum for fertilization
What is the age that menopause occurs and what is a criteria for menopause
Because you’re overies shrink what is no longer being made and what does that increase the risk for (bone)
Menopause occurs at 50–52 YOA
Menopause = no period +12 months
Due to over shrinking estrogen is no longer made which increases the risk for osteoporosis
What does the anterior pituitary secrete
What is the hypothalamus AKA
What does it tell the pituitary gland to do
Anterior pituitary: FSH/LSH
Hypothalamus a.k.a. inhibitor of prolactin release
-Tells pituitary gland to stop lactation
What do the ovaries regulate
Ovaries regulate secondary facial characteristics + growth, proliferation, maturation
Function of progesterone
Function of estrogen
Progesterone
-develops corpus luteum for implantation of embryo
Estrogen: develops secondary sex characteristics and contributes to vaginal growth, tubes, uterus
What functions do cyclic hormones drive
4 things
Expression and health
 -menstruation
- reproduction
- sexuality
- physical and emotional health
What is a common sight among your pregnant women in the cervix and how does it present
Pregnant women have Chadwick’s Sign
A.k.a. early sign of pregnancy is a darkening bluish color to the cervix
What is noted among infants in the opening of the vagina
 why does this occur
How long does it take to resolve
Among infants in the vagina there is a noted pink discharge due to maternal estrogen
Pink discharge resolves within 1 to 2 weeks post birth
Among adolescents what is important to build and why
What is not necessary unless Adolescence or sexually active, if they are sexually active what is required
Among adolescents it’s important to build rapport establish an open line of communication
Unless an adolescent is sexually active genital assessments are not required
If sexually active adolescent will need annual Pap smear plus STD testing
What are changes that acompany life span considerations related to menopause
Anatomical structures (2) Ragaue
Among women with menopause that have limited/absent estrogen
Noted:
- decreased uterus size
- ovaries shrink
- flattened vaginal Ruege
What is dyspareunia
Who is dyspareunia common in
Dyspareunia : painful sex due to dryness 
dyspareunia common in women with menopause
What do your older population (women Who have gone through menopause) have because of limited estrogen what are the common ages
(Risk of)
Older population going through menopause have an increased risk of endometrial cancer and vaginal infections due to limited estrogen
Common in ages 45 to 55
When is the median age for menarche
How do African-American girls differ from the median age
Median age for Menarche 12 YOA
African-American girls may begin puberty before 8 YOA
What kind of assessment is severe pubic pain
What do you want to do if a woman presents with severe pubic pain
Give a few signs and symptoms of severe pubic pain
And 2 causes
Severe pubic pain = emergency
If a woman presents severe pubic pain get an accurate description of the pain
S & S:
- Swelling/redness/warmth
- Inflammation of labia
- Abscess in Bartholin’s gland
Give two examples of acute infections
- Pelvic inflammatory disease (PID)
2. UTI with Nephrolithiasis or renal calculi
Give signs and symptoms for UTI with renal calculi and what you want to assess for
S & S (renal calculi) -flank pain CVA tenderness hematuria Dull/sharp pain
What medication is given for UTIs
-what does it treat
What are important patient teaching is related to this drug
Medication for UTI: Pyridium (Analgesic)
-Pyridium treats symptoms of UTI
Important patient teachings in regards to Pyridium include:
-** yellow and orange urine because of medications

Give gastrointestinal illnesses that development to urgent assessments and where they are located within the abdomen
Gastrointestinal illnesses: -peritonitis :  -appendicitis : Right lower quadrant -pancreatitis : Epigastric -cholecystitis : Right upper quadrant -***strangulated hernia : femoral inguinal region etopic pregnancy
With ectopic pregnancies = urgent assessment what do you want to ask and why (the why as in what do they cause )
With ectopic pregnancies ask when was your last pregnancy because a pregnancy in Fallopian tube may cause peritonitis
 But obtaining subjective data major areas of data collection include
Menstrual obstetrical menopause gynecological sexual history
Among menstrual history
- how is the in the cycle calculated
- what is the normal number of days within a cycle
- How long should the flow last
-Menstrual cycle calculated from first day
of last period to first day of next period
Normal days
-28–32 days or 20–40 days
Flow should last 2 to 8 days

When obtaining obstetrical history for subjective data what is vital to know in regards pregnancies
what is the difference between preterm and termed labor
(Weeks)
in regards to obstetrical history ask the patient for their gravida if any or any abortions
Termed: + 37 weeks
Pre-term: before 37 weeks
 in regards to menopause for subjective data what is important information to ask the patient
What are signs and symptoms of perimenopause
Age on starting
last Pap smear
Immunizations
Perimenopause:
- irregular periods
- Hot flashes, night sweats
- mood swings
- vaginal dryness
If a patient comes in complaining of vaginal discharge what is vital to get from the patient and why
If patient comes in complaining of vaginal discharge get:
Color
Odor
Consistency
Amout
-Done to assess for STI
Within sexual history for subjective data what are the five 5’s And why are they gathered
Five P’s:
- Partners
- practices
- protection
- Past STI
- prevent pregnancy
Gather to assess patient risks
Among adolescents, how should you assess the patient especially if what
what should you teach During the exam
(Give 2 actual examples)
Assess the patient in privacy not in front of parent especially if sexually active
For adolescence teach about STI risk and prevention including
- STI‘s may cause infertility because of Fallopian tube obstruction

2.Chlamydia and gonorrhea can be without symptoms
What ages is the HPV vaccine recommended from, how many doses
and who is the greatest risk for HPV, why
HPV vaccine recommended from ages 9–26 YOA, 2-3 doses
Men have the greatest risk of HPV due to strictures and urethral scarring because of STI‘s/STD’s
Give relevant risk factors to assess for when Obtaining subjective data
- obesity due to chronic heart disease, CAD
- osteoporosis: screen past 65 years of age
-hormonal contraceptives plus tobacco
Increased DVT/PE risk
- medications
- fam hx Of breast/cervical cancer
- Exposure to DES
 What increases your risk for developing cancer as a woman
(Think genes)
Having a family history of breast cancer with abnormal BRCA 1and 2 genes
+ Exposure to DES
What are medications that change the menstral cycle, appetite, libido of women
What medication increases the risk of yeast infections
Medication that change menstrual cycle, appetite, libido:
-antidepressants/antihypertensives
Medication to increase the risk of yeast infections:
-antibiotics

What must a woman have done in order to be placed on Accutane (Isotretinoin )
What is required monthly
 what is the drug considered to be
If the woman is sexually active what is required from her
Before being placed on Accutane women MUST have two pregnancy tests negative
Monthly pregnancy tests are required before medication refills
Acutane considered severely teratogenic
If sexually active: patient should use two forms of contraceptives

If a patient report discharge and after being assist with COCA you discover:
Patient has white cheesy patches and is on antibiotics
What do you suspect to be the issue
If patient has discharge stating to be white cheesy patches and to be on antibiotics :
•patient has candidiasis
What are common symptoms in relation to the female genitalia and rectal assessments
Pelvic pain
-Assess pain, if childbearing age do pregnancy test as LAST assessment
vaginal burning, discharge, itching -assessed for pediculosis, puritis  condyloma -warts in anus  vulvitis -information of Vulva
Amenorrhea -absence of period  Dysmenorrhea- -Painful period 
Premenstrual syndrome(PMS)
-Emotional plus physical symptoms
In teenagers who present with pelvic pain/ tenderness what do you want to assess for and what is the reason (sti )
And teenagers with a pink: access for obstructed fallopian tube due to the STI (gonorrhea)
-gonorrhea is often asymptomatic and untreated causing fallopian two complications
What are 3 causes of Amenorrhea 
amenorrhea: absence of period
Causes:
-Pregnant, ovulating, anorexia nervosa
What is considered to be sexual dysfunction among women when Seeking medical treatment
Sexual dysfunction considered in women with low libido and low lubrication
What are structural difficulties you must inquire about and what they cause among patients
Structural difficulties include:
-endometriosis causing increased infertility
-Polycystic ovarian syndrome causing hertuism especially around
•abdomen and nipple
Ancanthisis nigricans: hyperpigmentation on Nick and armpits
What are additional questions you can ask pregnant women
Ask about any cramping
Abnormal Pap smears
Any bleeding or spotting requires further investigation
Past STI‘s

In newborns and children:
what is best to avoid and why
how do you assess for sexual abuse (what are signs)
 what do toddlers love to do in regards to their vagina
In newborn and children:
-it’s best to avoid bubble baths due to the risk of UTI but if you continue to bathe getting nonfragrant
Assess for sexual abuse if
- bowel/bladder regression
- any blood drainage
- itching in general area could be hygiene related
Toddlers love to insert objects into vagina
What are signs and symptoms of UTI’s among children
Dysuria
Itching
Infection
Come on you’re older population how do you know to assess for cancer
If those an older population have any bleeding post mensies during menopause assess for cancer
What are additional questions you wanna ask your older population
-menopause symptom
Among older population (menopause)ask for the presence of vaginal dryness
What do you suspect if an older patient presents with vaginal pressure
Give signs and symptoms
If patient presents with vaginal pressure = vaginal prolapse
S&S:
- urinary incontinence
- cystocele: prolapsed bladder to vagina
If an older patient presents with a rectal pressure what do you suspect
Rectal pressure = rectocele or mass
: Assess for prolapsed rectum to vagina
If there is a menstraul disorder involving excessive bleeding what do you want to assess for
If a patient presents with excessive bleeding due to menstraul disorders assess the number of pads used in 24 hours and how soaked the pads become
What are lifespan considerations for women of different cultures/religions
Women with different cultures/religions there may be rules as to who can see women unclothed and do pelvic exams
Women may require a chaperone to be present
Women are expected to protect and preserve virginity and private parts
What are vital instructions to give the patient in preparation of a Pap smear (pelvic exam)
(3things)
WITHIN 24 HRS OF EXAM
- Do not be menstruating
- Do not have intercourse or any source of penetration
- No douching: washing/soaking inside of a vagina
When a woman is receiving a Pap smear what position do you want to place her in including head of bed
Why do you want to give a mirror to a woman when receiving a Pap smear
What does teaching during Pap smear provide the patient
Position a woman getting a Pap smear in the lithotomy position with head of bed elevated to allow for visualization of vaginal structures
Give women mirror to teach structure and function
Teaching during Pap smears lets the patient relax
What is vital to do for the patient in relation to their pap smears
What was the woman do before getting pap smear
It is vital to explain step-by-step what you’re doing to relax the patient
Patience miss empty bladder before getting Pap smears
What kind of specular do we use for a Pap smear nowadays
We use plastic specula
Why is the lithotomy position used for Pap smears and vaginal exams
The lithotomy position gives direct visualization of the genitalia
What does it mean to see the nurses inspecting the introitus
Inspecting the introitus means the nurse is inspecting the vaginal opening
What are signs and symptoms a pregnant woman Is going through a ruptured membranes and what kind of assessment does it become
With a ruptured membranes:
- assess for footing: babies feet
- umbilical cord around neck
- hands
If a pregnant woman suffers a ruptured membrane it becomes an emergency C-section
What are Life span considerations for children during physical exam
What are the Lifespan considerations for adolescence during physical exams and what do you want to give them during their genital exam
Children: have parent in room
Adolescent: give option to have parent in room
-When doing a vaginal exam on an adolescent use a mirror to educate on genitalia
What cultural population has the highest risk for cervical cancer and the highest death rate from cervical cancer
Hispanics/Latinas have increased rates of cervical cancer and are more likely to die from cervical cancer
What cultural population has the highest risk of breast cancer and the worst outcome
-Why
Mexicans have the highest risk for breast cancer in the worst outcome do to delayed care
Give common laboratory and diagnostic tests and what their purpose is
Urinalysis (UA): UTI
HCG pregnancy test: if no mensies
Pap smear(pelvic exam): cervical cancer screening
Culture and sensitivity: known infection
Cervical swab: HPV
How do you conduct a clean catch/midstream for culture and sensitivity
3 wipes:
Separate the labia use one tablet each side than one in the middle from top to bottom
Urinate a small stream
Stop
Place cup for collection
 Collect the remaining amount of urine
What are nursing diagnosis related to female genitalia and rectal assessments
Ineffective sexuality pattern
Risk for infection
Ineffective health maintenance
What are outcomes related to female genitalia and rectal assessments
Patient reports coreect risk factors, causes, prevention strategies for STI
Patient accurately reports disease process, treatment goals, potential S/E
What are nursing interventions for female genitalia rectal assessments
Offer variety of options for safe sex practices to provide choices, promote respect for differences
What does candidiasis present with
What does the patient report with candidiasis while having sex
Candidiasis will present with:
- Vulvo vaginal edema
- Thick white secretions along internal walls
- Puritis/ erythrma
While having sex with candidiasis patient will report:
-dysparenia

What can candidiasis be related to
3 things
Chronic infection
DM
HIV
What does bacterial vaginosis present with

1.creamy white to Grey secretions coding vaginal walls
2.STRONG fishy odor

3.vaginal itching/burning
How does chlamydia present
What will you see upon inspection of
Patients cervix With chlamydia
Chlamydia often asymptomatic but will present with clear white secretions
In patients with chlamydia youll see: -changes in cervical condition • reddened mucopurulent from 0S • easy bleeding upon Pap smear 
What will gonorrhea present to the patient with
What will patient with gonorrhea report:
What will the cervix of someone with gonorrhea look like
Patient presentation:
- yellow vaginal secretions
Patient reports:
patient will report dysuria and dyspareunia
Gonorrhea cervix:
-Per you lent cervical discharge and tenderness and tenderness with pelvic exam
 What is Chancre and what is there to know about chancre
chnacre = syphilis
-w is a painless lesion
What is the lesion associated with HPV
Condyloma acuminatum is associated with HPV
Described as fleshy pink/grey papilloma (wart like projections ) at vulva, vaginal, anu
