Reproductive Flashcards
How often should patients perform testicular self exam (TSE) and how to perform
Usually once a month after a warm shower. Roll testes between the index and middle finger.
Digital Rectal Exam (DRE)
Patient is bent over with their knees pulled up.
Who can perform a digital rectal exam?
A provider (MD, NP, PA)
What is included in the inspection of the male gentalia
Inspect the Pubic Hair, Shaft (normal, slightly wrinkled, lesions, bends), and Glans (free of lesions, foreskin or no foreskin, location of meatus)
What is circumcision?
The removal of the foreskin
What are the benefits to circumcision?
Decreased risk of penile cancer, UTIs, and infection of the glans
Phimosis & how is it treated
difficulty retracting the foreskin of the penis. usually treated with topical creams or circumcisions.
Paraphimosis
Foreskin trapped behind the glans (emergency), can lead to cut off of circulation
Hypospadias
When the ureter does not connect to the tip of the penis
Epispadias
Meatus is in a different area of the penis (txed with surgery)
Peyronie’s Disease
Bent penis. Connective tissue disorder. Can be painful.
How does cancer manifest on the penis?
Painless large nodules on the penis
What chronic disease can lead to scrotal edema?
Congestive heart failure
Torsion
Twisting of the spermatic cord (appears large & red)
Orchitis
Painful, heavy feeling in the scrotum. Infection related and treated with antibiotics, scrotal support, and ice.
Hydrocele
A collection of fluid (usually painless) in the scrotum and usually resolves on its own.
Transillumination
A flashlight aimed at the scrotum, if it is red then it is clear fluid. If it is not, then it is a mass or blood filled
How to position a patient with an inguinal hernia
Have the patient stand, turn their head, and cough to make the hernia more prominent
How to palpate a patient with an inguinal hernia
Put your fingers in the inguinal canal and have the patient shift their weight (left side palpation shift to the right and vice versa)
Symptoms of prostate cancer
- difficulty urinating
- decreased force or urine stream
- frequent urination at night
- dribbling after urination
- blood in urine
- swelling in legs
- discomfort in pelvic area
- bone pain
Symptoms of BPH ( benign prostatic hyperplasia)
- difficulty urinating
- decrease force of urine stream
- frequent urination at night
External hemorroids
(how do they feel, how are they treated, what to do they look like, are the visible?)
Painful, swollen, bleed with bowel movement, treated with creams or surgery. Look like varicose veins & visible upon expection
Internal hemorroids
(how do they feel, how are they treated, what to do they look like, are the visible?)
Not visible on inspection, not painful, complaints about bleeding
Pilonidal cyst
A small, fluid-filled sac that typically forms in the cleft of the buttocks, near the base of the spine (tailbone)
What additional information do we need to consider for transgender males?
Asking for pronouns, hormone therapy (testosterone is not birth control & they can still get pregnant), surgical interventions, gynecological history/childbearing history, psychological/mental health (self-image)
Menstruation
Monthly shedding of the uterine lining if pregnancy has not occurred (24 to 32 days)
Metorrhagia
Spotting between menstrual periods
Amenorrhea
Absence of menstruation
Primary amenorrhea
Menstruation has not begun
Secondary amenorrhea
They have their period and then it stopped
(norm is pregnancy or a change in hormones, etc.)
Dysmenorrhea
Painful periods
Menarche
Beginning of menstriation
Perimenopausal
Just before menopause
Menopause
Cessation of menstruation
Perimenopause symtpoms
Hot flashes, night sweats, vaginal dryness, mood swings, irregular menses, fatigue or trouble sleeping, decreased appetite, urinary urgency or leakage
What age range can menopause gegin?
40 to 50 with the average age being 51
How do you know your patient is in menopause?
1 year without menses
What is Toxic Shock Syndrome (TSS)
An infection of Staph or Step because the patient did not change their tampon.
S/S of Toxic Shock Syndrome (TSS)
Fever, intense pain, headache, hypotension, muscle pain, seizures leading to shock, renal failure and/or death.
How do we treat TSS?
Antibiotics, fluids, dialysis (if renal failure)
Pelvic Inflammatory Disease is secondary to
Gonorrhea/chlamydia (most common)
How often do you need a PAP smear?
3 to 5 years at the beginning of the age of 30
What is the role of an RN during a PAP smear?
Chaperone
What is something the nurse can tell the patient prior to a PA smear
Ask if they want to use the bathroom
How to avoid HPV?
Practice sexual monogamy
Limit number of lifetime sexual partner
Use barrier protection during sexual activity
HPV infecion is the most important risk factor
Females, especially late teens to mid-30s. Multiple partners, unprotected sex at a young age with uncircumcised male
Colorectal Cancer signs
Changes in bowel movements, melena, or unexplained weight loss
Suspected risks for colorectal cancer
diet (high in fat, red or processed meats & low in fiber), smoking, alcohol, etc.
Symptoms of hernia
Aching & sharp pain, burning, bulge, increased discomfort with activity
What additional information do we need to consider for transgender females?
Pronouns, therapies/surgeries, increased risk for DVT, high BP from hormone therapy, mental health, tucking, prostate exam.
Older adult female considerations of reproductive health
Vaginal bleeding (cervical cancer), drying, gray thinning public hair, sexual health, incr risk for cervical polyps (rarely cancerous)
A young female client refuses treatment for a sexually transmitted infection. The nurse explains that lack of treatment may put her at risk for which condition?
Pelvic inflammatory disease
Sexually transmitted infections (STIs) can increase the client’s risk of pelvic inflammatory disease, which leads to scarring and adhesions on the fallopian tubes, which in turn increase the risk for infertility and ectopic pregnancy.
An adult client has sought care at the clinic, stating that she believes she has “a raging yeast infection.” The nurse would expect to assess what type of vaginal discharge?
Thick, white vaginal discharge
An adult male client reports hesitancy when urinating. The nurse would further assess this client for what complication(s)?
Difficulty urinating, such as hesitancy, could signal a blockage, including prostatic enlargement.
An adult male client reports heaviness or dragging feeling in the scrotum. Their symptoms might suggest what complication(s)?
Scrotal hernia or testicular tumor
An teenage-aged male client reports painful urination. His symptoms might suggest what complication(s)?
Sexually transmitted infection
A male client has presented for follow-up to a diagnosis of genital warts. The nurse should expect to assess for what type of lesions?
Genital warts are single or multiple moist, fleshy papules. They do not contain fluid, and they do not typically bleed. Genital warts may be firm, but they are never shiny.
A client has sought care because of a sudden increase in the size of his scrotum. The nurse’s assessment reveals the presence of a large scrotal mass. How can the nurse best assess for a scrotal hernia?
Auscultate the mass for bowel sounds.
Bowel sounds auscultated over a scrotal mass indicate the presence of bowel and thus a scrotal hernia.
What is the most frequently used position for inspection and palpation of the anus, rectum, and prostate?
The left lateral position
The nurse is beginning the physical exam of a male client’s genitalia. The nurse is sitting on a stool in front of the client. In which position would it be best to place the client?
The client assumes a standing position.
What is the cremasteric reflex?
It controls the rise and relaxation of the scrotum.
The muscle contracts when cold and relaxes when warm.
What technique can the nurse use when planning to assess a male client for urethral discharge?
Gently squeeze the glans between the thumb and index finger.
While inspecting the penis of a client, the nurse suspects herpes progenitalis based on which assessment finding?
Clear vesicles that erupt
What specific STI may lead to cervical cancer?
HPV (human papillomavirus)
An adult female patient comes into the clinic reporting mucopurulent yellowish discharge. Their symptoms might suggest what complication(s)?
Mucopurulent cervicitis (MPC) which usually indicates infection with Chlamydia or gonorrhea. AND it can change the cervical pH (3.8–4.2)
Describe the anatomical location of the inguinal area
Located between the anterior superior iliac spine laterally and the symphysis pubis medially
What is a frequent site of hernia development?
Inguinal area
What are the non-modifiable risk factors for prostate cancer?
Increase age, black ancestry, and family history
What are the modifiable risk factors for prevention of prostate cancer?
Lower BMI, greater total physical activity, and high ejaculation frequency
What are the complication of binding?
Skin breakdown, rib fractures, atelectasis, and pneumonia
What are the complication of tucking?
Skin breakdown at perineum. Concern for urinary reflex/infections (epididymo-orchitis, prostatitis, cystitis)
Symptoms of Prostate Cancer
Trouble urinating
Decreased force in the stream of urine
Blood in the urine
Blood in the semen
Swelling in the legs
Discomfort in the pelvic area
Bone pain
An ulcer on the penis can indicate…
Syphilis, herpes simplex or chancroid
Bumps on the penis can indicate…
Condylomata acuminata, molluscum contagiosum
Is the meatus on the glans penis or is it proximal (hypospadias)?
If a hypospadias is present, the foreskin is typically not complete and is missing in the ventral surface
Colorectal cancer starts out as…
Polyps
Do transgender men need a pregnancy test?
Yes!
How is heaviness measured in menses?
The number of pads or tampons used = Indicator
How long can you keep a tampon in?
No longer than 4 hrs
Dyspareunia
Discomfort during intercourse
Menorrhagia
Increased amount of bleeding or duration of flow
Metorrhagia
Bleeding that occurs between periods/spotting between periods
What is PMS (premenstrual syndrome)
Complex of symptoms occurring 4 to 10 days before the onset of menses
what instructions does the nurse need to convey to the patient prior to a vaginal appointment>
No vaginal creams, jellies, spermicides, sexual intercourse, or douching 48 hrs prior
What is douching?
A device used to introduce a stream of water into the body for medical or hygienic reasons, or for the stream of water itself
How can the nurse inspect the anal opening for any bulges or lesions?
Ask client to perform Valsalva’s maneuver by straining or bearing down
The American Cancer Society and ACOG recommends that HPV testing should begin at
30+ years old
The American Cancer Society and ACOG recommends that pelvic exams should begin by
21 years old
What places someone at higher risk for cervical cancer?
Suppressed immune system (HIV+, organ transplant, or long-term steroid use)
How do we perform a GU exam for a patient who has undergone surgery with a vaginoplasty?
Use an endoscope
What considerations are related to Prostate removal?
Possible nerve damage
How should the normal cervix feel to the nurse’s fingers?
Firm, Round, Soft
An adult male client comes to the clinic for their annual physical examination. The nurse asks, “Do you have any current or chronic illnesses such as diabetes, hypertension, respiratory problems, or cardiovascular disease?” Why does the nurse ask this question?
To assess for erectile dysfunction
A nurse examines the anal area of a client and observes the presence of a varicose vein. How should the nurse document this finding?
External hemorrhoid
On palpation of a client’s prostate, a nurse detects hard, fixed, and irregular nodules on the prostate. Which condition should the nurse most suspect in this client?
Prostate cancer
A nurse inspects the cervix of a 33-year-old, nonpregnant client during a routine assessment. Which coloration of the cervix would indicate normal health in this client?
Pink
A female client visits the clinic reporting a thin, gray-white discharge that has a fishy smell. A focused assessment reveals gray-white discharge that coats the walls of the vagina and ectocervix. The nurse documents these findings as indicative of which of the following conditions?
bacterial vaginosis
What are the key symptoms of Trichomonas vaginitis, a sexually transmitted infection caused by a protozoan organism?
Key symptoms include yellow-green, frothy, and foul-smelling discharge; red, swollen labia; rough, red vaginal walls with small red spots (petechiae); itching; and urinary frequency.
What are the typical signs and symptoms of atrophic vaginitis that occur after menopause?
Symptoms include atrophy of the labia and vaginal walls, which become pale and dry, and may have small amounts of bloody discharge.
What are the symptoms of Candida vaginitis, and what causes it?
Candida vaginitis is caused by an overgrowth of yeast in the vagina. Symptoms include a thick, white, cheesy discharge, swollen and inflamed labia, vaginal mucosa irritation, itching, and discomfort.
What are the symptoms of bacterial vaginosis, and what is its suspected cause?
Bacterial vaginosis presents with thin, gray-white discharge that has a fishy odor, coating the vaginal walls and ectocervix. It is thought to be a sexually transmitted infection possibly caused by anaerobic bacteria.
T/F “Herpes simplex is painful and episodic with periods of remission and exacerbation.”
True
T/F “Most sexually transmitted infections present with painful nodules such as genital warts.”
False
T/F “Syphilis usually presents with a painless white-silver papule.”
True
T/F “Genital warts are caused by papillomavirus.”
True
A 17-year-old client has expressed concern over having a vaginal discharge just before their menses begins. What response should the nurse provide the client to best address their concerns?
If there are no other signs or symptoms, it is likely a result of normal ovulation
An uncircumcised, 78-year-old male has presented at the clinic reporting that they cannot retract the foreskin over the glans. On examination it is noted that the foreskin is very constricted. What is this condition called?
Phimosis
The nurse suspects that a male client may have a hernia. The nurse should further assess the client for
Bowel sounds at the buldge
An adult male patient comes into the clinic complaining of nocturia, what do you suspect is his complication?
Benign prostatic hypertrophy (BPH)
When the client bears down, a rosette of red mucosa prolapsing from the anus is visible. Digital rectal examination reveals no masses; no blood is found on the glove. What disorder of the anus or rectum is this likely to be?
Prolapse of the anus
Upon observation, the nurse documents that a male child’s urethral meatus is located on the underside of the penis. What is the term for this structural abnormality?
Hypospadias
