male and female genitourinary system Flashcards
developmental competence: adults and aging adults
- Male does not experience a definite end to fertility as female does
- Testosterone production declines after age 30 but continues very gradually so resulting physical changes are not evident until later in life
- In the absence of disease, withdrawal from sexual activity may be due to (any combination of)
loss of spouse, depression, preoccupation with work
marital or family conflicts
side effects of medication, heavy alcohol use
lack of privacy, living with children or in a nursing home
economic or emotional stress
poor nutrition or fatigue
circumcision (exam)
Circumcision:
Lowers risk for certain STIs such as HPV, herpes simplex virus,
genital ulcer disease in men and decreased risk for bacterial
vaginosis and trichomoniasis in females
timing an reasons for circumcision
During pregnancy or immediate neonatal period, parents may ask whether to circumcise male infant.
Religious and cultural as well as medical indications
American Academy of Pediatrics (AAP) health benefits outweigh risks
those who have been circumcised are at reduced risk of what
Reduced risk for contracting HIV infection through heterosexual contact
chronic kidney disease (exam)
Two main causes of ESRD: HTN and diabetes
Diabetes and HTN more common in some racial groups
bladder cancer
4th most common cancer in men with ethnic differences
Smoking is the most common risk factor along with occupational exposure to chemicals
Assess for painless hematuria
STIs
increasing #s each year
Types: chlamydia, gonorrhea, syphilis, HPV, HIV, & Hep B
Many are asymptomatic increased transmission
Use of counseling interventions
subjective data (exam)
Frequency, urgency, and nocturia
Dysuria (pain or burning)
Hesitancy (trouble starting) and straining
Urine color
Past genitourinary history
Penis—pain, lesion, discharge
Scrotum—self-care behaviors, lump
Sexual activity and contraceptive use
Sexually transmitted infection (STI) contact
inspect and palpate - penis
Penis
after inspection if uncircumcised, slide foreskin back to original position
inspect and palpate - scrotum (exam)
Scrotum
Perform transillumination if mass or swelling is detected
* Skin might appear taut and pitting
inspect and palpate - hernia (exam)
Hernia
Palpate inguinal canal
Palpate femoral area for a bulge
inspect and palpate - inguinal lymph nodes (exam)
Inguinal Lymph Nodes
Normal to palpate an isolated node on occasion
* Enlarged, hard, matted, fixed nodes are abnormal findings
urethritis
Urethritis (Urethral Discharge and Dysuria)
renal caliculi
Renal Calculi = kidney stone
* S/S: Abrubt sever flank pain into groin or abdomen, n/v, hematuria, obstruction of urinary flow
Acute Urinary Retention and Urinary Tract Infection
Acute Urinary Retention and Urinary Tract Infection
* Retention commonly caused by BPH
* Retention can lead to UTIs
Urethral Stricture
- Congenital or secondary to injury
abnormalities of the penis (exam)
phimosis - when the foreskin is tight and fixed, cannot be retracted
may have to be surgically fixed
abnormalities of the scrotum
testicular torsion
hydrocele
scrotal hernia
caused by indirect inguinal hernia
abnormal findings: inguinal and femoral hernias
Types
Indirect inguinal hernia – most common
Direct inguinal hernia
Femoral hernia – least common
Characteristics: reducible, incarcerated, or
strangulated
prostate cancer
Most frequently diagnosed cancer in men
Known risk factors:
Increasing age, African ancestry, family history, & inherited mutation of BRCA1 and BRCA2 genes
Follow screening recommendations relative to identified risk
Prostate Specific Antigen (PSA) blood test
colorectal cancer risk factors
age
inherited genetic syndromes (lynch)
family history
inflammatory bowel disease
type 2 diabetes
other generable modifiable risk factors
screening for colorectal cancers
Screening = colonoscopy
Polyps = precursor lesions
objective data: preparation and equipment (exam)
Preparation
Place patient in best position relative to gender
* Males: Left lateral decubitus, standing, or lithotomy
* Females: Lithotomy for examining genitalia or left lateral decubitus for exam of rectum alone
Equipment
Penlight
Lubricating jelly
Glove
Guaiac test container (Hemoccult) – for fecal occult blood testing
abnormal findings: hemorrhoids
Internal or external
Results from increased pressure
Rectal bleeding, pain, blood when wiping
abnormal findings: fecal impaction
Can lead to bowel obstructions
Need imaging to confirm
Tx = disimpaction, enemas, bowel regimen
abnormal findings: abscess
Rectal pain, fever, signs of inflammation/infection
Surgical drainage needed
abnormal findings: BPH
Urinary frequency, urgency, hesitancy, incomplete
emptying, nocturia, straining to void, intermittent
stream
Cervical cancer
Caused by Human Papilloma Virus (HPV)
infection
4th most common cancer in women worldwide
Pap test for screening
HPV vaccine:
* Can prevent 90% of cervical cancers in women
* Can prevent oropharyngeal, anal, and penile cancers in men
subjective data for women (exam)
Menstrual history
Obstetric history
Menopause - night sweats
Acute pelvic pain
Urinary symptoms (stress incontinence)
Vaginal discharge
Past history
Sexual activity
Contraceptive use (smoking habits)
Sexually transmitted infection (STI) contact
objective data preparation and equipment
Preparation
Assemble equipment before helping woman into position
Equipment
Gloves, lighting and speculums
Cotton tipped applicators and lubricant
Materials for cytologic study
* Slide, specimen container, vials, pH tape, prep bottles (NS, KOH and acetic acid)
abnormalities: urethritis and UTI
Dysuria, frequency, urgency, flank or suprapubic pain
Older adults: confusion, communication problems, lethargy
abnormalities: cervical cancer (exam)
Bleeding between menstrual periods, after sex or menopause, unusual discharge
Dx by Pap test and biopsy
abnormalities: candidiasis
Pruritis, thick, whitish clumpy discharge, redness and swelling surrounding vulva
Abx use, oral contraceptives, diabetes
male and female: assessing urinary function
Observe urine color/odor
Note pH and specific gravity (urinalysis)
Serum analysis of kidney function (blood tests)
BUN/CR
GFR
Monitor rate of output
If performing an exam, always have a
chaperone present, or be the chaperone for the
provider
