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NSB103 Health Assessment Reproductive health assessment across the lifespan. Prepared and presented by Dr Helen Donovan Kind acknowledgments for contributions to renal and genito urinary slides by Dr Pauline Gillan....

NSB103 Health Assessment Reproductive health assessment across the lifespan. Prepared and presented by Dr Helen Donovan Kind acknowledgments for contributions to renal and genito urinary slides by Dr Pauline Gillan. 1 Overview of this lecture Reproductive system Anatomy & Male and female physiology Hormonal influences Health Subjective & objective Assessment Across the lifespan Clinical Health Assessment Reasoning Health problems and goals. Cycle 2 Genito urinary System Renal/urinary system + Reproductive systems Kidneys Ureters Urinary bladder Urethra Reproductive organs 3 Female genito urinary anatomy 4 Male genitourinary anatomy Penis; scrotum; testes; spermatic cord Urethra; prostate gland (normal enlargement) Urinary bladder, ureters, kidney. 5 Reproductive hormonal changes across the lifespan. 6 Assessing the female reproductive system across the life span. 7 Female internal and external genitalia. 8 Assessing the female newborn genitalia. Female Skin Presence of normal anatomy for a newborn Maternal Hormonal influences Engorged and oedematous labia majora and prominent and protruding labia minora Enlarged clitoris Vaginal discharge (white, pink) normal to 1 month Breast buds may be evident 9 Ambiguous genitalia in the female. Virilized female Virilized female Enlarged clitoris Enlarged labia majora Fused labia majora 10 Skin rashes and infections Thrush/candida excoriation 11 Examination of female toddlers and female children Dependent upon age Examination is limited to inspection of the external genitalia Internal examination of the female genitalia not until puberty unless it is absolutely necessary. Gain cooperation from child and informed consent from the parents. Parent presence at the discretion of the child Privacy, warm environment, exposure to a minimum at all times. Positioning – supine in frog position or lithotomy in stirrups Prepubertal female internal examinations -Paediatric speculum or nasal speculum (medical personnel only usually) Sometimes paediatric genital examinations need to be under general anaesthetic. Helen Donovan Semester 1: 2021. 12 Female adolescent reproductive examination Parental presence is up to the adolescent Privacy and confidentiality assured Assess menstrual history Sexual maturity development (Tanners) Pelvic examination if requiring contraception Genital or vaginal irritation or infection Pap smears when sexually active 13 Adult Female reproductive system Assessment : history of Reproductive cancers (cervical, ovarian, endometrial) Sexual history (sexually transmitted diseases, discharge, sores, irritation) Obstetric history (menstruation, pregnancy ie. previous, ectopic, spontaneous abortions) Mittelschmerz (mid-cycle “ovary pain”),PMS,dysmenorrhoea, amenorrhoea, menorrhagia Metorrhagia (break through bleeding), epimenorrhagia (cyclical bleeding too often and too heavy) Polymenorrhea (cyclical bleeding too often but normal amount), endometriosis & retrograde bleeding Menopause symptoms (menstrual cycle, hot flashes, excessive sweating, palpitations, headaches, vaginal dryness, painful intercourse, changes in libido, mood swings) Assess for knowledge deficit and concerns. Examination – by medical personnel or nurse practitioners. Assure privacy and confidentiality (sheet, pillow) Minimal exposure at all times Warm room temperature. Informed consent Empty bladder Supine/lithotomy 14 Inspection, palpation and bimanual examination female adult reproductive system. Pubic hair and skin for distribution and health Female hair distribution (inverted triangle) condition of skin Palpate and inspect external genitalia Inflammation, oedema, excoriation, leukoplakia, ulceration, Labia majora/minora, clitoris and surface. drainage, lesions, nodules and asymmetry. Urethral meatus, vaginal introitus and perineum Perianal area and anus Pain, irritation, trauma, discolouration Speculum examination Cervix Discharge from Skene’s glands or urethral opening. Polyps, Pap smears inflammation or lateral position of the meatus Cultures Nodules, cysts, discomfort in vaginal wall. Bimanual examination Palpation of the vagina, cervix and uterus Enlarge, irregular cervix, ovaries. Medical staff or nurse practitioner. 15  OTHER REPRODUCTIVE HEALTH ISSUES FOR WOMEN Retroversion and retroflexion of the uterus May cause birth trauma / tumours Fibroid tumours (can palpate) Pelvic Inflammatory Disease Sexually Transmitted Infection 16 Sexually Transmitted Infections Female Syphilus - spirochaete Gonorrhea – bacterium Genital Herpes Simplex Virus (HSV) Chlamydia – bacterium Trichomoniasus - protozoan Human Papillomavirus (HPV) Vaginal Candidiasis – yeast Human Immunodeficiency Virus (HIV) Hepatitis B Virus (HBV) Pubic lice Scabies 17 The Female BREAST Tail of Spence 18 The Male Breast Men do get breast cancer 19 Breast assessment: both male and female Pain/tenderness Swelling or oedema Breast lumps or masses Nipple dimpling Nipple discharge Changes in nipples Health practitioner's examination as per self examination. 20 BREAST SELF EXAMINATION (BSE) Sourced from http://health.allrefer.com 21 BREAST SELF EXAMINATION (BSE) Sourced from http://health.allrefer.com Helen Donovan Semester 1: 2021. 22 SCREENING FOR BREAST CANCER Sourced from http://health.allrefer.com 23 Assessing for Pregnancy HCG in urine (>14 days) blood >9-10 days) Breast changes( 3-4 weeks) Amenorrhea (4 weeks) Ultrasound (4-5 weeks) Morning sickness (4-14 weeks) Skin pigmentation changes (>8 weeks) Bladder irritability (6-12 weeks) 24 Assessing the Pregnant Woman. Partnership Model Assessment - knowledge of changes in pregnancy physiological and psychological - breast changes - abdominal palpation/vaginal examination - observations, BP, Pulse, Urinalysis, fetal auscultation - knowledge deficits and concerns Documentation 25  Primary Assessment The Initial Contact Obtaining history – social, medical, surgical, general, obstetric, family, referrals when necessary Physical Assessment – Abdominal exam, height, weight, BMI, baseline observations, pathology, further tests ordered if required Learning needs assessment in relation to the stage of the pregnancy and the woman’s concerns. Abdominal Examination Preparation – bed height, position of woman, empty bladder, privacy, cultural safety Inspection – skin changes, abdominal shape Palpation – warm hands, use finger pads, gentle firm pressure. Fundal, lateral and pelvic palpation 27 Lie Attitude Denominator Helen Donovan Semester 1: 2021. 28 Fetal position Abdominal organs displaced Abdominal muscle separation Ease to palpate and auscultate fetus 29 Auscultation Located over the anterior shoulder of the fetus Equipment – Pinards, stethoscope, doppler, Cardiotocograph (CTG) Normal Heart Rate 120 - 160bpm. Take maternal pulse prior to fetal heart rate (FHR) 30 Assessment of Labour. Stages of labour 1st stage Latent – 6-8 hours: cervix – 3-4 cms dilated Active – 3/4cms – fully dilated (10 cms) 2nd stage Full expulsion of the fetus 3rd stage Expulsion of the placenta and membranes 4th stage Immediate stage after the 3rd stage (neonatal and maternal condition) 31  Assessment in the Puerperium Maternal Neonatal 6 weeks uterine size returns to pre-pregnancy Growth and development Perineal injury inspected Episiotomy Weight gain Perineal tear Check genitalia Vaginal examination Medical practitioner Enlarged scrotum/labia reduced Cervical changes Breast buds absent Exam of ovary Uterus Output Breasts Full but comfortable (BF) Empty is not Breast Feeding Mental Health Post natal blues Post partum depression Post natal psychosis Dad’s as well. 32  Assessing the older female adult reproductive system. Female Menopause – changes to external genitalia Vaginal introitus reduces in size and the vagina narrows and mucosa thins and is dryer Uterus and ovaries decrease in size and ovarian follicles disappear. Cancers Cervix, breast, ovarian 33 Reproductive assessment older female adult- menopause When assessing, be sensitive and mindful of the woman’s emotional state Signs and Symptoms Mood swings Sudden tears Fatigue Sleep disorders Difficulty concentrating, disorientation, mental confusion Dizziness, light headedness, episodes of loss of balance Weight gain Increase in allergies Depression Anxiety, panic disorder Irritability Breast pain (swelling, tenderness) Aching muscles GI problems 34 osteoporosis Assessing the male reproductive system across the life span. 35 Assessing the male newborn genitalia. Male. Skin Presence of normal anatomy Urinary meatus (do not attempt to retract the foreskin) Palpate the scrotum for testes Transillumination to determine presence of fluid (hydrocele) or mass (inguinal hernia) Foreskin should cover the glans in the uncircumcised penis Pendulous scrotum 36 Male newborn: External genitalia. Hypospadius and Undescended Testis. 37 Hypospadias Urethral anomaly (urinary rather than reproductive) Can impact on reproductive ability Urethral opening is on the underside on the penis 1:500 boys First degree Second degree Third degree 38 Epispadias Severe epispadias Urethra opens on the upperside of the penis Defect in the anterior pelvic wall Wall of the bladder penis 39 Undescended Testicle Testicle in the Empty scrotum inguinal canal. Unilateral undescended testicle common at birth. Bilateral regarded to be ambiguous genitalia until proven otherwise 40 Acute Testicular Torsion twist in the spermatic cord 41 Objective Assessment (subjective first) Gain informed consent. Parent must give consent. Must obtain informed consent from the person. Reassure them of privacy and confidentiality Ensure they understand the purpose of the examination. Inspection Remember your stages of the interview. Skin Joining, working and termination. External anatomical structures Symmetry (testicular positioning) Swelling/inflammation/rashes Surgical procedures Palpate Texture of skin and tissues looking for tumours, cysts, scar tissue. 42 Ambiguous genitalia in the male & female. Under-virilized male Virilized female Micropenis Bifid scrotum Bilateral undescended testes Virilized female Enlarged clitoris Enlarged labia majora Fused labia majora Male with micropenis, cleft scrotum, 43 Circumcision Glans exposed 44 Examination of Male toddlers and male children Positioning – reclining position with knees flexed and close to buttocks. Retract the foreskin until tight (should be easily retracted by age 6). Do not force the foreskin to retract. Check for discharge, crusting, lesions around or under the foreskin. Examine the scrotum for shape, size, and colour. (should be well-formed with rugae. Small and flat scrotum indicates undescended testes) 45  Male adolescent reproductive examination Tanner’s stages Parental presence up to the adolescent Privacy and confidentiality assured Adequate draping Teen modesty at its peak Sexual maturity development (Tanners) 46 Male Adult Physical Assessment Inspection and palpation only Reassure privacy, confidentiality, safety. Beware of temperature and environment Professional communication with procedures explained Exposure limited as necessary only. Always assess knowledge deficits and concerns. 47 Adult male reproductive health assessment. Pubic hair for male distribution and skin condition Inability to retract the foreskin (phimosis), discomfort, inflammation, rashes, chancre, purulent discharge, changes in sexual function Inspect and palpate the penis Tenderness, irregular placement, enlargement, nodules. Inspect & palpate the scrotum (testes, epidiymides, Inflammation and lesions( eg haemorrhoids, warts, skin vas deferens) tags) Inspect the perianal area Bulges in the area of the external ring (inguinal hernia) Inspect the inguinal an femoral area. Medical staff for prostate exam. Rectal Examination (medical staff for medical diagnosis) Nursing staff for faecal impaction 48 Common male reproductive health pathology Penis paraphymosis Balanitis Urethral meatus Discharge Inflammation Scrotal Hydrocele Spermatocele Varicocele Inguinal hernia Testicular tortion Testicular tumour Orchitis Epididymitis 49 Sexually Transmitted Infections - male Syphilis Genital herpes Gonorrhorea Genital warts HPV HIV Hep B Hep C 50 TESTICULAR SELF EXAMINATION Presence of testes in each scrotal sac Equal in size Mildly sensitive (nontender) Smooth and ovoid Movable. Warm environment Younger men most prone to testicular cancer 51 Breast assessment: both male and female Pain/tenderness Swelling or oedema Breast lumps or masses Nipple dimpling Nipple discharge Changes in nipples Health practitioner's examination as per self examination. 52  Assessing the older male adult Young old - 65 – 74 years Middle old - 75 – 84 years Older old – 85 years and older Body system changes means that health assessments need to accommodate for age changes. 53 Assessing the older adult reproductive system. Male Hyperplasia of the prostate main changes Cancer Testicular, prostate, bladder. Enlarged prostate assessment Assess Male Urinary changes Difficulty starting urinary stream/hesitancy ‘weak’ stream Incomplete bladder emptying 55  Consider the person and the context. Who is the person? Where are they living? Who supports them? What is their experience? Present, past, family history. Collect Cues and Information. Subjective and objective Data Processing the Information. Compare the data against normal parameters. Analyse, organise, categorising. Identify potential health issues/problems. Relate back to the data for relevance and direction. Set goals in collaboration with the person and their family Each goal is aligned with each potential health issue or problem. 56 Potential Health Problems related to the Genito-Urinary &/or Reproductive System Goal: to improve activity levels by reducing the pain experienced. Activity intolerance related to pain (dysmenorrhoea) Fear of breast cancer related to increased risk Some goals can factors address 2 issues. Disturbed body image related to mastectomy Goal: to reduce fatigue levels by Disturbed sleep patterns related to menopausal reducing sleep symptoms of night sweats disturbance from Fatigue related to disturbed sleep night sweats Self care deficit due to severe interference with activities Discomfort related to contraction of an STI. Reduced skin integrity related to the contraction of an STI Maternal stress related to knowledge deficit of If the cause of your health normal pregnancy care problem is described clearly, then it is easy to see Reduced fetal well being related to maternal what changes are needed. hypertension Here the person cannot purchase food due to an activity intolerance from the pain they experience. 57 Bibliography. A & P 2. Human Development (updated 11/10/05). Intro Biology 1. http://faculty.southwest.tn.edu/rburkett/A&P2_reproductive_system_lab.htm accessed 20/3/2012. Crisp, J. & Taylor, C. 2009. Potter and Perry’s Fundamentals of Nursing. 3 rd Ed. Mosby. Elsevier. Crisp, J., Taylor, C., Douglas, C. & Rebeiro, G. 2013. Potter and Perry’s Fundamentals of Nursing. 4 th Ed. Mosby. Elsevier Estes, M., Calleja, P., Theobald, K. and Harvey, T. 2013. Health Assessment and Physical Examination. Cengage Learning. Fraser, D. and Cooper, M. (2009) Myles Textbook for Midwives 15 th ed. 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