Flashcards in Male GU Deck (48):
What is in the ROS for male GU?
Urine first: Frequency of urination, urgency, hesitancy, retention
burning, pain with urination, polyuria, nocturia, hematuria, renal stones, reduced caliber of stream
Think Anatomy * Hernias, testicular pain or masses
penile discharge or lesions, STI's and Tx's, exposure to HIV, are you taking any precautions against HIV and STI's?
Sexual interest, orientation, function -satisfaction/problems. What are your methods of contraception, ask about abuse
Why are men so difficult to communicate with?
-males hesitate to speak
-don't feel comfortable
-anxiety is high and unexpressed
-they feel embarrassment
-Gender and age may affect interactions.
What constitutes professional demeanour?
-competence helps with patient trust confidence- or lack of it- can decrease or increase anxiety
-Acknowledge- patient's bodily responses
-Always make patient comfortable
-Ask permission before proceeding
-Be respectful always,
- make the pt feel at ease with bodily responses "its a normal process"
PMhx Screening, what are age appropriate questions?
-Date of last prostate exam
-Date of last PSA and result if known
- Date of last testicular exam
When obtaining a sexual history what can you ask?
Age of first coitus, number of sexual partners, how is your satisfaction? and problems? heamtospermia. Abuse, contraceptive/protection, privacy
When you ask questions make sure they are:
Why is anxiety high an unexpressed in males about GU concerns?
-They have anticipation of pain/discomfort
-Lack knowledge about proc
-previous bad experience with GU exam
-"urban legends" from friends
Why are males reluctant to seek preventitive healthcare or acknowledge need of assistance?
- access to health information is often limited: only look at media sources, internet, physician/clinician information available, go based off what family tell them.
-health beahaviors often neglected
How can your build the relationship with your male patient?
- ask open ended questions
-Maintain non-judgmental, respectful attitude
-Display tact, sensitivity, and humor when appropriate.
- explain what you are doing as you are doing it
- ask permission before proceeding
*pt consent is essential for invasive proc
What is the patients attitude affected by?
-cultural or religious beliefs
-previous positive or negative experiences
-what their friends tell them
What constitutes being sensitive towards your patient?
-Give the pt privacy to dress and undress
-Use drape to limit exposure
-Allow patient to cover up after exam
- Offer a tissue for cleaning.
Know anatomy for exam
Im not going to list it cause girl you know it :p
During a focused exam your are noting?
- any external abnormalities
-screening opportunity for testicular ca
- detection of hernias, swelling, or masses.
Relate findings and discuss them immediately with your patient
Before beginning the GU exam you should?
- explain the proc to the pt (diagrams or address pts concerns)
- Chaperone always
-Always wear gloves
-Perform exam with proper lighting
How should you position the patient?
Have pt lay in front of you and YOU raise his gown to umbiliquis
- note buldges or scars (herniation)
- look for obvious penile/scrotal abnormalities
-note any skin abnormalities on the penis, scrotum, or surrounding areas
How should you inspect the penis?
-first retract the foreskin (note circumcised or uncircumsized)
- Inspect glans (not inflamation, ulcers, nodules, or poor hygiene)
- return the foreskin to its natural position
- note location of urethral meatus (not discharge)
-palpate the shaft
Inspecting the scrotum you examine what ?
The skin of the scrotum, contour, swelling or buldges, testicles, epididymus
How do you perform testicular palpation?
-Gently palpate the tissue of the testes between thumb and forefinger----> each side should feel the same.
-Palpate from the epididymus to superficial inguinal ring
- If a testicle is missing, ask the pt why
surgically or cogenitally -> document why
- make not of an swelling, erythema, pain, nodules
-elicitated by light stroke of the superior medial (inner) thigh activates sensory nerve L1, L2
Nml finding - rise and fall of scrotum
What diagnosis is associated with testicular ca?
What diagnosis is transilluminate?
The celes: hydrocele & spermatocele
Varicocele are tender ? T or F
False, the diagnosis that are tender are epididymitis, torsion, anteverted epididymitus.
The femoral canal lies _____ in relation to the inguinal ligament
below the inguinal ligament
What are the three surrounding structures of the hasselback triangle
- inferior epigastric (lateral)
- rectus abdominus (medial)
- inguinal ligament (inferior)
What is the difference between indirect and direct inguinal hernias?
Indirect ---> through canal can lead to necrosis of intestines
direct---> breaches posterior inguinal wall, passes medial to inferior epigastic vessels.
How do you examine a hernia
-use your right hand for the right side. Left for the left.
- start low enough in the scrotom so your finger can reach far as the internal canal.
- follow the spermatic cord upward to above the inguinal ligament and find the triangular slit like opening.
-if you detect a diffuse swelling amidst the cord structure or note protuberance within the inguinal canal the pt has a hernia
Have the pt bear down and cough
- this manuever increases the abdominal pressure forcing the intestines/peritoneal fluid through any defect which may exist.
- for femoral hernia place fingers at anterior thigh in the region of the femoral canal and ask the pt to bear down or cough.
Incarcerated hernia are always tender? T or F
False can be both.
Strangulated hernias are
tender, show sign of tenderness or not, but require urgent intervension.
Common positions for the DRE include?
Modified lithotomy, left lateral position, standing flexed at hips
Before starting the DRE
-ask the pt if he feels stable and comfortable before proceeding
-make sure lighting is sufficient
To perform the DRE
-glove both hands and spread buttocks apart
-Inspect the sacrococcygeal and perianal areas (fissures, skin tags, hemorrhoids, bleeding, abscess draining)
- palpate throughout the rectum and the prostate, noting masses or tenderness.
- ask the pt about localized pain
-place lubricant and inform pt you are going inside
-talk through this part
- place index finger against the anus ask pt to bear down as if trying to have BM.
upwards, posteriorally, and laterally to feel for any rectal masses.
- orient fingers so that it is towards the umbilicus.
- In this position, your finger should be resting on the prostate
-collect stool put on guiac card for occult blood
What are possible rectal exam findings?
Nml rectal mucosa - feels uniformly smooth and pliable.
polyps may be attached by a stalk or base
masses or irregularly shaped nodules
areas of ununsual hardness
abscesses may be indicated by extreme tenderness
Prostate glands increase how many folds between puberty and age 20
5. Consistency of the prostate gland is rubbery and smooth. Urge to urinate is nml
By the 5th decade the prostate enlarges? T or F
loves you <3
A normal prostate consists of
- about 2.5 cm from side to side
- prominent median sulcus
-consistency is rubbery and smooth
- tenderness not usual but patient should feel urge to urinate when you palpate it.
How would you examine the prostate?
- Inform the pt first
-Use the same techniques as DRE (perform prostate exam while doing DRE actually)
- Sweep your finger over the prostate (found in anterior rectal wall)
- Identify the two lobes with a longitudinal groove (median sulcus between them )
- Note: size, nodularity, consistency, tenderness
The best position the patient should be in during prostate exam is ?
Most easily performed when pt is in decubital or lithotomy position.
What is abnormal findings in a prostate exam?
Boggy prostate- indicated inflammation
Abscence of a prostate can indicate
Ca or radiation therapy
What must you also not in the presence of an enlarged prostate?
If a patient has suprapubic abdominal pain, a distended abdomen, or both must
examine the prostate.
Concluding the prostate/rectal exam
-inform pt you are withdrawing finger
-note the color of any fecal matter on glove
- use fecal matter for guiac
-offer pt tissues for wiping
- always remove gloves outside the sight of your patiet
- allow pt to dress privately
-when should the pt follow up?
- Are you sending pt to specialist?
- Are there screening exams needed?
-When will the next physical exam be?
Patient education in young males < 40
- sexuality, including safe sex practices
- self-care including testicular exam