NURS 306 Health Assessment Final

NURS 306 Health Assessment Final: 3 hours for exam – have VSIM and PrepU done by Wednesday Reproductive System • Female System: • Lymphatics of Female: ◦ Vulva to lower vagina – drain into inguinal nodes ◦ Internal genitalia – drains into pelvic/abdominal nodes (not palpable) • Reproductive History: ◦ Menstrual ▪ Menarche: age at onset of menses ▪ Menopause: absence of menses for 12 consecutive months (48-55 years) ▪ Postmenopausal bleeding: occurring 6 months or more after cessation of menses ▪ Amenorrhea: absence of menses ▪ Dysmenorrhea: pain with menses ▪ Polymenorrhea – menses occurs every fewer than 21 days ▪ Oligomenorrhea – infrequent bleeding – skip some months – see in athletes ▪ Menorrhagia – excessive bleeding lasting longer than 7 days ▪ Metrorahhgia – intramenstrual bleeding – bleed between periods ▪ Poccoital – bleeding after intercourse ▪ Premenstrual Syndrome (PMS): cluster of emotional, behavioral and physical symptoms occurring 5 days before menses for 3 consecutive cycles ▪ Frequency – every 24-32 days (average 28 days) ▪ Duration – 3-7 days ▪ Men should be involved – especially with ovulation: • Mid-term – 10-16 days into cycle (with 28 day cycle) • How do you tell? – Some people feel it, temperature goes up ◦ Obstetric ▪ Pregnancy: • Gravida (G): total number of pregnancies • Para (P): outcomes of pregnancies ◦ F: full-term ◦ P: premature ◦ A: abortion – induced or spontaneous ◦ L: living child • Ask about contraception – kind? Satisfied? ▪ Vulvovaginal symptoms – discharge/itching • Do COLDSPA – color, lumps, pain? ◦ Sexual ▪ Sexual preference and response: • Relationship status • Explain why you are asking • Affirm conversation is confidential ▪ Sexual contacts? History of STD’s? Safe Sex? • Health Promotion for Women: ◦ Note normal signs of aging – dryness, decreased estrogen, ovulation stops, thinning/graying of pubic hair, skin is less elastic ◦ Changes in anatomy from puberty to menopause, cervical cancer screening (PAP), early prenatal care, family planning, STD’s/HIV ▪ Cervical cancer: screen with PAP and HPV infection • Risk factors –viral/behavioral, high-risk strains • Other – early sexual activity, multiple partners, history of STD’s • HPV vaccine – 11-26 years old – preventative, does not treat ▪ STD’s and HIV: • Chlamydia trachomatis – most commonly reported • Infection rates higher in women (15-19 years old) ◦ Untreated – PID, infertile ◦ Transmission in women – heterosexual • Gonorrhea – also common • Syphilis – less common • Male System: • Lymphatics of Male: ◦ Penile and scrotal surfaces – drain into inguinal nodes ◦ Testes – drain into abdomen • Health History: ◦ Common/concerning symptoms ▪ Scrotal pain, swelling, lesions • Do COLDSPA – onset, painless? • Self-testicular examination ▪ Penile discharge or lesions • Leaking, dripping? • Had symptoms before? ▪ Problems with urination • BPH or cancer – men over 70 at risk • Weak flow? Starting or stopping issue? • Blood in urine? Discomfort or heaviness? • Day or night? How often? ▪ Inguinal pain/swelling • Point to area, may indicate hernia, unilateral/bilateral • When does it hurt? When lifting, standing, bending? ▪ Sexual preference/response • Assess libido/arousal phase – orgasm/ejaculation – absent, premature, early, out of control? • Sexual activity and history of STD’s ◦ Aging – not what is normal/educate patient ▪ Fewer viable sperm, decrease in testosterone levels, erections less firm, increase in prostate gland size, testes less firm/smaller • Physical Exam: ◦ Penis – inspection of skin, prepuce (retract to inspect), glans ◦ Scrotum and contents – inspect skin, lift for posterior, contours ▪ Look for epidermoid cysts – common and benign ▪ Look for edema ◦ Abnormalities: ▪ Hypospadias – urethral meatus/opening is under penis (line) ▪ Epispadias – meatus opening is anterior on penis (not at tip) ▪ Hydrocele – fluid filled sac around testicle – effects bottom so can put fingers above the mass ▪ Scrotal hernia – part of intestines down into scrotum – coming from top to bottom – cannot put fingers above the mass ▪ Genital warts ▪ Genital herpes simplex ▪ Syphilis ▪ Chancroid – infection with necrotizing ulcers ▪ Cryptorchidism – undescended testicle ▪ Acute orchitis – enlarge testicle ▪ Tumor of testicles – early (singular), late (multiple) ▪ Spermatocele and Cyst of the Epididymis – fluid filled cyst of the epididymis ▪ Varicocele of the Spermatic Cord – enlargement o