Health Assessment Ch.

17, 24, 25, 26 Key Terms and Concepts
Male Genitourinary System The shoulder where the glans joins the shaft. corona Either of the columns of erectile tissue forming the body of the penis. (medical corpus cavernosum dictionary) An undescended testicle that hasn¶t moved into the proper position in the cryptorchidism scrotum. Common in premature infants. Occurs in 3-4% of term infants, although most descend by 3 months Pain or burning with urination. It is common with acute cystitis, prostatitis, and dysuria urethritis. Dorsal location of meatus (abnormal). Urethral meatus should be positioned epispadias centrally. A fold of the foreskin extending from the urethral meatus ventrally. frenulum Erectile tissue at the distal end of the shaft. glans penis Abnormal. A bulge at the external inguinal ring or at the femoral canal. Inspect hernia the inguinal region for a bulge as the person stands and as he strains down. Direct, Indirect, and Femoral. See pg. 739 for femoral.

hesitancy hydrocele hypospadias nocturia nocturnal enuresis paraphimosis phimosis priapism spermatocele spongiosum penis

Trouble starting the urinary stream. A cystic collection of serous fluid in the tunica vaginalis, surrounding the testes. It appears as a large scrotum. Can be seen in boys under 2 years. Ventral location of meatus (abnormal). Urethral meatus should be positioned centrally. Awakening during the night to urinate. Occurs together with frequency and urgency in urinary tract disorders. Involuntary passing urine after an age which continence is expected. Inquire about this which children 5 years or older. Unable to return foreskin to original position. Unable to retract the foreskin. Prolonged penile erection. Usually painful and needs medical attention. A cyst that develops in the epididymis filled with milky or clear fluid containing sperm. Usually small and painless. Spongy tissue surrounding the urethra. Prevents the urethra from closing during erection.


Health Assessment Ch. 17, 24, 25, 26 Key Terms and Concepts

Nursing Diagnosis Ineffective Sexuality Pattern S/S: Identification of sexual difficulties, limitations, or changes

Related To Effects of illness or medical treatment Drugs Radiation Anomalies Extreme fatigue Obesity Pain Performance anxiety Deficient knowledge/skill about alternative responses to health-related transitions Pregnancy Surgery Recent childbirth Trauma Menopause Impaired relationship with a significant other Fear of pregnancy or of acquiring a sexually transmitted disease Conflicts with sexual orientation or variant preferences Ineffective or absent role models Loss of job or ability to work Separation from or loss of significant other Diminished or absent sensory and/or motor impulses Urinary Retention S/S: Effects of medications Anesthetics Bladder distention Diminished force of urinary stream Opiates Psychotropics Dribbling Strong sphincter Dysuria Urethral blockage associated with fecal impaction Hesitancy Prostate hypertrophy High residual urine Surgical swelling Nocturia Postpartum edema Sensation of bladder fullness Small, frequent voiding or absence Anxiety (fear of postoperative pain) of urine output

Medical Diagnosis Urinary tract infection Incontinence Neurogenic bladder dysfunction Urinary calculi (stones)

Male infertility Erectile dysfunction Prostate, bladder, kidney cancer Prostate obstruction


Health Assessment Ch. 17, 24, 25, 26 Key Terms and Concepts

Anus, Rectum, and Prostate benign prostatic hypertrophy

Enlargement of the prostate gland during the middle adult years. Present in 1 of 10 males at age 40 and increases with age. Caused by a hormonal imbalance that leads to proliferation of benign adenomas that gradually impede urine output because they obstruct the urethra.


Health Assessment Ch. 17, 24, 25, 26 Key Terms and Concepts

dyschezia fissure

flatulence hemorrhoid meconium melena occult blood prostate gland

rectal prolapse


Pain while passing a bowel movement. May be due to hemorrhoid, fissure, or constipation. Painful longitudinal tear in the surface mucosa at the anal margin. Most occur in the posterior midline area. Result from trauma (passing a large hard stool or irritant diarrheal stools. Person has itching, bleeding, exquisite pain. A resulting spasm in the sphincters makes the area painful to examine. The need to pass gas frequently. Painless flabby papules due to varicose vein of the hemorrhoidal plexus. Occurs with straining. Infant¶s first stool. Should occur within 24-48 hours of birth. Black or bloody stools from GI bleeding Blood in the feces that is not visibly apparent (hidden). Lies in front of the anterior wall of the rectum and 2cm behind the symphysis pubis. Surrounds the bladder neck and the urethra and has 15-30 ducts that open into the urethra. Secretes a thin, milky alkaline fluid that helps sperm viability. It is bilobed with a round or heart shape. The two lobes are separated by the median sulcus. On inspection, note these characteristics: Size: 2.5cm long by 4cm wide should not protrude more than 1cm into the rectum. Shape: heart shape, with palpable central grove Surface: smooth Consistency: elastic, rubbery Mobility: slightly movable Sensitivity: nontender to palpitation. Rectal mucous membrane protrudes through the anus, appearing as a moist red doughnut with radiating lines. Occurs following a Valsalva maneuver, such as straining at stool or with exercise. Excessive fat in the stool as in malabsorption of fat.

Nursing Diagnosis Constipation S/S: Frequency less than usual pattern Hard, formed stools

Related To Less than adequate dietary intake and bulk Neuromuscular or musculoskeletal impairment Pain and discomfort on defecation Effects of diagnostic procedures

Health Assessment Ch. 17, 24, 25, 26 Key Terms and Concepts
Palpable mass Straining at stool Less than usual amount of stool Decreased bowel sounds Gas pain and flatulence Abdominal or back pain Reported feeling of abdominal or rectal fullness or pressure Impaired appetite Headache Nausea Irritability Palpable hard stool on rectal examination Bowel Incontinence S/S: Involuntary passage of stool Lack of awareness of need to defecate Lack of awareness of passage of stool Rectal oozing of stool Urgency Pregnancy Aging Medication Stress or anxiety Weak abdominal musculature Immobility or less than adequate physical activity Chronic use of laxatives and enemas Ignoring the urge to defecate Fear of rectal or cardiac pain Gastrointestinal lesions

Diarrhea Impaction Impairment Cognitive Neuromuscular Perceptual Large stool volume Depression Severe anxiety Physical or psychological barriers that prevent access to an acceptable toileting area Effects of medications
Excessive use of laxatives


Perceived Constipation Diarrhea Impaired Skin integrity Risk for Constipation Risk for imbalanced Fluid volume Health-seeking behaviors for information on high-fiber diet

Medical Diagnosis Prostate obstruction Prostate cancer External hemorrhoid Anorectal fistula Rectal polyps Perianal abscess

Rectal Prolapse Rectal Cancer Anal Fissure Pilonidal Cyst Rectal Bleeding


Health Assessment Ch. 17, 24, 25, 26 Key Terms and Concepts

Breast and Regional Lymphatics colostrum

Cooper's ligaments



inframammary ridge lactiferous lymphadenopathy mastalgia mastitis

Montgomery's glands Paget's disease

Thick yellow fluid that is the precursor to milk, containing the same amount of protein and lactose but practically no fat. Produced for the first few days after delivery. It is rich in antibodies that protect the newborn from infection. Suspensory ligaments. Fibrous bands extending vertically from the surface to attach on chest wall muscles. They support the breast tissue. They become contracted in cancer of the breast, producing pits or dimples in the overlying skin. Discharge from the nipple. Some medications can cause this including: oral contraceptives, phenothiazines, diuretics, digitalis, steroids, methyldopa, and calcium channel blockers. Breast enlargement in males. Common in adolescence and usually temporary. Also occurs with anabolic steroid use, some medications, and some disease states. A firm transverse ridge of compressed tissue in the lower quadrants. Especially noticeable in large breasts. Ducts that drain the mammary gland at the nipple. Inflamed lymph nodes. Breast tenderness and pain. Uncommon. Inflammatory mass before abscess formation. Usually occurs in a single quadrant. Area is red, swollen, tender, very hot, and hard. Woman will have headache, fever, malaise, chills, and sweating, increased pulse, flulike symptoms. Sebaceous glands in the areola. Make oily secretions to keep the nipple and areola lubricated. (Intraductal carcinoma). Early lesion has unilateral, clear, yellow discharge and dry, scaling crusts, friable at nipple apex. Spreads outward

Health Assessment Ch. 17, 24, 25, 26 Key Terms and Concepts
to areola with erythematous halo on areola and crusted, eczematous, retracted nipple. Later lesion shows nipple reddened, excoriated, ulcerated, with bloody discharge when surface is eroded, and an erythematous plaque surrounding the nipple. Symptoms include tingling, burning, itching. Lymphatic obstruction producing edema. It thickens the skin and exaggerates the hair follicles, giving it an orange peel look. It suggests cancer. Edema usually begins in the skin around and beneath the areola, the most dependent area of the breast but can also infiltrate the nipple. Extra nipple. Persists and is visible somewhere along the track of the mammary ridge. Congenital. Located in the superior lateral corner of the breast tissue. Projects up and laterally into the axilla. The five steps of breast development/sexual maturity rating. 1. Preadolescent: only a small elevated nipple. 2. Breast bud stage: small round mound of breast and nipple develops. The areola widens. 3. The breast and areola enlarge; the nipple is flush with the breast surface. 4. The areola and nipple form a secondary mound over the breast. 5. Mature breast: only the nipple protrudes; the areola is flush with the breast contour.

peau d'orange

supernumerary nipple tail of Spence Tanner staging

Nursing Diagnosis Ineffective Breastfeeding S/S: Unsatisfactory breastfeeding process Actual or perceived inadequate milk supply Infant inability to attach onto maternal breast correctly Nonsustained suckling at the breast Persistence of sore nipples beyond first week of breastfeeding Observable signs of inadequate infant intake Insufficient emptying of each breast per feeding Insufficient opportunity for suckling at the breast Infant arching and crying at the breast, resisting latching on Ineffective Coping S/S: Change in communication pattern Inability to meet or be responsible for basic needs Fear of pain, death Frequent headaches Emotional tension Insomnia Verbalizes inability to cope or inability to ask for help

Related To Prematurity Infant receiving supplemental feedings with artificial nipple Poor infant sucking reflex Nonsupportive partner/family Deficient knowledge Interruption of breastfeeding Maternal anxiety or ambivalence

Effects of acute or chronic illness Loss of control over body part or body system Lack of support systems Low self-esteem Major change in lifestyle Unrealistic perceptions Situational or maturational crisis Knowledge deficit about: Disease process, Therapeutic regimen, Prognosis

Health Assessment Ch. 17, 24, 25, 26 Key Terms and Concepts
Inability to perform expected roles Separation from or loss of significant other Physical inactivity Sensory overload Stress-related disorders: Ulcers, Hypertension, Irritable bowel Substance abuse Inappropriate use of defense mechanisms: Withdrawal, Depression, Overeating, Blaming, Scapegoating, Manipulative behavior, Self-pity Chronic anxiety Indecisiveness

Medical Diagnosis Mastitis Peau d'orange Fibrous tissue

Paget's disease lymphadenopathy Breast cancer

Female Genitourinary System adnexa amenorrhea atrophic vaginitis


Appendages of an organ. Uterine adnexa: Ovaries, Fallopian tubes, and ligaments. Absent menses. S: post menopausal vaginal itching, dryness, burning sensation, dyspareunia, mucoid discharge O: pale mucosa with abraded areas that bleed easily; may have bloody discharge. An opportunistic infection related to chronic estrogen deficiency. S: ¾ women have no symptoms. May have urinary frequency, dysuria, or vaginal discharge, postcoital bleeding. O: may have yellow or green mucopurulent discharge; friable cervic, cervical motion tenderness.

Health Assessment Ch. 17, 24, 25, 26 Key Terms and Concepts
contraceptive cystocele Birth control S: feeling of pressure in vagina, stress incontinence. O: with straining or standing, note introitus widening and the presence of a soft, round anterior bulge. The bladder, covered by vaginal mucosa, prolapses into vagina. Pain or cramps before or during the period. Discharge occurring with vaginitis of any cause. Painful urination. The number of pregnancies. Blood in urine. Subjective: episodes of local pain, dysuria, fever Objective: clusters of small, shallow vesicles with surrounding erythema; erupt on genital areas and inner thigh. Also inguinal adenopathy, edema. Vesicles on labia rupture in 1 to 3 days, leaving painful ulcers. Initial infection lasts 7 to 10 days. Virus remains dormant indefinitely. Recurrent infections last 3 to 10 days with milder symptoms. Genital warts. S: painless warty growths, may be unnoticed by women. O: pink or flesh colored, soft, pointed, moist, warty papules. Single or multiple in cauliflower like patch. Occur around vulva, introitus, anus, vagina, and cervix. The date of the last menstrual period. Subjective data collected. Age at first period. Mean age is 12-13; delayed onset suggests endocrine or underweight problem. Cessation of menstruation. Heavy menses. Menstruation Mucous filled cyst on the cervix caused by covering of the follicle with squamous epithelium. Waking up in the night to urinate. Screens for cervical cancer. Do not obtain during menses or if heavy infectious discharge is present. The number of births. From age 40-55 yrs. Hormones shift, resulting in vasomotor instability. S: feeling of pressure in the vagina, possibly constipation. O: with straining or standing, note introitus widening and the presence of a soft, round bulge from posterior. All conditions that can be transmitted during intercourse or intimate sexual contact with an infected partner. O: with straining or standing, uterus protrudes in the vagina. Prolapse is graded: first through third degree (whole uterus protrudes).

dysmenorrhea dyspareunia dysuria gravida hematuria herpes simplex virus type 2

human papillomavirus (HPV)

last menstrual period (LMP) menarche menopause menorrhagia menses nabothian cysts nocturia Papanicolaou (Pap) smear para perimenopausal rectocele

sexually transmitted disease (STD) speculum (Graves', Pederson) uterine prolapse

Nursing Diagnosis Sexual Dysfunction

Related To Depression

Health Assessment Ch. 17, 24, 25, 26 Key Terms and Concepts
S/S: Decreased or absent sexual desire Impotence Delayed development of secondary sex characteristics Sexual promiscuity Exhibitionism Guilt Alterations in achieving perceived sex role or sexual satisfaction Verbalization about the problem Conflicts involving values Changes in interest in self and others Seeking confirmation of desirability Voyeurism Transsexualism Transvestism Masochism/sadism Functional Urinary Incontinence S/S: Unpredictable voiding pattern Unrecognized signals of bladder fullness Urge to void or bladder contractions sufficiently strong to result in loss of urine before reaching an appropriate site or receptacle Disturbance in self-esteem or body image Lack of significant other Lack of privacy Effects of actual or perceived limitation imposed by disease and/or therapy Substance abuse Physical or psychosocial abuse Dysfunctional interpersonal relationships Ineffective or absent role models Failure to identify satisfactorily with same-sex parent Cultural norms regarding male/female roles Values conflict Knowledge deficit

Deficits Cognitive Motor Sensory Altered environment

Medical Diagnosis sexually transmitted diseases vaginitis leiomyomata pelvic pain/sexual pain endometriosis

Ectopic Pregnancy Bartholin gland abscess Cancer of the cervix/endometrial Menstrual irregularities Urinary tract infection


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