Week 10: Special Examinations – Breast, Genital, Prostate, A ✓ Solved

Week 10: Special Examinations—Breast, Genital, Prostate, and

One critical element of any physical exam is the ability of the examiner to put the patient at ease. By putting the patient at ease, nurses are more likely to glean quality, meaningful information that will help the patient get the best care possible. When someone feels safe, listened to, and cared about, exams often go more smoothly. This is especially true when dealing with issues concerning breasts, genitals, prostates, and rectums, which are subjects that many patients find difficult to talk about. As a result, it is important to gain a firm understanding of how to gain vital information and perform the necessary assessment techniques in as non-invasive a manner as possible.

For this week, you explore how to assess problems with the breasts, genitalia, rectum, and prostate.

Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature.

• Analyze the subjective portion of the note. List additional information that should be included in the documentation.
• Analyze the objective portion of the note. List additional information that should be included in the documentation.
• Is the assessment supported by the subjective and objective information? Why or why not?
• Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?
• Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

Paper For Above Instructions

Analyzing the subjective portion of the note reveals a need for further details to provide a comprehensive understanding of the patient’s condition. The patient, a 21-year-old white female (WF), presents with painless bumps in the genital area, which raises several questions. Firstly, additional information regarding the characteristics of the bumps could enhance the examination record, such as size, color, and texture. Furthermore, obtaining a more detailed sexual history, including the specific practices engaged in and the number of sexual partners, could provide insight into potential sexually transmitted infections (STIs). Additionally, inquiring about any associated symptoms, such as itching or discomfort, would be beneficial. Importantly, comprehensive documentation should also include details about any recent exposure to STIs, medications taken, and a complete obstetric and gynecological history.

Focusing on the objective portion, while it provides relevant physical examination findings, there are aspects that could be expanded. Vital signs, including temperature, blood pressure, respiratory rate, and heart rate, have been documented, which indicates the patient's stability. However, pertinent negatives should be noted, such as any abnormalities concerning lymphatic drainage around the genital area. Documentation regarding the appearance, size, and location of the ulcer noted on the external labia should also be emphasized, including the presence or absence of any surrounding erythema or other significant findings. Specimen collection for herpes simplex virus (HSV) testing is mentioned, which is crucial; however, the assessment of the cervical and uterine areas might also be noted, even if the examination was focused on the external genitalia. This broader perspective in the documentation enhances the understanding of the patient’s health status.

The assessment made by the healthcare provider must align with both the subjective and objective information gathered. In this case, the assessment of a chancre as a diagnosis appears valid, considering the provided history of a painless ulcer on the labia and the patient’s history of chlamydia. However, further evaluation into her sexual history and a comprehensive review of associated symptoms could potentially reveal additional conditions. Therefore, although the assessment aligns with the current findings, it would merit cautious consideration until further diagnostic testing corroborates the diagnosis.

Diagnostic testing plays a pivotal role in confirming the proposed assessment. In this case, HSV testing is appropriate, given the appearance of the lesions and the patient’s sexual history. The results of the diagnostic tests will directly influence the diagnosis, especially if the results indicate a positive for herpes simplex virus, thus confirming the suspected chancre. In addition to HSV, other possible diagnostic tests—such as a Pap smear for cervical cytology or tests for other STIs (e.g., syphilis)—might be warranted to rule out additional etiologies for the genital bumps. Diagnostics will be essential in clarifying the patient’s condition, ensuring appropriate treatment is provided.

Regarding the current diagnosis of a chancre, careful deliberation is necessary. While the diagnosis aligns with the presented symptoms, it is crucial to explore three possible differential diagnoses. The first differential could be genital warts (condylomata acuminata), caused by human papillomavirus (HPV). This may present as painless bumps and can occur in sexually active individuals. The second consideration is molluscum contagiosum, a viral infection that can present as painful or painless lesions in the genital area, with a similar appearance to the bumps described. The third possibility is fibromas or other benign skin lesions, which could occasionally resemble ulcerative lesions. Each of these potential diagnoses requires careful consideration, emphasizing the importance of correlation with the literature to ascertain an accurate diagnosis. The careful evaluation of clinical history, lesion characteristics, and relevant diagnostic tests will provide a framework for making informed clinical decisions.

Supporting evidence from the literature plays a crucial role in guiding clinical decisions in this scenario. According to Arora et al. (2018), understanding the clinical presentation of STIs, including the differing visual signs of lesions and potential systemic involvement, is vital in formulating a differential diagnosis. Furthermore, the Centers for Disease Control and Prevention (CDC) (2019) provide guidelines on diagnosing STIs, emphasizing the importance of sexual history and comprehensive examinations. Jacobs & Corman (2019) discuss the significance of considering benign versus malignant etiologies when assessing external genital lesions in females, highlighting that a thorough assessment is crucial in forming an accurate diagnosis. Utilizing these references will provide support for the analysis conducted and ensure the approach aligns with current best practices in clinical assessment.

References

• Arora, S., Gupta, A., & Singh, J. (2018). Understanding Sexually Transmitted Infections: A Clinician's Guide. Journal of Clinical Medicine Research, 10(3), 872-878.
• Centers for Disease Control and Prevention. (2019). Sexually transmitted diseases (STDs). Retrieved from [CDC website link]
• Jacobs, A. J., & Corman, S. L. (2019). Benign Genital Lesions in Women: Differential Diagnosis. American Family Physician, 99(4), 246-252.
• Sullivan, D. D. (2019). Guide to Clinical Documentation (3rd ed.). Philadelphia, PA: F.A. Davis.
• Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced Health Assessment and Clinical Diagnosis in Primary Care. St. Louis, MO: Elsevier Mosby.
• Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel's Guide to Physical Examination: An Interprofessional Approach (9th ed.). St. Louis, MO: Elsevier Mosby.
• Cucci, E., Santoro, A., DiGesu, C., DiCerce, R., & Sallustio, G. (2015). Sclerosing adenosis of the breast: Report of two cases and review of the literature. Polish Journal of Radiology, 80, 122–127.
• Sabbagh, C., Mauvis, F., Vecten, A., Ainseba, N., Cosse, C., Diouf, M., & Regimbeau, J. M. (2014). What is the best position for analyzing the lower and middle rectum and sphincter function in a digital rectal examination? A randomized controlled study in men. Digestive and Liver Disease, 46(12), 1082–1085.
• Westhoff, C. L., Jones, H. E., & Guiahi, M. (2011). Do new guidelines and technology make the routine pelvic examination obsolete? Journal of Women’s Health, 20(1), 5–10.