NURS 6512 Assessing the Genitalia and Rectum
Walden University NURS 6512 Assessing the Genitalia and Rectum-Step-By-Step Guide
This guide will demonstrate how to complete the Walden University NURS 6512 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 Assessing the Genitalia and Rectum
Whether one passes or fails an academic assignment such as the Walden University NURS 6512 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 Assessing the Genitalia and Rectum
The introduction for the Walden University NURS 6512 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 Assessing the Genitalia and Rectum
After the introduction, move into the main part of the NURS 6512 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 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 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 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. The purpose of this paper is to explore the potential history, physical exam, and differential diagnosis 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.
My experience with my leadership so far has been mostly positive. There was one instance that I will never forget when this executive leader, who is supposed to hold one of the highest positions in the hospital, came to visit our unit during our morning huddles. We discussed the new staffing method the hospital is about to implement, known as the NHPPD (Nursing actual Hours Per Patient Day) method. Of course, questions about patient acuities came up. Our unit is known for caring for acute medical psyche geriatric patients and is the designated acute medical-surgical- COVID unit. Our concern, of course, is patient acuities. The presenter did not answer many of our questions directly or clearly. Finally, the executive leader said, “If you are not happy with the staffing method, the door is open for you.” For us staff, it simply means shut up and suck it up, or you may be free to resign. I understand that being a leader is stressful, and you may not be able to please everybody, but still, you are being looked up to, and your knowledge, decisions, and attitude as a leader your subordinates are following as an inspiration. Patience is a virtue. A leader should be a force to calm down and bring balance. People look up to you for answers and solutions if there is an issue. Clearly, that leader did not show patience or compassion to her staff.
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/
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Patients are frequently uncomfortable discussing with healthcare professional’s issues that involve the genitalia and rectum; however, gathering an adequate history and properly conducting a physical exam are vital. Examining case studies of genital and rectal abnormalities can help prepare advanced practice nurses to accurately assess patients with problems in these areas.
In this Lab Assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.
To Prepare
• Review the Episodic note case study your instructor provides you for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your Episodic note case study.
• Based on the Episodic note case study:
o Review this week’s Learning Resources, and consider the insights they provide about the case study. Refer to Chapter 3 of the Sullivan resource to guide you as you complete your Lab Assignment.
o Search the Walden library or the Internet for evidence-based resources to support your answers to the questions provided.
o Consider what history would be necessary to collect from the patient in the case study.
o Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
o Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Lab Assignment
Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature.
• Analyze the subjective portion of the note. List additional information that should be included in the documentation.
• Analyze the objective portion of the note. List additional information that should be included in the documentation.
• Is the assessment supported by the subjective and objective information? Why or why not?
• Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?
• Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.
By Day 7 of Week 10
Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
• Please save your Assignment using the naming convention “WK10Assgn+last name+first initial.(extension)” as the name.
• Click the Week 10 Assignment Rubric to review the Grading Criteria for the Assignment.
• Click the Week 10 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK10Assgn+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Week 10 Assignment Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 10 Assignment draft and review the originality report.
Submit Your Assignment by Day 7 of Week 10
To participate in this Assignment:
Week 10 Assignment
________________________________________
What’s Coming Up in Module 4?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
Next week, you will consider how evidence-based practice guidelines and ethical considerations factor into health assessments. You specifically explore evidence-based practice guidelines and ethical considerations for specific scenarios.
Week 11 Final Exam
Photo Credit: [DirtyDog_Creative]/[Vetta]/Getty Images
Next week, you take your Final Exam, which will cover the topics and resources from Weeks 7, 8, 9, and 10 for this course. Please take the time to review and plan your time accordingly so that you may be better prepared for your exam.
Next Module
To go to the next Module:
Module 4
Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal
One critical element of any physical exam is the ability of the examiner to put the patient at ease. By putting the patient at ease, nurses are more likely to glean quality, meaningful information that will help the patient get the best care possible. When someone feels safe, listened to, and cared about, exams often go more smoothly. This is especially true when dealing with issues concerning breasts, genitals, prostates, and rectums, which are subjects that many patients find difficult to talk about. As a result, it is important to gain a firm understanding of how to gain vital information and perform the necessary assessment techniques in as non-invasive a manner as possible.
For this week, you explore how to assess problems with the breasts, genitalia, rectum, and prostate.
Learning Objectives
Students will:
• Evaluate abnormal findings on the genitalia and rectum
• Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the breasts, genitalia, prostate, and rectum
________________________________________
Learning Resources
Required Readings (click to expand/reduce)
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
• Chapter 17, “Breasts and Axillae”
This chapter focuses on examining the breasts and axillae. The authors describe the examination procedures and the anatomy and physiology of breasts.
• Chapter 19, “Female Genitalia”
In this chapter, the authors explain how to conduct an examination of female genitalia. The chapter also describes the form and function of female genitalia.
• Chapter 20, “Male Genitalia”
The authors explain the biology of the penis, testicles, epididymides, scrotum, prostate gland, and seminal vesicles. Additionally, the chapter explains how to perform an exam of these areas.
• Chapter 21, “Anus, Rectum, and Prostate”
This chapter focuses on performing an exam of the anus, rectum, and prostate. The authors also explain the anatomy and physiology of the anus, rectum, and prostate.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
Chapter 5, “Amenorrhea”
Amenorrhea, or the absence of menstruation, is the focus of this chapter. The authors include key questions to ask patients when taking histories and explain what to look for in the physical exam.
Chapter 6, “Breast Lumps and Nipple Discharge”
This chapter focuses on the important topic of breast lumps and nipple discharge. Because breast cancer is the most common type of cancer in women, it is important to get an accurate diagnosis. Information in the chapter includes key questions to ask and what to look for in the physical exam.
Chapter 7, “Breast Pain”
Determining the cause of breast pain can be difficult. This chapter examines how to determine the likely cause of the pain through diagnostic tests, physical examination, and careful analysis of a patient’s health history.
Chapter 27, “Penile Discharge”
The focus of this chapter is on how to diagnose the causes of penile discharge. The authors include specific questions to ask when gathering a patient’s history to narrow down the likely diagnosis. They also give advice on performing a focused physical exam.
Chapter 36, “Vaginal Bleeding”
In this chapter, the causes of vaginal bleeding are explored. The authors focus on symptoms outside the regular menstrual cycle. The authors discuss key questions to ask the patient as well as specific physical examination procedures and laboratory studies that may be useful in reaching a diagnosis.
Chapter 37, “Vaginal Discharge and Itching”
This chapter examines the process of identifying causes of vaginal discharge and itching. The authors include questions on the characteristics of the discharge, the possibility of the issues being the result of a sexually transmitted infection, and how often the discharge occurs. A chart highlights potential diagnoses based on patient history, physical findings, and diagnostic studies.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
• Chapter 3, “SOAP Notes” (Previously read in Week 8)
Cucci, E., Santoro, A., DiGesu, C., DiCerce, R., & Sallustio, G. (2015). Sclerosing adenosis of the breast: Report of two cases and review of the literature. Polish Journal of Radiology, 80, 122–127. doi:10.12659/PJR.892706. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356184/
Sabbagh , C., Mauvis, F., Vecten, A., Ainseba, N., Cosse, C., Diouf, M., & Regimbeau, J. M. (2014). What is the best position for analyzing the lower and middle rectum and sphincter function in a digital rectal examination? A randomized, controlled study in men. Digestive and Liver Disease, 46(12), 1082–1085. doi:10.1016/j.dld.2014.08.045
Westhoff , C. L., Jones, H. E., & Guiahi, M. (2011). Do new guidelines and technology make the routine pelvic examination obsolete? Journal of Women’s Health, 20(1), 5–10.
This article describes the benefits of new technology and guidelines for pelvic exams. The authors also detail which guidelines and technology may become obsolete.
Centers for Disease Control and Prevention. (2019). Sexually transmitted diseases (STDs). Retrieved from http://www.cdc.gov/std/#
This section of the CDC website provides a range of information on sexually transmitted diseases (STDs). The website includes reports on STDs, related projects and initiatives, treatment information, and program tools.
Document: Final Exam Review (Word document)
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Optional Resource
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
• Chapter 8, “The Chest: Chest Wall, Pulmonary, and Cardiovascular Systems; The Breasts” (Section 2, “The Breasts,” pp. 434–444)
Section 2 of this chapter focuses on the anatomy and physiology of breasts. The section provides descriptions of breast examinations and common breast conditions.
• Chapter 11, “The Female Genitalia and Reproductive System” (pp. 541–562)
In this chapter, the authors provide an overview of the female reproductive system. The authors also describe symptoms of disorders in the reproductive system.
• Chapter 12, “The Male Genitalia and Reproductive System” (pp. 563–584)
The authors of this chapter detail the anatomy of the male reproductive system. Additionally, the authors describe how to conduct an exam of the male reproductive system.
• Review of Chapter 9, “The Abdomen, Perineum, Anus, and Rectosigmoid” (pp. 445–527)
Required Media (click to expand/reduce)
Special Examinations – Breast, Genital, Prostate, and Rectal – Week 10 (14m)
Online media for Seidel’s Guide to Physical Examination
It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 16 and 18–20 that relate to special examinations, including breast, genital, prostate, and rectal. Refer to the Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/
Sample Answer 2 for NURS 6512 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 that supports the assessment.
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
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
Champagne, B. J., Steele, S. R., Hendren, S. K., Bakaki, P. M., Roberts, P. L., Delaney, C. P., … & MacRae, H. M. (2017). The American Society of Colon and Rectal Surgeons assessment tool for performance of laparoscopic colectomy. Diseases of the Colon & Rectum, 60(7), 738-744.
Cox, C. L. (2019). Physical Assessment for Nurses and Healthcare Professionals. John Wiley & Sons.
DOI: https://doi.org/10.1097/DCR.0000000000000817
Forbes, H., & Watt, E. (2020). Jarvis’s Health Assessment and Physical Examination – E-Book: Australian and New Zealand. Elsevier Health Sciences.
Kohtz, C., Brown, S. C., Williams, R., & O’Connor, P. A. (2017). Physical assessment techniques in nursing education: a replicated study. Journal of Nursing Education, 56(5), 287-291. https://doi.org/10.3928/01484834-20170421-06
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.
Sample Answer 3 for NURS 6512 Assessing the Genitalia and Rectum
The SOAP note concerns T.S, a 32-year-old female with symptoms of pain when voiding, urinary frequency, and urgency that has lasted two days. She mentions that she had similar symptoms years back. She also reports having flank pain that disrupts her sleep, and she feels warm. Physical exam findings include mild suprapubic tenderness. The purpose of this paper is to analyze the SOAP note, identify additional information needed, and describe likely diagnoses.
Subjective Portion
The HPI in the subjective portion should include information describing the timing of the dysuria. This includes whether the dysuria occurs at the start or end of voiding to establish the underlying pathology. Dysuria at the start suggests urethral pathology, while at the end of voiding suggests bladder pathology (AlShuhayb et al., 2022). The HPI should also include the persistence and severity of the dysuria. In addition, information on the characteristics of urine should be provided, for instance, the amount of urine and if the urine is malodorous, cloudy, or bloody. Information on the patient’s contraceptive use should be included in the HPI. The subjective portion should also include the client’s immunization history, current medications, reproductive history, including menstrual history, family history, and social history. Furthermore, the review of systems should have included each body system and indicated pertinent positives and negatives.
Objective Portion
The objective portion only contains findings from vital signs and pelvic exam. It should include anthropometric measures, height, weight, and BMI, vital in determining the client’s general nutritional status. In addition, physical findings from general, cardiovascular, and respiratory exams should be included since they are vital body systems. Findings from the examination of the external genitalia should be included to identify if the patient has vulvar ulcers, vesicles, pustules, mucosal inflammation, or vaginal discharge (AlShuhayb et al., 2022).
Assessment Supported
The identified assessment findings are UTI and STI. The subjective findings of dysuria, urinary frequency, urgency, and flank pain support UTI. It is also supported by objective findings of suprapubic tenderness (Czajkowski et al., 2021). STI is supported by the findings of dysuria, flank pain, feeling warm, and suprapubic tenderness.
Diagnostic Tests
Appropriate diagnostic tests include dipstick urinalysis, urine culture, blood culture, and vaginal nucleic acid amplification test (NAAT). Urinalysis is the most helpful diagnostic test in a patient with dysuria. Urine culture is indicated for patients with risk factors for complicated UTI or those who do not respond to initial therapy (Tai et al., 2022). A blood culture will be indicated since the patient reports feeling warm to, rule out systemic infection. In addition, vaginal NAAT will identify the presence of Chlamydia trachomatis and Neisseria gonorrhoeae.
Rejection or Acceptance
UTI is consistent with the patient’s pain symptoms when voiding, increased frequency, urgency, flank pain, and suprapubic tenderness. Thus, I would accept UTI as a diagnosis. STI is a broad term for other STIs; the diagnosis should be specific. Besides, the patient does not have sufficient physical findings to support STI; thus, I would reject the diagnosis.
Possible Conditions
Urinary Tract Infection (UTI): UTI in females present with symptoms like dysuria, a sensation of a full bladder, urinary urgency, frequency, suprapubic tenderness, flank pain, and blood in the urine (Jelly et al., 2022). It is also characterized by systemic symptoms such as fevers, chills, and malaise. The patient’s dysuria, increased frequency, urgency, flank pain, feeling warm, and mild suprapubic tenderness makes UTI a possible diagnosis.
Cystitis: This is a bladder infection. The onset of symptoms is usually sudden. Typical manifestations include dysuria, urinary frequency, urgency, and passing small volumes of urine (Frazier & Huppmann, 2020). Other common symptoms are suprapubic pain, low back pain, and nocturia. The patient has dysuria, increased frequency, urgency, and suprapubic tenderness, making Cystitis a possible diagnosis.
Ureth
ritis: This is inflammation of the urethra. Clinical features include urethral discharge dysuria, urethral irritation, or itch (Sadoghi et al., 2022). This is a differential diagnosis owing to the patient’s history of dysuria.
Conclusion
The subjective portion should have additional information to describe the dysuria and characteristics of urine. The ROS should have included pertinent negatives and positives from other systems. The objective portion lacks the anthropometric measurements and findings from general, cardiovascular, respiratory, and external genitalia exams. UTI is an acceptable diagnosis, but STI should be rejected due to a lack of adequate physical findings to support it. The possible diagnoses are UTI, cystitis, and urethritis.
References
AlShuhayb, F. H., Alanazi, M. G., Alghizzi, A. A., Khinkar, H. J., Ali, F. N., Alnahari, E. H. H. O., … & Aleidi, H. A. (2022). An Overview on Urinary tract infection Diagnostic and Management Approach in Primary Health Care. Archives of Pharmacy Practice, 1, 15. https://doi.org/10.51847/3neIMfJIpm
Czajkowski, K., Broś-Konopielko, M., & Teliga-Czajkowska, J. (2021). Urinary tract infection in women. Przeglad menopauzalny = Menopause review, 20(1), 40–47. https://doi.org/10.5114/pm.2021.105382
Frazier, R. L., & Huppmann, A. R. (2020). Educational Case: Acute Cystitis. Academic pathology, 7, 2374289520951923. https://doi.org/10.1177/2374289520951923
Jelly, P., Verma, R., Kumawat, R., Choudhary, S., Chadha, L., & Sharma, R. (2022). Occurrence of urinary tract infection and preventive strategies practiced by female students at a tertiary care teaching institution. Journal of Education and health promotion, pp. 11, 122. https://doi.org/10.4103/jehp.jehp_750_21
Sadoghi, B., Kränke, B., Komericki, P., & Hutterer, G. (2022). Sexually transmitted pathogens causing urethritis: A mini-review and proposal of a clinically based diagnostic and therapeutic algorithm. Frontiers in medicine, 9, 931765. https://doi.org/10.3389/fmed.2022.931765
Tai, L. H., Ho, S. W., Yeh, C. B., & Chen, C. C. (2022). Woman With Dysuria. Annals of Emergency Medicine, 79(5), e103-e104. https://doi.org/10.1016/j.annemergmed.2021.11.012
Sample Answer for NURS 6512 Assessing the Genitalia and Rectum
The SOAP note portrays a 21-year-old White female patient presenting with external bumps on her genital area. She describes the bumps as painless and rough but denies having abnormal vaginal discharge. The patient states that she had a history of chlamydia about two years ago, but she completed the medication. This paper analyzes the SOAP note’s subjective, objective, and assessment portion and discusses the differential diagnoses.
Subjective Portion
Additional information needed in the HPI includes condoms use and the medication the patient used in treating chlamydia. The PMH should include information on the age the patient was diagnosed with asthma and history of the last asthma attack and hospitalization due to asthma. Additional information is required on the allergies the patient has that trigger asthma attacks. The social history should include information on the patient’s level of education, employment, health promotion practices, exercise, diet, sleeping patterns, hobbies, and cultural practices. Furthermore, the subjective portion should include immunization status, surgical history, and reproductive health history. In addition, a review of systems (ROS) should be provided, including positive and negative symptoms in general, respiratory, cardiovascular, gastrointestinal, and genitourinary symptoms.
Objective Portion
The objective portion should have more information on findings from the general physical examination. This includes information on dressing and grooming, general health status, mood, speech, posture, gait, eye contact, and speech. Since it is a focused exam of the genitalia and rectum, information should be provided on speculum examination, bimanual examination, and rectal exam findings.
Assessment
The identified differential is chancre. Chancre refers to a painless ulcer with an indurated margin and a clean base (Roett, 2020). It is supported by subjective and objective findings based on the patient’s history of painless rough bumps on the external genitalia. Exam findings of a hard, round, small, painless ulcer on the external labia support the differential of chancre.
Diagnostics
Diagnostics are essential for this case scenario to help determine the causative agent of the genital ulcer. A genital ulcer is a common manifestation in various STIs, including
HSV infection, chancroid, syphilis, granuloma inguinale, and lymphogranuloma venereum (Maliyar et al., 2019). Diagnostic tests that should be indicated for this case include polymerase chain reaction testing or culture for HSV infection and HSV type-specific serology. Serologic testing is needed to rule out syphilis and culture for H. ducreyi to rule out chancroid (Maliyar et al., 2019). In addition, genital swabs or bubo aspirate can be tested for C. trachomatis through direct immunofluorescence, culture, or nucleic acid amplification to rule out lymphogranuloma venereum.
Differential Diagnoses
Chancre is a term used to describe a specific genital ulcer rather than a medical diagnosis. Therefore, I would reject the current diagnosis of chancre since it does not fit a medical diagnosis term. Conditions that may be considered differential diagnoses include:
Herpes simplex virus (HSV) infection
The initial manifestation of genital HSV infection includes multiple vesicular lesions, often painless, on the foreskin, vagina, labia, or rectum. The vesicles often rupture spontaneously to become painful, shallow ulcers (Roett, 2020). Prodromal symptoms often occur before the ulceration, including a mild tingling sensation or sharp pain in the hips, buttocks, or legs (Roett, 2020). Genital HSV is a differential diagnosis based on findings of painless rough external genital bumps and the presence of a hard, round, small, painless ulcer on the outer labia.
Primary Syphilis
The classic symptom of primary syphilis is a painless ulcer with an indurated margin and a clean base. Primary syphilis typically presents with solitary lesions, but multiple lesions can occur (O’Byrne & MacPherson, 2019). Infected persons may develop unilateral or bilateral painless, non-suppurative inguinal adenopathy after the appearance of the chancre (O’Byrne & MacPherson, 2019). Pertinent positive findings consistent with primary syphilis include the history of painless rough external bumps and findings of a firm, round, small, painless ulcer noted on the outer labia. Furthermore, the patient has a history of multiple sexual partners, which puts her at risk of contracting STIs such as syphilis.
Chancroid
Chancroid manifests with a non-indurated and painful genital ulcer with a serpiginous border and friable base. The genital ulcers develop on the prepuce and frenulum of the penis in men or on the vulva or cervix in females (Lautenschlager et al., 2017). In addition, infected persons have tender, suppurative, unilateral inguinal lymphadenopathy (Lautenschlager et al., 2017). Chancroid is a differential diagnosis based on the presence of a genital ulcer on the outer labia. However, the patient’s ulcer is painless, making it a less likely primary diagnosis.
Conclusion
The subjective portion should include additional information on contraceptive use, history of asthma, surgical, reproductive history, social history, and ROS. The objective portion should include findings from the general exam, speculum, bimanual, and rectal exam. Diagnostics are appropriate to rule out or confirm HSV infection, chancroid, syphilis, granuloma inguinale, and lymphogranuloma venereum. The possible differential diagnoses include HSV infection, syphilis, and chancroid.
References
Lautenschlager, S., Kemp, M., Christensen, J. J., Mayans, M. V., & Moi, H. (2017). 2017 European guideline for the management of chancroid. International journal of STD & AIDS, 28(4), 324-329. https://doi.org/10.1177/0956462416687913
Maliyar, K., Mufti, A., Syed, M., Selk, A., Dutil, M., Bunce, P. E., & Alavi, A. (2019). Genital ulcer disease: a review of pathogenesis and clinical features. Journal of cutaneous medicine and surgery, 23(6), 624-634. https://doi.org/10.1177/1203475419858955
O’Byrne, P., & MacPherson, P. (2019). Syphilis. BMJ (Clinical research ed.), 365, l4159. https://doi.org/10.1136/bmj.l4159
Roett, M. A. (2020). Genital Ulcers: Differential Diagnosis and Management. American Family Physician, 101(6), 355-361.