The Reproductive Health Assessments Paper
Reproductive health is a profound priority area for healthcare professionals considering the prevalence of life-threatening conditions such as cancer and sexually transmitted infections (STIs). In this sense, the universal guidelines for reproductive health recommend that women embark on health exams at the age of 21 or sooner if they are sexually active and have symptoms of various conditions. According to Barad (2021), conducting historical and physical examinations on women form the basis of gynecologic evaluation, which is necessary for assessing multiple problems such as pelvic pain, vaginal bleeding, and vaginal discharge. The prospect of obtaining historical and physical information provides clues for gynecologists to identify and address underlying gynecological conditions. While conducting physical examinations on women, it is essential to incorporate special considerations such as comfort, consent, full disclosure, and transparency pertinent to protecting privacy and safeguarding dignity. For instance, gynecological evaluations entail exposing the external and internal anatomy of the genitalia, an aspect that explains the obligation of adhering to strict ethical and privacy protocols. Since gynecological evaluation is a profound process for diagnosing underlying reproductive conditions, this paper uses Maya’s case study to plan for gynecologic exam techniques, discuss special considerations relevant when performing an invasive exam, and describe universal precautions necessary when conducting a physical examination of a patient. The Reproductive Health Assessments Paper
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A Plan for Gynecologic Physical Assessment for Maya
Undeniably, assessing a patient’s history and medical background should form the basis for gynecologic physical assessment planning. In Maya’s case study, she has already provided relevant information regarding her medication history, family history of health problems, immunizations, menstrual cycle, and appropriate signs that signify the presence or absence of conditions such as breast cancer or sinus problems, among other health problems. As a result, such information provides insights into the expectations and strategies for conducting a physical assessment to ascertain her complaints regarding vaginal discomfort and perceptions of burn/sting after wiping the vagina or having sex.
Notably, a plan for gynecologic physical assessment includes sequential and systematic examination approaches focusing on the external and internal anatomy of the genitalia. Bialy & Wray (2020) support the plausibility of performing a rectal examination alongside a gynecological physical assessment to detect underlying vital signs thoroughly. Before commencing the gynecologic exam, it is essential to ensure that the patient is medically, emotionally, and psychologically prepared since exposing the external and internal anatomy of the patient’s genitalia is a topic of ethical and professional scrutiny. For instance, it is vital to obtain informed consent before the examination to warrant the patient’s awareness and conformity to the procedures. In the context of reproductive system assessments, only the following complaints prompt APRNs to conduct a gynecological exam: sexually transmitted infection screening, pain, vaginal discharge, infections, pregnancy or postpartum, itching, menstrual abnormalities, and issues like bleeding and pelvic floor disorders (Baily & Wray, 2021)The Reproductive Health Assessments Paper. Notably, Maya’s case justifies the need for physical examination because she complains about a burning or stinging sensation on her vagina when wiping it or after having sex.
Female Gynecological Exam Techniques and the Assessed Anatomy
The initial processes of preparing for a gynecologic exam include availing necessary room aesthetics and tools such as surface gradient, lighting, and essential equipment. After that, it is crucial to inform the client about the procedural expectations and strategies. Many female patients request the presence of a female chaperone to bolster their confidence and comfort in complying with procedural expectations (Baily & Wray, 2021)The Reproductive Health Assessments Paper. As an APRN, it is within the ethical and professional authority to grant a patient’s request for a chaperone. Following a thorough preparation for the physical examination, the subsequent gynecological techniques should follow a sequence that includes examining the external vulva, internal speculum, bimanual pelvic, and rectovaginal.
Examining the external vulva
This is the first technique for a gynecologic exam and involves a series of activities, including palpating the labia for tenderness or growths, moving the fingers along both labia to detect nodules, cysts, tenderness, and abscesses necessary for asserting the presence or absence of abnormalities or other conditions. During the external examination of the vulva, it is essential to evaluate the fundamental development of the vulvar anatomy, including hair distribution, erythema, rashes, lesions, discharge, and tenderness (Barad, 2021). In this sense, it is crucial to examine the vaginal opening to identify signs of pelvic organ prolapse, a posterior bulge, and displacement of the cervix toward the introitus. The assessed anatomy for this technique includes the Bartholin glands, labia, perineum, and cervix. The Reproductive Health Assessments Paper
Speculum examination
This technique entails inserting a gloved finger into the vagina to determine the position of the cervix and the subsequent insertion of a speculum with blades. It is crucial to widening the vagina by pressing two fingers on the posterior vaginal wall (Barad, 2021). Further, the examiner should ensure that the speculum blades are in the posterior fornix to enable the cervix to pop into view once the blades open (Baily & Wray, 2021). Consequently, it is possible to examine the anatomy of the cervix and identify abnormalities such as color changes, lesions, discharge, and bleeding (Taylor et al., 2017). If the examiner does not have a good view of cervical anatomy, it is essential to proceed to the subsequent examination, which entails the bimanual examination.
The bimanual and rectal examinations
The bimanual examination technique entails palpating the internal pelvic organs by inserting two fingers into the vagina alongside simultaneous abdominopelvic pressure (Qin et al., 2020)The Reproductive Health Assessments Paper. It is essential to lubricate the dominant hand, especially the two fingers, before inserting them slowly into the vagina during this process. Further, it is crucial to use the non-dominant hand to press the abdomen to enable the examiner’s fingers to locate and check the size of pelvic organs. Consequently, the assessed anatomy for this technique includes the uterus, ovaries, bladder, urethra, adnexa, and cervix.
If there is a need for further examination, it is essential to proceed to the last technique; the rectal examination. In this sense, examiners palpate the rectovaginal septum by inserting the index finger in the vagina and the middle finger in the rectum (Barad, 2021). The rectal examination aims to identify and detect abnormalities in various organs, including the uterus, ovaries, and bladder. When applying these physical examination techniques, it is essential to ensure that the patient maintains the appropriate positions necessary for maximum effectiveness and results. Also, it is crucial to address pain and discomfort by listening to patients’ opinions, concerns, and suggestions.
Special Considerations when Performing an Invasive Exam
Undeniably, conducting a physical examination on patients is a daunting endeavor because of the prevailing ethical and professional dilemmas in exposing patients’ genitalia. Therefore, healthcare professionals need to embrace special considerations necessary for eliminating fear, shame, and discomfort towards techniques for physical examination. When performing invasive tests that expose a patient’s genitalia, the ethical considerations should entail various processes, including providing consent, preserving patients’ autonomy to decide procedural trajectories, promoting transparency and full disclosure, and ensuring patient comfort. The Reproductive Health Assessments Paper
Consent and full disclosure of information
Examiners should involve patients in consensus decisions to eliminate anxiety and fear. According to Queensland Health (2017), informed consent promotes two-way communication between patients and care providers. It reflects the ethical principle that “a patient has the right to decide what is appropriate for them, considering their circumstances, beliefs, and priorities” (p. 8). When conducting invasive procedures such as surgical operations, gynecological examinations, and oral health interventions, providing consent and ensuring full information disclosure form the basis of patient-centered and dignified care. As a result, these considerations improve awareness and patient conformity to the procedures. In turn, they guarantee procedural timeliness, convenience, and effectiveness.
Ensuring patient’s comfort
Often, gynecological examination techniques rely massively upon a patient’s positioning and comfort. For instance, processes like speculum blade insertion and bimanual pelvic examination can result in pain and discomfort if examiners fail to embrace patient safety and comfort strategies. According to O’Laughlin et al. (2021), it is essential to ensure proper lubrication, draping, dressing, and positioning of equipment inserted into the vagina to reduce pain, anxiety, and fear during examinations. Externally, healthcare professionals should ensure proper lighting, appropriate patient positioning (dorsal lithotomy positions)The Reproductive Health Assessments Paper, and grant the patient’s request for a female chaperone. These considerations can bolster individual confidence and comfort by eliminating fear and anxiety pertinent to gynecologic physical examinations.
Preserving patients’ autonomy and dignity
Examiners should reserve patients’ autonomy when conducting gynecologic examinations to allow patients to make informed decisions and participate in care trajectories. For instance, this consideration should apply when providing consent to patients. According to Bruce (2020), consent “must be rooted in autonomous choices by patients” (p. 126). Another process of preserving patient autonomy and dignity during invasive procedures entails listening to their needs, opinions, and suggestions regarding comfort and perceptions of pain. These considerations allow examiners to improve processes and address discomfort cues.
Universal Precautions when Conducting a Physical Examination of a Patient
Often, gynecologic examination techniques entail inserting equipment and fingers into the vagina, exposing the external and internal anatomy to various health risks, including infections, injuries, and increased contact with contamination. As a result, it is essential to uphold the universally accepted precautions when conducting gynecologic examinations that expose a patient’s genitalia to multiple threats. According to Broussard & Kahwaji (2019), the Centers for Disease Control and Prevention (CDC) introduced the universal precautions in 1985 to provide standardized guidelines for preventing transmission of bloodborne pathogens from exposure therapy blood and other potentially infectious materials (OPIM). Consequently, the universal standards applicable when conducting gynecologic examinations include: The Reproductive Health Assessments Paper
Hand hygiene
It is essential to embrace the universally accepted hand hygiene protocols before and after conducting gynecologic examinations. Broussard & Kahwaji (2019) support the rationale of washing hands before and after direct patient contact, immediately after removing gloves, before handling invasive devices, and after contact with blood fluids, secretions, and non-intact skin, and excretions. Further, hand hygiene guidelines encompass protective equipment such as gloves, hand lubrication, and sanitization to prevent infection transmission. In gynecologic examinations, it is essential to embrace these guidelines by sanitizing invasive devices such as speculum blades, lubricating fingers before inserting them into vaginas and rectums, and wearing gloves to reduce the likelihood of skin contact.
Contact Precautions
It is crucial to maintain contact precautions when conducting gynecologic examinations to prevent patients’ susceptibility to infections. According to Broussard & Kahwaji (2019), hand hygiene should follow personal protective equipment (PPE) such as gloves. Also, it is essential to ensure appropriate patient placement by avoiding crowded rooms that would increase the likelihood of infection transmission. In this sense, private rooms are preferred areas for conducting gynecologic examinations since they are easy to disinfect and clean The Reproductive Health Assessments Paper.
Droplet Precautions
Finally, it is imperative to be aware of droplet precautions when conducting gynecologic examinations. For instance, invasive procedures such as speculum and bimanual tests can trigger discharges, bleeding, and excretion droplets that can infect the surface, increasing the likelihood of infection transmission. In this sense, it is ideal to use private rooms instead of public rooms to reduce the possibility of infections. Finally, it is vital to wash hands before and after examining patients.
Conclusion
Reproductive system assessments and the subsequent physical examination are essential processes for promoting reproductive health since they enable examiners to identify risk factors for diseases such as cancer. The standardized procedure for conducting gynecologic tests includes sequential techniques such as examining external vulva and vulvar anatomy, internal speculum, bimanual pelvic, and rectovaginal examinations. While these procedures entail exposing patients’ genitalia, care providers must adhere to special considerations and universal precautions. For instance, special considerations for such processes include providing consent to patients, exposing information by ensuring transparency and openness, ensuring comfort, and preserving patients’ autonomy to decide care trajectories. On the other hand, universal precautions when conducting gynecologic examinations include hand hygiene, droplets precautions, and strategies to minimize contact. These considerations and precautions apply to Maya’s case. The Reproductive Health Assessments Paper
References
Barad, D. H. (2021, March). General Gynecologic Evaluation – Gynecology and Obstetrics. MSD Manual Professional Edition. https://www.msdmanuals.com/professional/gynecology-and-obstetrics/approach-to-the-gynecologic-patient/general-gynecologic-evaluation
Bialy, A., & Wray, A. A. (2020). Gynecologic examination. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK534223/
Broussard, I. M., & Kahwaji, C. I. (2019, March 16). Universal precautions. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470223/
Bruce, L. (2020). A pot ignored boils on: Sustained calls for explicit consent of intimate medical exams. HEC Forum, 32(2), 125–145. https://doi.org/10.1007/s10730-020-09399-4
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
Qin, J., Saraiya, M., Martinez, G., & Sawaya, G. F. (2020). Prevalence of potentially unnecessary bimanual pelvic examinations and Papanicolaou tests among adolescent girls and young women aged 15-20 years in the United States. JAMA Internal Medicine, 180(2), 274–280. https://doi.org/10.1001/jamainternmed.2019.5727
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
Taylor, G. A., McDonagh, D., & Hansen, M. J. (2017). Improving the pelvic exam experience: A human-centered design study. The Design Journal, 20(sup1), S2348–S2362. https://doi.org/10.1080/14606925.2017.1352750 The Reproductive Health Assessments Paper
Female Genitourinary SOAP Note Form
Date: __________
Name: Maya S.
DOB: 01/01/XXXX
SUBJECTIVE:
Chief Complaint: Annual women’s visit
History of Present Illness: 22-year-old female presents for physical examination
Review of Systems:
General: denies weight change, fatigue, fever, night sweats, and chills.
HEENT: denies vision changes, hearing change, sinus problems, trouble swallowing, ringing in the ears, runny nose, and a reduced sense of smell.
Cardiac: Denies cardiac arrhythmia, skipping beats, shortness of breath, chest pain, and unexplained swelling.
Pulmonary: Denies the presence of a recent cough and shortness of breath (SOB).
GI: denies abdominal pain, nausea, vomiting, diarrhea, or constipation.
GU: Denies frequency, urgency, or hesitancy or vaginal discharge, lesions, and dyspareunia but indicates burning sensation when wiping the vagina or after having sex.
Musculoskeletal: denies joint weakness, muscle pain, and joint pain.
Skin: denies lesions, rashes, and itching.
Breast: Denies breast pain, discharge, or masses.
Neuro: Denies tingling, numbness, problems with fainting, seizures, and headaches.
Psychiatric: No psychiatric issue was appreciated in the patient’s responses.
Endocrine: Denies polydipsia, polyuria, polyphagia, and intolerance the heat and cold.
Hematologic: Denies bleeding disorders, anemia, and blood transfusions.
Allergies: No known drug allergies (NKD)
Medications: 75 of the thyroid medicine
Immunizations: unclear immunization history.
Past Medical History: low thyroid
Gynecologic History: No past female checkups or consultations with an ob-gyn.
Menstrual History: FDLMP: 21st January 2021 Menarche: at the age of 12. The Reproductive Health Assessments Paper
OB History: 1 misscarriage
Last Pap Smear: None
Last Mammogram: None
Sexual History: has had a boyfriend for the past four months, started dating at the age of 17, and broke with her past boyfriend in 2019 (after 2 years of dating). Do not use condoms as birth control.
General History: hypothyroidism and 1 miscarriage.
Surgical History: None
Family History: mother had breast cancer, Grandma had cancer, and dad’s mom has high blood pressure.
Genetic Testing History: BRCA 1 & 2 positive.
Social History: The patient does not smoke but drinks a glass of wine every week.
OBJECTIVE:
Physical Exam:
Vitals: BP: 108/68 mm/Hg, HR: 78 bpm, RR: 16 bpm, T: 98.7°F, Ht: 5’2″, Wt: 54.9 kg (121 lbs.), BMI: 22.1 kg/m2
General: Well-nourished, well-developed individual, NAD
Skin: No rashes or lesions
HEENT: Normocephalic, white sclera, no conjunctival injection, PERRLA, pearly gray TM B/L, no nasal discharge, nasal septum midline, throat without lesions or exudates, MMM, clean dentition
Neck: Trachea midline; thyroid midline, equally rises and falls; no enlargement, asymmetry, masses, nodules, or tenderness appreciated on palpation
Cardiac: RRR, S1 and S2 identified, no M/G/R or S3, S4 on auscultation
Pulmonary: Symmetric chest lift, CTA B/L; no wheezes, rhonchi, rales on auscultation
GI: Active bowel sounds ×4 quadrants, soft, NTND abdomen, mildly obese, no organomegaly
Breast: Medium-sized breasts, pendulous, nipples symmetrical; no skin changes, nipple discharge, retraction, lesions, masses, or tenderness appreciated on exam; no lymphadenopathy in axillary region bilaterally
GU: The Reproductive Health Assessments Paper
Vulva/Labia Majora: No lesions, rashes, and irritation
Bartholin Glands: No masses, inflammation, or discharge.
Skene Glands: No discharge, masses, or inflammation.
Clitoris: No piercings and enlargements.
Urethra: No prolapsed, discharge, and non-tender
Bladder: No prolapsed or unusual discharge
Vagina: No discharge, bleeding but lesions. A sample was taken of vaginal secretion and sent to a lab for further microscopic evaluation and culture.
Cervix: No erythema, or discharge, but cervical lesions are appreciated on the examination.
Uterus: A bimanual exam revealed the uterus as non-tender with movement, smooth, firm, and midline.
Adnexa: No masses, small, and non-tender.
Extremities: No deformities, ambulates with no weakness bilaterally on inspection, no varicosities, no cyanosis or edema
Neuro: AAO×3, pleasant affect
Procedure note: The patient was prepared for a screening Pap smear. With a female chaperone present, the patient verbally consented to a gynecologic exam. Risks of the procedure were explained.
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After consent, the patient was placed in lithotomy position. External genitalia were inspected and palpated. No tenderness, masses, or enlarged glands were noted. The urethra was not prolapsed or tender.
A lubricated plastic speculum was inserted into the vagina. The vaginal walls and cervix were visualized. A brush was used to remove cervical cell sample from the cervical os. Another sample was taken of vaginal secretions. Samples were placed in separate specimen containers and sent to a lab for further microscopic evaluation and culture.
A bimanual exam was then performed. The uterus was found to be midline, freely mobile, smooth, and nontender. There were no adnexal masses or tenderness. The bladder was nondistended. No palpable masses were found on examination.
The patient tolerated the procedure well and was released to return home. The patient was educated about mild spotting of blood and vaginal discomfort after the procedure for one to two days.
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