1
Q
what are some assessments made during a sexual health assessment
A
Assess comfort level
- mutual understanding
- neutral/inclusive language
- ubiquity statements
- establish rapport
- follow client cues
- ask for preferred pronouns
- avoid assumptions
2
Q
sexual health assessments to ask a client
A
- sexual orientation
- gender identity
- sex assigned at birth
- sexually active? if yes, this year?
- how many sexual partners
- with men? women? other?
- kind of sex?
3
Q
Girl Can you Stop Holding my Hair
Types of STI
A
Gonnorhea
Chlamydia
Syphillis
HPV
Herpes
4
Q
symptoms of Gonorrhea
A
- dysuria
- pain during sex
- post-coital bleeding (when there is irregular bleeding after sex but its not menstruation)
- genital burning/itching/discharge
- abdominal pain
5
Q
Chlamydia symptoms
A
genital discharge, dysuria, lower abdominal pain, fever/chills, post-coital bleeding and pain during sex
6
Q
syphillis symptoms
A
- open painless sore in genital or anus
- body rash
- flu like symptoms
- lymphadenopathy - swelling of lymph nodes
7
Q
herpes symptoms
A
- sores inside/outside genital, anus, thighs buttocks,
- lymphadenopathy
- dysuria
- fever
8
Q
HPV symptoms
A
- anal/genital warts and can be asymptomatic and go unnoticed
9
Q
Importance of understanding risk factors of STI?
A
- victim of sexual abuse
- anonymous partnering
- sexual contact from another person having an STI
- engaging in unprotected sex
10
Q
After understanding the importance of risk in STI, how can you assess this risk?
A
- genital symptoms
- sexual history
- psychosocial history and factors (substance abuse, sex trade worker, abuse)
- reproductive health history
- STI history
- clients knowledge
- relationships - past/present
- sexual risk behaviors - no. of partners, sexual activities, contraception? (girl you better be using that, you dont want no fugly looking baby)
11
Q
How can you educate clients and provide counselling regarding an STI?
A
- Education of different modes of transmission when one has an STI
- difference between contraceptive vs STI protection (birth pill does not protect you from STI)
- safer sex counselling
- proper use of barrier methods
- harm reduction counselling
- education on risk of different sexual activities
12
Q
when selecting appropriate testing, why should you look out for “I have been tested “ syndrome? and how can you prevent it?
A
- The false sense of security that these individuals may develop (after multiple negative test) a sense that “it can never happen to me.” - treated with counselling.
- The individual who has had some form of medical attention (Pap smear, given blood) and thinks they have been tested for STIs. treated by educating
13
Q
Why is motivational interviewing used to assess for STI
A
- used to promote primary and secondary prevention of STIs.
- May be helpful in encouraging patients to practice safer sexual behaviour
14
Q
Post-test counselling
A
- organism (bact or viral) or syndrome specific advice
- preventing re-infection
- informing partners
- also used as an educational opportunity for people paranoid about STI but showed negative results
15
Q
who performs partner notification?
A
- client
- HCP/public health referral - with consent from client
- contact referral - HCP puts infected person on a time frame (usually 24-48 hrs) to inform partners about exposure and refer them to appropriate services
last one lowkey scary
16
Q
barriers to partner notification
A
- fear due to abuse
- blame/guilt (losing partner)
- revictimization
- anonymous partnering
- feared legal procedures
17
Q
where do you go when you suspect a child being abused?
A
Children’s aid society
18
Q
How to assess sexual health for an adoloscent client?
A
- ensuring privacy
- exploring puberty and gender identity
- Assess social supports
- asking open ended questions
- assess safety and support
- discuss content,sex and intimacy
- provide validation
19
Q
follow up
A
- ensure resolution of symptoms
- follow up testing as indicated
- follow through on partner notification
- if ongoing: routine 3 month interval assessment, reinforcing safer sex practice
20
Q
subjective assessment for Anus and rectum
A
- defecate regularly? straining with stool but nothing comes out (tensemus)?, drink coffee/tea (increases motility of colon), pain while passing bowel movement (hemmorhoid, fissure,constipation)
- change in bowel habits (IBS)
- rectal bleeding? bleeding in stool?
- medications taken - laxatives, stool softeners
- problems in rectal area? problem controlling feces?
- usual amount of high fiber in food? excersise and amount of water intake?
21
Q
theyre called melena
Why are black/bloody stool of concern?
A
result of occult blood from iron ingestion of gastrointestinal bleeding
22
Q
they are called steatorrhea
what do frothy stool indicate?
A
excess fat in stool, malabsption of fat
23
Q
pt. comes in with itchy rectal area (pruritus). What do you think this indicates?
- melena
- steatorrhea
- hemorrhoids
- dyschezia
A
hemorrhoids
dychezia - pain w defecation
24
Q
How do you observe rectal area for a male patient?
A
- instruct standing male pt. to point his toes together (uwu) (this relaxes his regional muscles and makes it easier to spread the buttocks)
25
how do you observe rectal area for a femal pt.
lithotomy position - helps as you can examine genitalia if needed ()
left lateral decubitus - only for rectal exam
26
how can you help a patient relax when doing an objective assessment of the anus
- ensure privacy
- explain procedure
- communicate throughout examination
- use gentle but firm and gradual movements
27
subjective questions for genitourinary system
- frequency, urgency (indicative of an infection), nocturia (urinary tract disorder)?
- dysuria? pain with urination
- hesitancy and straining - indicative of prostate enlargement
- colour of urine
- sexual activity and contraceptive use - STI contact
- STI risk reduction
MALE:
- problems with penis - lesions, pain, discharge? (ureathal discharge indicative of an infection)
- scrotum (self care, lump?) - assess for hernia (if lump present)
FEMALE:
- menstrual history - menstrual periods, how often?, duration of cycle?, clotting? (indicated vaginal pooling or heavy flow)
- obstetrical history - ever been pregnant (gravida: no. of pregnancies, para: no. of births, abortions: interupted pregnancy and miscarriage)
- menopause - periods slowed down? (cessation of menstrual cycle)
- vaginal discharge - unusual amount? irritating?
- self care behaviors - last pap test, gyno checkup
28
Upon conducting an assement on genitourinary system client talks about how they have been seeing dark red urine. What is this and is it a concern?
Hematuria - a critical finding which is the most common symptom of cancers of the bladder and kidney. Hematuria is also associated with disease, inflammation, infection, or trauma within the urinary tract.
29
# hint: client weight 40 kg
Upon conducting an assement on genitourinary system for a 17 year old client, she talks about how she has not got undergone a menstrual cycle. What does this indicate?
delayed onset suggests endocrine or underweight problem.
30
# related to menses (blood during menstruation)
Amenorrhea vs Menorrhagia
Amenorrhea - absence of menses
Menorrhagia - heavy menses
31
what is a perimenopausal period?
ages 40 to 55 years is characterized by hormone shifts, which result in vasomotor instability.
32
What does an erectile dysfunction indicate?
future heart disease or type 2 diabetes.
33
Prevention of STI with oral sex
Dental dams or condoms cut open help prevent STI transmission during oral sex.
34
# step 1 of objective assessment in male
Objective assessment in male:Inspect and Palpate the Penis
- skin looks wrinkled, hairless and no lesions, dorsal vein may be present, glans looks smooth and lesion free, ureathral meatus in the centre
TECHNIQUE:
- compress glans anteroposteriorly between thumb and forefinger : meatus edge should be pink, smooth with no discharge (*eges that are red and edematous are indicative of urethiritis*)
- palpate shaft of penis betwen first 2 fingers and thumb : should feel smooth, semi-firm and nontender
35
# first 2 about glans and the rest related to position of meatus
explain these terms:
- Phimosis
- paraphimosis
- Hypospadias
- Epispadias
- Phimosis: inability to retract the foreskin.
- Paraphimosis: inability to return foreskin to original position.
- Hypospadias: ventral location of meatus.
- Epispadias: dorsal location of meatus
36
# step 2 of objective assessment in male
Objective assessment in male:Inspect and Palpate the scrotum
TECHNIQUE:
- Inspect scrotum as you hold penis out of the way (use back of hand) : Assymetry is normal - left scrotal half is usually lower than right
- spread rugae out between fingers, lift sac to inspect posterior scrotum
PALPATE:
- Palpate each scrotal half gently between your thumb and first two fingers.
- Testes normally feel oval, firm and rubbery, smooth, and equal bilaterally, and they are freely movable and slightly tender to moderate pressure.
- Each epididymis normally feels discrete, softer than the testis, smooth, and nontender.
TECHNIQUE:
- Palpate each spermatic cord between your thumb and forefinger, along its length from the epididymis up to the external inguinal ring. You should feel a smooth, nontender cord.
37
Upon inspection of scrotum, there was pitting edema/ scrotal swelling. What does this indicate?
heart failure, renal failure, inflammation
38
# NORMAL OR ABNORMAL
Sebacceous cyst, yellowish- 1cm nodules, firm and non-tender, multiple found on scrotum
NORMAL
39
# Why are these abnormal findings?
Absence of testis
Atrophied testes
An indurated, swollen, and tender epididymis
- may be a temporary migration or true cryptorchidism
- small and soft.
- indicative of epididymitis
40
# in objective assessment for male pt.
What is transillumination and when is it done?
Perform this manoeuvre only if you note a swelling or mass. Darken the room. Shine a strong flashlight from behind the scrotal contents. Normal scrotal contents cannot be transilluminated.
41
# 3rd step in Objective Assessment for male
Inspect and Palpate for hernia
- Inspect the inguinal region for a bulge as the patient stands and as the patient strains down.
TECHNIQUE:
- Palpate the inguinal canal, place your right index finger low on the right scrotal half
- Palpate up the length of the spermatic cord, invaginating the scrotal skin as you go, to the external inguinal ring.
- Feel like triangular slitlike opening, if it will admit your finger, gently insert it into the canal and ask the person to “bear down.”
- Normally, you feel no change.
- Repeat the procedure on the left side.
- Palpate the femoral area for a bulge. Normally, you feel none.
42
# NORMAL OR ABNORMAL?
On palpating inguinal lymph node: you find a hard, matted, fixed node and is about 3cm
Abnormal
43
Normal urine output
1500ml per day
44
A client undergoes an inability to pass urine, characterized by lower abdominal pain and bladder distension. What is this?
Critical finding: Acute urinary retention and is confirmed with a bladder scan. Management is done via intermittent or indwelling catheter
45
# NORMAL OR ABNORMAL
less than 30ml/hour urine
ABNORMAL
46
# NORMAL OR ABNORMAL
Pt. has an indwelling catheter, upon taking vital signs: clients vital signs were temp: 38, blood pressure: 130/42 and had positive disptick for leukocytes.
ABNORMAL
make sure that the tubing should be free from kinking; collecting bag should be below bladder level;
47
# most prevalent STI
Why is HPV dangerous?
HPV infection can lead to development of cancers of the cervix, vulva, and vagina in females, penile cancers in males, and anal and oropharyngeal cancers in both sexes.
48
which gender is more prone to HPV?
Female
49
# objective assessment female step 1
Inspect external genitalia
INSPECTION:
- skin colour
- hair distribution (inverted triangle)
- labia majora: symmetrical and plump, nulliparous - labia meets in the middle, after birth - no longer meet in middle
- skin texture - no lesions, except for 1cm sebaceous cysts
seperate labia majora to inspect anatomical features:
- clitoris
- labia minora - dark pink , moist, symmetrical
- ureathral opening - appears like a slit and sits midline
- perineum (in between anus and vaginal opening) - normally smooth
- anus - coarse w pigmentation
50
# normal or abnormal
15 year old client has no pubic hair or development of breasts
abnormal (should be formed by age of 13)
51
# objective assessment female step 2
Palpate external genitalia
TECHNIQUE:
**Assess the urethra and Skene’s glands**
- Dip your gloved finger in a bowl of warm water to lubricate. Then insert your index finger into the vagina, and gently milk the urethra by applying pressure up and out. should cause no pain
**Assess Barthloin's gland**
- Palpate the posterior parts of the labia majora with your index finger in the vagina and your thumb outside. Labia feels soft and homogenous
**Pelvic musculature**
- Palpate the perineum. Normally, it feels thick, smooth, and muscular in a nulliparous woman but thin and rigid in a multiparous woman.
- The patient to squeeze the vaginal opening around your fingers; it should feel tight in a nulliparous woman and should have less tone in a multiparous woman.
- Using your index and middle fingers, separate the vaginal orifice and ask the patient to strain down. Normally, no bulging of vaginal walls or urinary incontinence occurs.
52
What does bulging of vaginal wall indicate?
Bulging of the vaginal wall indicates cystocele, rectocele, or uterine prolapse.
53
# part 3 of objective assessment in female
Inspect cervix
- Colour: normally pink, second month of pregnancy: blue, after menopause: pale
- position: cervix midline, anterior/posterior (projects 1-3 cm into vagina) (abnormal - lateral postion - adhesion/tumor, projection of more than 3cm - indicates prolapse)
- size - diameter is 2.5cm (an inch)
- o- small and round in nalliparous, horizontal and irregular in multiparous (abnormal - hypertrophy of more than 4cm occurs with inflammation/tumor)
- surface - normally smooth (abnormal- white patch, strawberry spot)
- nabothian cysts - common after childbirth (abnormal: cervical polyp - bright red)
- cervical secretions- can be thick/thin, opaque or stringy, odourless and non irritating (abnormal- irritation - yellow, green, white or gray)
54
# part 4 in objective assessment in female
Palpate cervix
- palpate vaginal wall: no induration or tenderness
locate cervix and palpate for CCM
- Consistency - smooth and firm like nose, feels velvety and softens at 5-6 weeks of pregnancy (abnormal - nodular)
- contour- evenly rounded (abnormal - irregular)
- mobility - moving finger from side to side in cervix - no pain (abnormal- immobility w malignancy)
uterus: anteverted, midposition and retroverted (abnormal - Enlarged uterus, Lateral displacement, nodular mass, Irregular, asymmetrical uterus, Fixed and immobile uterus, tenderness)
Adnexa: one hand on abdomen, and another in the ipsilateral side of vagina, push hand on abdomen and try to palpate ovary- feels smooth, almond shaped, slightly sensitive, not painful , fallopian tube usually not palpable (abnormal - enlarged nodule, or adnexa, immobile and tenderness)
55
# NORMAL OR ABNORMAL
cervical eversion, or ectropion after delivery
Normal - cervical eversion, or ectropion, may occur normally after vaginal deliveries. The endocervical canal is everted or “rolled out.” It looks like a red, beefy halo inside the pink cervix surrounding the Os.
56
# CRITICAL OR NOT?
Pulsation or palpable falopian tube
suggests ectopic pregnancy (egg grows out of main cavity) - immediate referral
NSE203
flashcards
Decks in class (3)
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