Reproductive Systems Assessments Paper
George, a 75-year-old patient, grapples with various conditions associated with his genitourinary system. These conditions include urinary hesitancy, increased nocturia, and post-void dribbling. Apart from the three health conditions, George manages other comorbidities, including hypertension, hypercholesterolemia, and osteoarthritis. Undeniably, his medical history will play a significant role in determining the trajectories of genitourinary examination, treatment, and clinical advice. George’s case study validates the importance of promoting reproductive and urinary health. In this sense, conducting a genitourinary examination is consistent with identifying underlying conditions such as cancer, hernias, malignant masses, and orchitis. While male genitalia examination is a profound process of bolstering reproductive and urinary health, this paper elaborates on a care plan for George while expounding ethical considerations and universal precautions necessary when conducting invasive examinations such as genitourinary exams. Reproductive Systems Assessments Paper
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A Plan for Genitourinary Examination for George
George complains about urinary hesitancy, increased nocturia, and postvoid dribbling. He reports symptoms such as frequent urination at night, the perception of dribbling, and urine hesitancy. Further, he visited the hospital for a regular follow-up appointment for hypertension, hypercholesterolemia, and osteoarthritis. These conditions are essential in informing assessment practices and care plans for George.
Steps for Conducting Genitourinary Examination
Based on George’s response to clinical questions regarding his medical history and symptoms like urine hesitancy, dribbling, and increased nocturia, it is vivid to contend that genitourinary examination is a necessary strategy for revealing the prospect of underlying conditions and informing treatment interventions. In this sense, male genitalia examination activities follow sequential techniques for examining external and internal genitalia anatomy and organs. In George’s case, it would be profound to conduct an abdominal examination, external genitalia exam, hernia and inguinal node exams, digital rectal examination (DRE), and upright exam. Reproductive Systems Assessments Paper
Abdominal examination
An abdominal examination provides diagnostic clues and indications regarding abnormalities in gastrointestinal and genitourinary pathologies. According to Mealie et al. (2021), “a well-performed abdominal examination decreases the need for detailed radiological investigations. Also, it plays a significant role in patient management. According to Mealie et al. (2021), the standard steps for conducting an abdominal exam include washing hands with an alcohol-based sanitizer to curtail the likelihood of infections, identifying the patient, providing a brief explanation regarding the steps, purpose, and expectations of the examination, and positioning the patient in a supine position necessary for palpating the abdomen. Reproductive Systems Assessments Paper
Abdominal palpation is an effective strategy for examining abdominal hernias. According to Ansari (2019), it is possible to diagnose hernias by the patient’s abdomen while they are in standing position. If palpation methods fails to detect hernias, it is essential to instruct the patient to cough or perform a Valsalva maneuver as the examiner palpates the abdominal walls. A properly-conducted abdominal examination can provide clues and indications of the underlying umbilical, ventral wall, fumeral hernias, depending on the focal location of the examiner. Finally, it is crucial to collaborate with the patient to identify and address perceptions of pain and discomfort during abdominal palpitations and hernia examination. Reproductive Systems Assessments Paper
External genitalia examination
The purpose of conducting an external genitalia examination is to identify abnormalities in external genital organs such as the penis, foreskin, and scrotum. According to the UC San Diego School of Medicine (2018), it is essential to ensure that the patient stands in front of the examiner and raises their gown to the level of the umbilicus, exposing the entire genital area. Before embarking on an external genitalia examination, it is crucial to put on a pair of gloves to guarantee hygiene and reduce exposure to infections.
The most profound strategies for conducting physical examination for external genitalia are inspection and palpation. During an inspection, it is essential to conduct various activities, including retracting the prepuce (foreskin) of the uncircumcised penis to inspect the glans and urethral meatus, and gently compressing the glans between thumps to inspect for patency, inflammation, or urethral discharge (Gawlik et al., 2022)Reproductive Systems Assessments Paper. On the other hand, palpation is essential in identifying abnormalities in the penis, epididymis, scrotum, and prostate gland. According to Gawlik et al. (2022), the examiner should place the index or middle finger posteriorly while placing the thump anteriorly when palpitating the penis, scrotum, and epididymis. A proper-conducted inspection and palpation can reveal multiple abnormalities on external genital organs and surfaces, including paraphimosis, penile condyloma, inguinal hernias, syphilitic ulcer, HSV cysts, and testicular enlargement caused by hydrocele, and orchitis. Other issues identifiable by an external genitalia exam include swellings and skin edema or redness Reproductive Systems Assessments Paper.
Digital rectal examination
After an external genitalia examination, it is essential to conduct a rectal/prostate exam to examine internal genital organs and tissues. Byram Health (2019) contends that a digital rectal exam (DRE) is crucial for evaluating the prostate gland and identifying enlargement or irregularities. On the other hand, Kennard (2022) argues that this examination is appropriate for male patients with prostate enlargement or cancer symptoms, including urinary retention, urgency, leakages, and dribbling. The standard steps for conducting this exam include positioning the patient in an ideal position for easy anal/rectal navigation, putting on surgical gloves, and covering the index finger with lubricant before inserting it into the patient’s rectum. Finally, the examiner should move the index finger in various directions to detect abnormalities such as enlargements, fissures, and masses in the prostate and other internal genital organs such as seminal vesicles, vas deferens, epididymis, bulbourethral gland, and ejaculatory duct Reproductive Systems Assessments Paper.
Special Considerations when Performing Genitourinary Examination for George
Genitourinary examination entails non-invasive and invasive procedures that expose the patient’s genitalia. Undeniably, any process or practice that exposes a patient’s genitalia is a subject of ethical and moral scrutiny because of the underlying perceptions of privacy violations and beliefs. Chiocca (2019) argues that healthcare professionals bear the obligation of considering ethical and personal perceptions, ideas, and views before endeavoring to conduct genitourinary examinations. In this sense, respecting patients’ beliefs, right to privacy, and opinions enables healthcare professionals to develop meaningful relationships with patients and deliver professional practices while eliminating perceptions of insecurity, privacy violation, and shame. Eventually, it is crucial to involve George in every aspect of the genitourinary examination to incorporate special considerations, including ethical and professional standards. The ideal strategies for incorporating ethical and professional considerations into genitourinary exams are obtaining consent, encouraging full information disclosure, ensuring comfort, and preserving George’s autonomy to control and impact examination activities Reproductive Systems Assessments Paper.
Obtaining consent and fully disclosing information
Genitourinary examination exposes the patient’s genitalia and results in perceptions of shame and discomfort. As a result, obtaining patients’ consent and providing necessary information are profound approaches to ensuring conformity and awareness of the processes. Queensland Health (2017) echoes the principle that patients have the right to decide what is appropriate for them, depending on their situations, beliefs, perceptions, and priorities. As a result, sharing information and obtaining consent is consistent with understanding patients’ needs and preferences and eliminating areas of uncertainty.
Ensuring comfort and preserving autonomy
Ensuring comfort during genitourinary examination entails various aspects, including proper lubrication, draping, dressing, proper lighting, and patient positioning (O’Laughlin et al., 2021). These aspects determine whether the patient conforms with processes or otherwise. On the other hand, preserving patients’ autonomy entails granting their requests and considering their opinions when making decisions. For example, male patients can request a male chaperone during the genitourinary examination. In such situations, it is essential to allow them to make choices and weigh options for bolstering their confidence and conformity with genitalia examination processes. Reproductive Systems Assessments Paper
Universal Precautions to Consider When Conducting a Genitourinary Examination
Undeniably, genitourinary examinations and associated techniques such as rectal exams can help healthcare professionals to detect, identify, and assess abnormalities in the internal genital organs such as the prostate. However, these approaches can exacerbate the underlying conditions by causing injuries, bleeding, and rectal fissures when adequate preparation and implementation strategies are lacking. These considerations validate the rationale for incorporating universal precautions into examination practices. According to Broussard & Kahwaji (2019), the Centers for Disease Control and Prevention (CDC) introduced universal precautions to curtail pathogen transmission from exposure to blood and other potentially infectious materials. These precautions include maintaining hand hygiene and ensuring contact precautions.
When conducting the genitourinary examination, it is essential to implement hand hygiene protocols and incorporate contact precautions into activities. For instance, abdominal, external genitalia, and rectal inspections entail various steps such as palpitations, inserting fingers, and navigating internal genital organs. As a result, there is a likelihood of infection transmission if proper protective measures are lacking. Hand hygiene and contact precautions applicable in the genitourinary examination include washing hands before and after contact with the patient, wearing gloves, and ensuring appropriate patient placement by avoiding crowded rooms. Reproductive Systems Assessments Paper
Conclusion
Conducting genitourinary examination and subsequent activities like abdominal, external genitalia, and rectal examinations promote patient health and well-being by detecting underlying health conditions like prostate cancer and other abnormalities. However, these procedures fall under invasive processes because they expose patients’ genitalia, raising ethical and professional questions. For instance, examiners should obtain consent, disclose information, ensure comfort, and preserve patients’ autonomy to decide care trajectories. These steps can eliminate perceptions of shame, discomfort, and fear associated with invasive procedures. Finally, it is crucial to incorporate universal precautions such as hand hygiene protocols and contact precautions to promote safer processes and intercept infection transmission patterns.
References
Ansari, P. (2019). Hernias of the abdominal wall. MSD Manual Professional Edition; MSD Manuals. https://www.msdmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/hernias-of-the-abdominal-wall
Broussard, I. M., & Kahwaji, C. I. (2019, March 16). Universal precautions. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470223/
Byram Healthcare. (2019, May 6). Commonly performed urology tests. Byram Healthcare. https://www.byramhealthcare.com/blogs/commonly-performed-urology-tests
Chiocca, E. M. (2019). Advanced pediatric assessment (3rd ed.). Springer Publishing.
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Gawlik, K., Bernadette Mazurek Melnyk, & Teall, A. M. (2022). Evidence-based physical examination handbook (1st ed., pp. 1–472). Springer Publishing Company.
Kennard, J. (2022, March 14). What is a prostate exam? Why and how it is done. Verywell Health. https://www.verywellhealth.com/prostate-examination-2329024
Mealie, C. A., & Manthey, D. E. (2019, July). Abdominal exam. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459220/
O’Laughlin, D. J., Strelow, B., Fellows, N., Kelsey, E., Peters, S., Stevens, J., & Tweedy, J. (2021). Addressing anxiety and fear during the female pelvic examination. Journal of Primary Care & Community Health, 12, 215013272199219. https://doi.org/10.1177/2150132721992195 Reproductive Systems Assessments Paper
Queensland Health. (2017). Guide to informed decision-making in health care. https://www.health.qld.gov.au/data/assets/pdf_file/0019/143074/ic-guide.pdf
UC San Diego School of Medicine. (2018). UC San Diego’s Practical Guide to Clinical Medicine: A comprehensive physical examination and clinical education site for medical students and other health care professionals. https://meded.ucsd.edu/clinicalmed/genital.html Reproductive Systems Assessments Paper
