NURS 6512 Assignment 1: Lab Assignment: Assessing the Genitalia and Rectum

NURS 6512 Assignment 1: Lab Assignment: Assessing the Genitalia and Rectum

Walden University NURS 6512 Assignment 1: Lab Assignment: Assessing the Genitalia and Rectum-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University  NURS 6512 Assignment 1: Lab Assignment: Assessing the Genitalia and Rectum assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NURS 6512 Assignment 1: Lab Assignment: Assessing the Genitalia and Rectum

Whether one passes or fails an academic assignment such as the Walden University  NURS 6512 Assignment 1: Lab Assignment: Assessing the Genitalia and Rectum depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for  NURS 6512 Assignment 1: Lab Assignment: Assessing the Genitalia and Rectum

The introduction for the Walden University  NURS 6512 Assignment 1: Lab Assignment: Assessing the Genitalia and Rectum is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for  NURS 6512 Assignment 1: Lab Assignment: Assessing the Genitalia and Rectum 

After the introduction, move into the main part of the  NURS 6512 Assignment 1: Lab Assignment: Assessing the Genitalia and Rectum assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for  NURS 6512 Assignment 1: Lab Assignment: Assessing the Genitalia and Rectum

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for  NURS 6512 Assignment 1: Lab Assignment: Assessing the Genitalia and Rectum

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NURS 6512 Assignment 1: Lab Assignment: Assessing the Genitalia and Rectum

Background

The client, T.S., is a 32-year-old woman who presented with dysuria, frequency, and urgency to the clinic. She denies using anything to ease the discomfort. The client reports that these symptoms have persisted for the past year. She discloses having a new partner for the last three months and being sexually active. This paper analyzes the subjective portion, the objective portion of the note, how subjective and objective information supports the assessment, appropriate diagnostics, and rejection/acceptance of the current diagnosis.

The Subjective Portion Analysis and Additional Information

The presented subjective data include dysuria, frequency, and urgency, which have persisted for the past year. These symptoms characterize urinary tract infection (UTI). However, additional information is required to confirm the client’s condition. First, the client’s history of STDs or previous UTI occurrences should be included in subjective data. Furthermore, the subjective portion should capture information regarding using protection during sexual intercourse and experiencing pain or discomfort during intercourse. Finally, informations about any discharge or blood spots should be documented to guide inappropriate diagnosis and treatment.

The Objective Portion Analysis and Additional Information

The objective data indicates mild tenderness to palpation in the client’s suprapubic region, no adnexal tenderness, a normal-sized uterus and adnexa, no vaginal discharge, and a normal cervix. However, additional objective data is needed to assist in the client’s diagnosis and treatment. First, the presence or absence of blood in the urine should be included in the objective portion. Furthermore, the healthcare professional should evaluate the color and smell of the client’s urine. Finally, details of chills/fever should be documented.

Does the Subjective and Objective Information Support Client’s Assessment

The client’s assessment is urinary tract infection (UTI). UTI in women is mainly characterized by fever, a persistent

and strong urge to urinate, chills, a burning sensation when urinating, foul-smelling and cloudy urine, and pelvic pain (Gupta et al., 2017). The client reports these symptoms, including dysuria, frequency, and urgency, persisted for the past year. Therefore, the presented subjective data supports the client’s assessment of urinary tract infection. Additionally, objective data, including suprapubic or pelvic pain on palpation, cloudy or foul-smelling urine, bloody urine, or bleeding of the inflamed bladder wall, characterize UTIs in women (Flores-Mireles et al., 2019). The client’s object data indicates mild tenderness to palpation in the suprapubic area, supporting her assessment of urinary tract infection.

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Appropriate Diagnostics

In addition to subjective and objective data, diagnostics would be needed to make the client’s diagnosis. The first diagnostic is a urine culture . The presence of uropathogen in urine cultures is a definitive UTI diagnostic test. Additionally, a urinalysis or urine dipstick should be performed to assess pyuria. The presence of pyuria in this client indicates that she has UTI. According to Beahm et al. (2017), pyuria in urine dipstick or a significant volume of uropathogen in a urine culture indicates UTI. STD tests should also be performed. Positive results for STDs indicate sexually transmitted UTIs. A CT scan should also be used to identify pyelonephritis or abscesses. The presence of pyelonephritis or abscesses indicates UTI. Finally, ultrasonography should be done due to its extreme sensitivity in detecting obstruction, tumors, abscesses, and cysts.

Acceptance of the Current Diagnosis

The client’s current diagnosis is urinary tract infection (UTI), mainly characterized by fever, a persistent and strong urge to urinate, chills, burning sensation when urinating, foul-smelling and cloudy urine, and pelvic pain. The client reports dysuria, frequency, and urgency, which have persisted for the past year. These symptoms align with her current diagnosis, UTI; hence it should be accepted. Additionally, the UTI is characterized by objective data, including hematuria, fever/chills, oliguria, foul-smelling urine, suprapubic region, or abdominal pain. The client’s objective data indicates mild tenderness to palpation in the client’s suprapubic area. Therefore, the client’s current diagnosis should be accepted.

Overall, the client is a 32-year-old woman who presented to the clinic with dysuria, frequency, and urgency, which have persisted for the past year. Additional subjective data, including the client’s history of STDs or previous UTI incidents, information regarding using protection during sexual intercourse and experiencing pain or discomfort during intercourse, and details about any discharge or blood spots are needed to assist the healthcare provider in making an appropriate diagnosis for this client. The objective data indicates mild tenderness to palpation in the client’s suprapubic region, no adnexal tenderness, a normal-sized uterus and adnexa, no vaginal discharge, and a normal cervix. However, additional objective data, including the presence or absence of blood in the urine, color, smell of their urine, and details of chills/fever, are needed to assist in the client’s diagnosis. The client’s assessment is urinary tract infection (UTI), mainly characterized by fever, a persistent and strong urge to urinate, chills, burning sensation when urinating, foul-smelling and cloudy urine, and pelvic pain. These symptoms are reported in the client’s objective and subjective data. Therefore, her assessment is supported by subjective and objective data and should be accepted as the most appropriate diagnosis for this client.

References

Beahm, N. P., Nicolle, L. E., Bursey, A., Smyth, D. J., & Tsuyuki, R. T. (2017). The assessment and management of urinary tract infections in adults: guidelines for pharmacists. Canadian Pharmacists Journal/Revue des Pharmaciens du Canada, 150(5), 298-305. Doi: 10.1177/1715163517723036

Flores-Mireles, A., Hreha, T. N., & Hunstad, D. A. (2019). Pathophysiology, treatment, and prevention of catheter-associated urinary tract infection. Topics in spinal cord injury rehabilitation, 25(3), 228-240. DOI: 10.1310/sci2503-228.

Gupta, K., Grigoryan, L., & Trautner, B. (2017). Urinary tract infection. Annals of internal medicine, 167(7), 49-64. https://doi.org/10.7326/AITC201710030

Sample Answer 2 for NURS 6512 Assignment 1: Lab Assignment: Assessing the Genitalia and Rectum

Assessment of the genitalia and rectum is vital in depicting genitourinary and gastrointestinal abnormalities respectively. A rectal examination is necessary to complete an abdominal exam. Meanwhile, assessment of the genitalia is usually sensitive and must be done in the presence of a chaperone. In the subsequent paragraphs, potential history, physical exam, and differential diagnosis shall be explored based on a case scenario of T.S. a 32-year-old woman who presents with dysuria, frequency, and urgency for two days. She is sexually active and has had a new partner for the past three months.

Subjective

A triad of urgency, frequency, and dysuria characterizes a pathology that is most likely in the urinary tract. Consequently, it is essential to inquire about associated symptoms such as hematuria, fever, and malaise. Association with malaise and fever is common in urinary tract infections. Similarly, it is important to inquire about the presence of any abnormal vaginal discharge, and burning sensation during urination since she is sexually active and a sexually transmitted infection might be the cause of her symptoms. Likewise, changes in the smell and color of the urine must be elicited as well as associated suprapubic pain. Related to sexually transmitted infections, it is crucial to inquire about the number of sexual partners if similar symptoms have manifested in her partner or the use of protection during intercourse (Garcia & Wray, 2022).

Similarly, her last menstrual period must be known to determine if pregnant as this will impact the management (Bono et al., 2022). Additionally, a history of medication use, alcohol, smoking, and use of illicit drugs must be elicited. A history of contact with an individual with a chronic cough or TB prior to the occurrence of the previous symptoms must be elicited as urogenital TB may present similarly. Finally, it is crucial to inquire about any history of trauma or recent urethral catheterization as these are common risk factors for urinary tract infections.

Objective

The vital signs are mandatory in this patient as it is a pelvic exam. In the general exam, the mental and nutrition status of the patient must be noted. Additionally, a complete abdominal exam must be conducted as the patient has flank pain and suprapubic tenderness. Palpation of the abdomen for any masses and percussion of the flank for costovertebral angle tenderness must be done (Bono et al., 2022). Similarly, complete respiratory and cardiovascular exams must be conducted as a routine during the assessment of any patient. Finally, a digital rectal examination must be performed to exclude associated rectal abnormalities.

Assessment

In addition to urinalysis, STI, and pap smear testing, a complete blood count and urine culture must be conducted as the patient presents with signs of infection. Similarly, a pregnancy test must be conducted as this may complicate urinary tract infections. Additionally, she has no appetite and therefore a random blood sugar must be done to exclude hypoglycemia. Similarly, urea, creatinine, and electrolyte must be conducted to check the renal function as the patient has flank pain. Finally, Inflammatory markers such as ESR and CRP as well as blood cultures must be done as the patient has flank pain which may indicate pyelonephritis (Bono et al., 2022). Imaging tests are not necessary for the diagnosis of lower UTI. However, the patient has flank pain, and therefore, a CT scan of the abdomen and pelvis with or without IV contrast as well as an ultrasound of the kidneys and bladder must be done to identify any pathologies and outline the architecture of the kidney and bladder (Belyayeva & Jeong, 2022)

The possible diagnoses include a urinary tract infection and a sexually-transmitted infection. Urinary tract infections refer to the infection of the bladder, urethra, ureters, or kidneys (Bono et al., 2022). UTIs are more common in women, a consequence of a short urethra and proximity of the anal and genital regions (Bono et al., 2022). A triad of frequency, dysuria, and urgency collectively defines the irritative lower urinary tract symptoms (Bono et al., 2022). Similarly, suprapubic tenderness is a key feature of lower urinary tract infections. However, the patient is also feverish and has flank pain which also denotes the potential for involvement of the upper urinary tract (Bono et al., 2022). T.S is also sexually active, a risk factor for urinary tract infection.

A sexually transmitted infection is another possible diagnosis. T.S is sexually active and she has had her new partner for the last three months which is a key risk factor for this condition (Garcia & Wray, 2022). Most STIs present with suprapubic pain. Most STIs are asymptomatic and if symptomatic manifests with urethral discharge, vaginal discharge, pruritus, and pain (Garcia & Wray, 2022). T.S was negative for the aforementioned features.

Other differential diagnoses include pyelonephritis, interstitial cystitis, and urethritis due to an STI. Pyelonephritis is of the renal pelvis and parenchyma (Belyayeva & Jeong, 2022). It is usually a complication of ascending bacterial infection of the bladder and manifests principally with frequency, dysuria, urgency, fever, malaise, flank pain, and suprapubic pain (Belyayeva & Jeong, 2022). Interstitial cystitis is a chronic noninfectious idiopathic cystitis associated with recurrent suprapubic pain (Daniels et al., 2018). It presents with urgency, frequency, suprapubic discomfort, and pain relieved by voiding. T.S has some of these features although the gradual onset of symptomatology and a duration of more than six weeks is required for the diagnosis of this condition (Daniels et al., 2018). Finally, urethritis secondary to an STI may present in females with only frequency, urgency, and dysuria with minimal or no vaginal discharge (Young et al., 2022).

Conclusion

Assessment of the genitalia and rectum is sensitive and may help identify abnormalities of the rectum and genitourinary tract. Most abnormalities of the genitourinary system particularly UTIs and STIs can be diagnosed clinically. Consequently, a comprehensive history and physical examination are mandatory. Most UTIs are common in females. Pregnancy must always be excluded in a patient presenting with features suggestive of a UTI.

References

Belyayeva, M., & Jeong, J. M. (2022). Acute Pyelonephritis. https://pubmed.ncbi.nlm.nih.gov/30137822/

Bono, M. J., Leslie, S. W., & Reygaert, W. C. (2022). Urinary Tract Infection. https://pubmed.ncbi.nlm.nih.gov/29261874/

Daniels, A. M., Schulte, A. R., & Herndon, C. M. (2018). Interstitial cystitis: An update on the disease process and treatment. Journal of Pain & Palliative Care Pharmacotherapy, 32(1), 49–58. https://doi.org/10.1080/15360288.2018.1476433

Garcia, M. R., & Wray, A. A. (2022). Sexually Transmitted Infections. https://pubmed.ncbi.nlm.nih.gov/32809643/

Young, A., Toncar, A., & Wray, A. A. (2022). Urethritis. https://pubmed.ncbi.nlm.nih.gov/30725967/

Sample Answer 3 for NURS 6512 Assignment 1: Lab Assignment: Assessing the Genitalia and Rectum

Genitourinary problems are among the public health concerns globally. Nurses and other healthcare providers adopt evidence-based interventions that would optimize patient outcomes in the treatment of these conditions. Subjective and objective data help nurses to formulate diagnoses and treatment plans. Therefore, this essay examines TS’s case study. TS has presented to the hospital complaining of dysuria, urgency, and frequency for the last two days. The essay focuses on topics that include additional subjective and objective information that should be obtained from the patient, if subjective and objective data supports the assessment, appropriate diagnostics, accepting or rejecting the diagnosis, and differential diagnoses to be considered for the patient.

Additional Subjective Information

Additional subjective information should be obtained from TS. Firstly, information about the character of her urine should be obtained. This includes information such as the smell and color of the urine. Bloodstained urine could indicate bladder problems while urine with a strong smell could imply that TS has a urinary tract infection. The nurse should also ask for information about the presence or absence of abnormal vaginal discharge. For instance, yellow or purulent vaginal discharge would indicate sexually transmitted infections. The character of TS’s symptoms should also be obtained. This includes seeking information on the factors that precipitate or alleviate her urinary symptoms. She should be asked about any activity that worsens or relieves her symptoms (Kaur & Kaur, 2021). The nurse should also assess her current level of pain using the pain rating scale. Pain rating could indicate the severity of her condition.

The nurse should also ask TS about her sexual habits. This includes sexual preferences and the use of protection when engaging in sexual intercourse. The information would help the nurse rule out causes such as sexually transmitted infections. Additional sexual-related information that should be obtained includes the use of contraceptives, the last menstrual period, and menstrual cycle problems. The nurse should also obtain information about any history of recurrent urinary tract infections. This would help determine if she has chronic urinary tract infections. Similarly, information about the history of sexually transmitted infections should be obtained to rule them out in her case. Information about her partner’s history of sexually transmitted infections and testing should also be obtained to rule out a risk of STD transmission. Information about TS’s social history is also needed. This includes data about smoking, dietary practices, and alcohol use (Bono et al., 2024). The nurse should also rule out the potential of heredity of TS’s problem. Information about a family history of health problems such as kidney disease or symptoms that TS has should be obtained.

Additional Objective Information

Additional objective information should be obtained in TS’s case to guide the development of an accurate diagnosis and treatment plan. Firstly, the nurse should provide information about TS’s general appearance. Information such as her overall grooming, weight changes, presence or absence of chills or fatigue should be included in the objective portion. Abdominal assessment should provide information about the presence or absence of organomegaly, or abnormal pulsations. The case study should also provide detailed information about urine description (Bono et al., 2024). This includes urine color, smell, and the presence or absence of pus or blood in the urine.

The nurse should also provide information about the assessment of the genitourinary system. Information such as the presence or absence of vaginal discharge, lesions, or trauma should be documented to rule out causes such as sexually transmitted infections and intimate partner violence. The nurse should also assess TS’s level of pain. She should use a pain rating scale to determine the severity of her pain and prioritize the treatment plan accordingly (Boon et al., 2021). Pain assessment should also include TS’s experiences of pain on abdominal palpation.

If the Assessment is Supported by Subjective and Objective Information

Subjective and objective information support TS’s assessment. Nurses obtain subjective information by asking patients questions that relate to their health problems and different body systems. The subjective data helps the nurse determine the severity of a health problem and its impact on the client’s health and overall well-being. TS’s case study has subjective information. They include her chief complaints, history of her presenting illness, surgical history, past medical history, medication use, allergies, and social history. Nurses obtain objective data from their patients by using methods such as inspection, palpation, auscultation, and percussion. The objective data validates subjective claims by the patient. The case study has objective information. They include TS’s vital signs, abdominal assessment, and diagnostics ordered.

Appropriate Diagnostics for the Case

Some diagnostic and laboratory investigations should be ordered in TS’s case study to guide develop an accurate diagnosis and treatment plan. Firstly, a urinalysis test should be performed to rule out urinary tract infections. A diagnosis of urinary tract infection will be made should her urine test reveal the presence of leucocytes and nitrites. The presence of proteins in urine will indicate cardiovascular problems such as hypertension while the presence of glucose would imply that TS has diabetes. The presence of ketones will indicate the possibility of dehydration. TS should also be tested for sexually transmitted infections. Blood tests, vaginal swabs, and urine samples should be taken to rule out sexually transmitted infections such as gonorrhea and chlamydia infections. An abdominal CT scan should also be performed to rule out causes such as kidney stones. MRI might also be needed to rule out kidney stones and other renal pathologies that could be associated with TS’s problems (Kaur & Kaur, 2021). Lastly, cervical screening for cervical cancer should be done. Cervical screening would also help rule out other causes such as vaginosis in TS’s case.

Accepting or Rejecting Current Diagnosis Differential Diagnoses

I would accept the current diagnosis. TS’s complaints align with those seen in patients with urinary tract infections and sexually transmitted infections. Often, patients with these conditions experience dysuria, urgency, frequency, and fever, which are present in TS’s case (Bono et al., 2024). Therefore, additional diagnostic and laboratory tests will help determine if TS is suffering from STDs or UTIs. TS’s history of engaging in unprotected sex with her new partner makes STDs among the probable diagnoses to be considered.

One of the differential diagnoses that should be considered for TS is perinephric abscess. Perinephric access is a condition that develops from the spread of infections from other regions of the genitourinary tract to the kidneys (Okafor & Onyeaso, 2024). The infections result in the development of abscesses. Patients experience symptoms that include fever, chills, nausea, vomiting, flank pain, and fatigue (Adams et al., 2020). Unlike urinary tract infections or STDs, patients with perinephric abscesses might not experience symptoms such as urinary frequency or dysuria.

The other differential diagnosis that should be considered for TS is urethral syndrome. Urethral syndrome is a genitourinary condition characterized by urinary frequency, urgency, suprapubic pain, and dysuria. It develops from any condition that causes urethral irritation and inflammation. The urethral syndrome can develop due to sexually transmitted infections, urinary tract infections, or the use of foods that irritate the urethra (Sell et al., 2021). A confirmed diagnosis of either UTI or STD might indicate its co-existence with urethral syndrome.

The last differential diagnosis that should be considered for TS is kidney stones. Kidney stones develop from crystal deposition in the kidneys. Factors such as dehydration, intake of diets rich in salt, and overweight or obesity predispose individuals to kidney stones. Patients experience symptoms such as severe, sharp back or flank pain, pain radiating to the groin or lower abdominal regions, and dysuria. Patients might also report passing red or brown urine, foul-smelling and cloudy urine, frequency, nausea and vomiting, chills, and fever (Thongprayoon et al., 2020; Wang et al., 2021). The absence of red or brown-colored urine and sharp pain show that kidney stones are not the cause of TS’s complaints.

Conclusion

Overall, additional subjective and objective information should be obtained in the case study. Subjective and objective data support the assessment. Additional diagnostics and laboratory investigations should be ordered to develop an accurate diagnosis and treatment plan. I accept the current diagnosis based on TS’s symptoms. The three differential diagnoses that should be considered in TS’s case study include kidney stones, urethral syndrome, and perinephric abscess.

 References

Adams, M., Bouzigard, R., Al-Obaidi, M., & Zangeneh, T. T. (2020). Perinephric abscess in a renal transplant recipient due to Mycoplasma hominis: Case report and review of the literature. Transplant Infectious Disease, 22(5), e13308. https://doi.org/10.1111/tid.13308

Bono, M. J., Leslie, S. W., & Reygaert, W. C. (2024). Uncomplicated Urinary Tract Infections. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK470195/

Boon, H. A., Bruel, A. V. den, Struyf, T., Gillemot, A., Bullens, D., & Verbakel, J. Y. (2021). Clinical Features for the Diagnosis of Pediatric Urinary Tract Infections: Systematic Review and Meta-Analysis. The Annals of Family Medicine, 19(5), 437–446. https://doi.org/10.1370/afm.2684

Kaur, R., & Kaur, R. (2021). Symptoms, risk factors, diagnosis and treatment of urinary tract infections. Postgraduate Medical Journal, 97(1154), 803–812. https://doi.org/10.1136/postgradmedj-2020-139090

Okafor, C. N., & Onyeaso, E. E. (2024). Perinephric Abscess. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK536936/

Sell, J., Nasir, M., & Courchesne, C. (2021). Urethritis: Rapid Evidence Review. American Family Physician, 103(9), 553–558.

Thongprayoon, C., Krambeck, A. E., & Rule, A. D. (2020). Determining the true burden of kidney stone disease. Nature Reviews Nephrology, 16(12), Article 12. https://doi.org/10.1038/s41581-020-0320-7

Wang, Z., Zhang, Y., Zhang, J., Deng, Q., & Liang, H. (2021). Recent advances on the mechanisms of kidney stone formation (Review). International Journal of Molecular Medicine, 48(2), 1–10. https://doi.org/10.3892/ijmm.2021.4982

Sample Answer for NURS 6512 Assignment 1: Lab Assignment: Assessing the Genitalia and Rectum

Assessment is one of the skills that nurses should possess in their practice. Nurses use their assessment knowledge and skills in developing accurate diagnoses and plans of care for their patients. The assessment skills that nurses often use in their practice include history taking and physical examination such as observation, palpation, percussion, and auscultation. Assessment results also guide the evaluation of care given to the patients. Nurses use evaluation information to determine the accuracy of their diagnoses, plans, and interventions used to address the care needs of their patients. Therefore, this paper is an examination of a case study of client who presented to the clinic with genitourinary problem. The client came with a history of external pumps in her genital area, which are painless and rough. The history obtained from her shows that she had the last pap smear test three years ago, which was normal. The patient does not have any significant medical, family or surgical history. Therefore, the paper examines the subjective and objective data that should be obtained for the patient, diagnostic investigations and differential diagnoses for the client.

Additional Subjective Data

The nurse should focus on obtaining additional subjective data from the patient besides those in the case snapshot. The additional subjective data will guide the development of accurate diagnosis and treatment plan for the client. The nurse should obtain the information about additional symptoms that are associated with the external pumps on her genitalia (Stephen & Skillen, 2020). The nurse should obtain information such as size, shape, any discharge, or changes in the pumps that might have occurred over the past in terms of appearance. The nurse should also obtain additional information about any history of similar pumps in the past. A history of closely related pumps of the genital area could guide the development of diagnoses such as warts in the patient. There is also the need for the nurse to obtain information related to medication use by the patient. A history of medication uses such as those used in managing the pumps could aid in determining the cause of the problem (Stephen & Skillen, 2020). History on medication use could also guide the determination of whether the pumps are attributable to side effects or adverse reactions to a drug.

Moreover, the nurse should obtain information about the use of any irritants in the past that might have caused the pump. For example, information about the types of soaps that the patient uses should be obtained. The client should also be asked about her sexual preferences. This will provide information about her sexual habits, which might have led to the development of the pumps. The effect of the pumps on the self-perception of the client should also be obtained. The nurse should try to rate the effect of the pumps on her self-image and self-esteem using an appropriate rating scale (Forbes & Watt, 2020). The additional subjective data that may be needed include history of skin problems such as eczema, menstrual history, and occupational history to determine any risk factors in her workplace place.

Additional Objective Data

Additional objective data should also be obtained from the client to increase the accuracy of the diagnosis. The nurse should have performed a rectal examination. The examination could have provided clues such as the presence of hemorrhoids or anal fissures. The nurse should have also provided information about the general appearance of the client. The general appearance could have provided clues on the social, emotional and physical impact of the pumps on the client (Cox, 2019). The nurse should have also performed head to toe examination of the client. The examination could have included the assessment of the skin to determine the existence of undetected skin lesions. The nurse should have also examined the oral cavity for any lesions, neck for inflamed lymph nodes and neck rigidity. The nurse should have also assessed the chest for any abnormal findings such as appearance, shape, or palpitations on auscultation (Champagne et al., 2017). The above information could have guided the accuracy of the diagnoses made by the nurse.

Whether Subjective and Objective Data Support the Assessment

The assessment is supported by subjective and objective data. Subjective data is the data that the patient provides concerning her experience with the health problem. The information is based on the perceived experiences by the patient and the management of the health problem. Subjective data provides the basis of assessment and physical examinations of the patient. The examples of subjective data that support the assessment include the client’s complaints, history of the complains, history of any vaginal discharge, her Pap smear examinations, and any significant past medical, surgical and family history. Objective data on the other hand is the data that the nurse obtains using assessment and physical examination techniques. The data is not based on the subjective experiences of the patient with the disease but the physiological changes in the patient due to the disease. Objective data is used to validate the subjective data (Perry et al., 2021). The examples of objective data in the case study include vital signs, auscultation of the heart and lungs and the observation of the genitalia. The diagnostic investigations that were ordered also form part of the objective data.

Diagnostics

The development of accurate diagnosis of the client’s problem can be achieved by performing a number of diagnostic investigations. One of them is skin scrap. A scrap of the pumps can be obtained for laboratory examination. The other investigation is tzank smear to test for herpes simplex. The client should be tested for syphilis using diagnostics such as Darkfield microscopy or enzyme immunoassay (Perry et al., 2021).

Current Diagnosis

The current diagnosis of chancre is accurate. Patients with chancre present with symptoms similar to those of the client in the case study. For example, the ulcers are asymptomatic and can last for a period of up to six weeks (Cox, 2019).

Differential Diagnoses

One of the differential diagnoses that should be considered for the patient in the case study is contact dermatitis. Contact dermatitis is a skin condition that is characterized by symptoms such as the presence of rashes, which are dry, scaly and cracked. It is however the least likely due to the absence of itchiness and oozing or crusting of the rashes. The second differential diagnosis is syphilis. The client has a history of multiple sexual partners, which predisposes her to syphilis. Patients with syphilis also show skin rashes such as chancre in the early stages of syphilis. The last differential diagnosis is herpes simplex. Patients with herpes simplex may have symptoms such as rashes in the genitals (Perry et al., 2021). However, it is least unlikely for the patient due to the lack of symptoms such as lymphadenopathy and fever.

Conclusion

The diagnosis of chancre in the case study is accurate. Additional subjective and objective data should be obtained to come up with an accurate diagnosis. Differential diagnoses such as syphilis, herpes simplex, and contact dermatitis should however be considered. In addition, further diagnostic investigations should be performed to come up with an accurate diagnosis.

References

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Forbes, H., & Watt, E. (2020). Jarvis’s Health Assessment and Physical Examination – E-Book: Australian and New Zealand. Elsevier Health Sciences.

Perry, A. G., Potter, P. A., Ostendorf, W., & Laplante, N. (2021). Clinical Nursing Skills and Techniques—E-Book. Elsevier Health Sciences.

Stephen, T. C., & Skillen, D. L. (2020). Canadian Nursing Health Assessment. Lippincott Williams & Wilkins.