1 | HEALTH ASSESSMENT

Stomach STEP II – Conjugation pathway, whereby the liver

Gastrin: STIMULATES cells add another substance to a toxic chemical or
o GASTRIC JUICE SECRETION drug, to render it less harmful.
o STORE FAT, VIT (A, B12, D, E, and K),
Highly acidic: ph (0.9-1.5) COPPER, AND IRON
o STOMACH MOTOR FUNCTION Functions of the liver
1. Nutrient conversion – liver cells convert some
Stomach wall: Mucosal barrier with a thick coat of nutrients into others
o Amino acids can be converted to lipids or
bicarbonate-rich mucus
glucose
o Fats can be converted to phospholipids
Mucoid secretions: coat stomach wall and prevent o Vit D is converted to its active form
autodigestion 2. Synthesis of new molecules – synthesizes
Pepsinogen: Aids in protein digestion blood proteins such as;
✔ Albumin
✔ fibrinogen
Hydrochloric acid: released in response to gastrin.
✔ globulins
o Functions in protein digestion, ✔ clotting factors

Intrinsic factor: Promotes absorption of vitamin B12
Chyme: is either delivered in small amounts to the
duodenum or forced backward to the stomach for
further mixing
✔ CEPHALIC PHASE
✔ GASTRIC PHASE
✔ INTESTINAL PHASE – pH is 3 or above,
gastric secretion is stimulated (gastrin).
*pH is 2 or below, gastric secretion is
inhibited (secretin)
SPLEEN FUNCTIONS:
✔ Filter the blood of cellular debris
✔ Digest microorganisms
✔ Return breakdown products to the liver
Liver
Portal Vein – Neutralizes gastric acid, emusifies
fats, facilitates fat and cholesterol absorption
Excretion – cholesterol, fats, and bile pigments
such as bilirubin
DETOXIFICATION
STEP I: CONVERTS A TOXIC CHEMICAL INTO A
LESS HARMFUL CHEMICAL
Chemical reactions:
o (such as oxidation, reduction and hydrolysis)
o produces free radicals
o Reduces the damage of free radicals
Hepatic duct: joins with the cystic duct (which
drains the gallbladder) to form the common bile duct.
Sphincter of Oddi
✔ If relaxed: bile enters the duodenum
✔ If contracted: bile is stored in gallbladder
Pancreas
Exocrine cells in the pancreas secretes:
● Trypsinogen and Chymotrypsin for protein
digestion.
● Amylase to break down starch.
● Lipase for fat digestion.
● Sodium bicarbonate to neutralize the
acidity of the stomach contents that enter
the duodenum.
● Pancreas is an exocrine gland
Large Intestine
✔ Serves as a reservoir for fecal material until
defecation occurs
✔ Decreased motility: causes greater
absorption and hard feces in the transverse
colon causes constipation.
✔ Increased motility: causes less absorption
and diarrhea or loose feces.
o Bacteria in the large intestine aids in
the synthesis of Vitamin K and some
of vitamin B groups.
✔ Feces – leave the body via the rectum and
anus
✔ Anus contains:
 2 | HEALTH ASSESSMENT

o Internal sphincter – involuntary 4. Digestion/Absorption

control ● Dyspepsia(Indigestion)
o External sphincter – voluntary control ● Heart burn/pyrosis
Abdominal wall muscles ● Pain - Referred pain
✔ protect the internal organs ✔ Gastritis
✔ allow normal compression ✔ GERD
o coughing/sneezing ✔ PUD
o urination ✔ Stomach cancer
o defecation
o childbirth 5. Bowel habits (constipation):
ASSESSMENT ● Note number of stools/day or week
✔ Health history ● Changes in size or color of stool
✔ Physical examination ● Alterations in food/fluid intake
● Painful defecation
PRESENTING PROBLEMS: ● Associated symptoms (abdominal pain,
1. Mouth cramps)
Check for: Causes: Mechanical obstruction or surgery
✔ Dental carries
✔ Bleeding gums Psychological factors resulting to use of
✔ Dryness/ increase salivation restricted toilet facilities
✔ Odors ● Drugs - atropine and codeine
✔ Difficulty of chewing ● Old age

2. Ingestion
● Changes in appetite: Anorexia
● Note food preferences/dislikes
● Digestive disorders, cancers
● Psychological disorders
o Older clients: experience a decline in
appetite (altered metabolism,
decreased taste sensation, decreased
mobility, depression)
● Food intolerances: Allergies, fluid, fatty
foods.
3. Weight gain/loss:
a.Dysphagia
● Nausea and Vomiting
● dietary intolerance, pregnancy
● Regurgitation - foods eaten Positioning. Type 1 and 2: CONSTIPATION
● like pebbles, Less fiber and less liquid
b. Stomatitis intake.
C. Achalasia ● exert a lot of pressure on the rectum
Nature of vomitus - Color/Taste/Consistency – Type 3: IDEAL
Possible Source ● softer and is easy to pass
● Yellowish or greenish – May contain bile Type 4: IDEAL
● Bright red (arterial) – Hemorrhage, peptic ● does not exert any pressure in the anal and
ulcer rectal cavity
● Dark red (venous) – Hemorrhage, Types 5, 6, 7 – STOMACH UPSET, DIARRHEA
esophageal or gastric varices ● Type 5: softer consistency, easily passed
● “Coffee grounds” – Digested blood from ● Type 6: with foul smell
slowly bleeding gastric or duodenal ulcer ● Type 7: diarrhea
● Undigested food – Gastric tumor? Ulcer ● Take note: thin, ribbon like appearance
obstruction? (cancer)
● “Bitter” taste – Bile
● “Sour” or “Acid” – Gastric contents Diarrhea - No. of stools/day, Consistency
● Fecal components – Intestinal Obstruction
6. Hepatic/biliary problems
 3 | HEALTH ASSESSMENT

● Jaundice ● PALER than the general skin tone

● Pruritus Abnormal findings
● Urine changes ● Grey turner’s sign - purple discoloration of
● Clay colored stools the flank (Bleeding) = PANCREATITIS
● Increased bleeding ● Cullen’s sign
● Cholangitis – stones partially block o superficial edema and bruising in the
● Stone – total block of bile subcutaneous fatty tissue around
Use of medication: the umbilicus (Bleeding) =
● Note use of antacids, vitamin supplements; PANCREATITIS, TRAUMA
aspirin and anti-inflammatory agents, high ● Jaundice - liver, gallbladder problems
iron intake ● Ascites – Liver Cirrhosis
Life Style
● Eating behaviors (rapid ingestion, skipping 1. Vascularity of the abdomen
meals, snacking), cultural/religious values ● Normal Findings: scattered fine veins may
(vegetarian, kosher foods [drained of blood]), be visible
ingestion of alcohol, smoking ● Abnormal findings:
● exercise (promotes peristalsis- regular bowel ✔ Spider angioma- dilated surface
movement) arterioles and capillaries with a surface
Past medical history: star – liver disease
● Childhood, adult, psychiatric illness ✔ Dilated veins - liver cirrhosis
(anorexia nervosa) ✔ STRIAE – normal findings
● stretch marks (tears in the skin
● Bleeding disorders
because of weight gain) or past
● Menstrual history
pregnancy or weight gain
● Exposure to infectious agents ● Liver Cirrhosis (ascites)
● Allergies
● Cancer 2. Scar – Document
● Prior abdominal surgery or trauma – risk
● source of scar
of developing ADHESIONS
● location (quadrant)
● shape, length (use ruler), specific
Physical Assessment: characteristic
Preparing the Client Hypertrophic scar is a condition on the skin that is
● Adequate lighting marked by excess scar tissue at the site of skin
● Ask client to empty bladder before exam injury.
● Instruct – remove clothes, put on a gown Keloid: excess scar tissue
● Supine position, HOB lowered, head or Deep iregular scars: burns
pillow, knees bent or on pillow, arms at side Lesions and rashes – Abdomen is free of lesions
or across chest and rashes. Flat or raised brown moles are normal
● Expose abdomen, drape genitalia and Abnormal Findings - Bleeding moles
female breasts ● Psoriasis
● Stand on client’s right side ● Petechiae
● Ticklish clients: use controlled hands-on
technique; place client’s hands under your 3. Umbilicus
own ● pinkish, similar to surrounding skin tone.
Preparing the client ● is midline at lateral line
● Warm room, hands and stethoscope ● inverted or protruding no more than 0.5cm
● Keep your fingernails short ● Abnormal: Umbilical hernia
● Palpate tender areas last ● Deviated (pressure from mass, enlarged
● Use distraction organ, hernia, fluid)
Abdominal Contour: Look across the abdomen at
Equipment eye level from the:
● Small pillow ✔ client’s side
● Stethoscope ✔ from behind the client’s head
● Ruler ✔ from the foot of the bed
● Marking pen May be abnormal: Severe wt. loss/cachexia
(starvation, terminal illness
Abdominal Inspection

Usually abnormal: Protuberant/Distended abdomen
– obesity, air or fluid accommodation
4. Abdominal Mass
● Distention below the umbilicus – full
bladder, uterine enlargement, ovarian cyst
● Distention of the upper abdomen –
pancreatic mass, gastric dilation
Measuring Abdominal Girth (Abdominal
distention)
Measurement is done:
✔ Daily in hospital
✔ During a doctor’s office visit
✔ home nursing visit
✔ same time of day, preferably in AM just after
voiding
✔ at designated time (bedridden / with
indwelling catheters)
✔ standing position (ideal position)
✔ use umbilicus – as starting point
Assess abdominal symmetry: Look at client’s
abdomen as she lies in a relaxed supine position.
● Normal: Symmetric
● Abnormal: Asymmetry (organ enlargement,
masses, hernia or bowel obstruction)
● Have client raise his/her head.
● Normal: No bulges
● Abnormal: Hernia
● Mass within abdominal wall is prominent
o Abnormal - Vigorous wide
exaggerated pulsations
● Peristaltic waves – may be visible in very
thin people.
o Abnormal – Peristaltic waves
increase and progress in a wave like
fashion from LUQ to RUQ
5. Abdominal Auscultation
● warm stethoscope before use
● apply with light pressure or simply rest
(tender abdomen)
● start RLQ – proceed clockwise in all
quadrants
● confirm bowel sounds in each quadrant,
listen for up to 5 minutes (minimum)
● Normal findings: soft clicks, gurgles,
intermittent 5-30/min
o Borborygmi: hyperactive bowel
sounds, loud, prolonged gurgles
● Deviation from normal:
o Hypoactive – abdominal surgery,
late bowel obstruction
o Hyperactive – diarrhea,
gastroenteritis
o Decreased/ Absent – surgical
emergency
4 | HEALTH ASSESSMENT
Vascular sounds
● Use bell of stethoscope to listen for bruits
Bruits at the left and right MCL
● between the umbilicus and the anterior iliac
spine – stenosis of the iliac arteries
Venous hums: are continuous sound found in the
epigastric region and around the umbilicus. They are
caused by Portal Hypertension.
Auscultate for friction rub over the liver & spleen.
● Listen over right and left lower rib cage with
diaphragm of stethoscope.
● Normally no friction rubs
● Abnormal: High-pitched, rough, grating
sound
✔ Heard w/ respiration
✔ Hepatic abscess or metastasis or
splenic infarction, abscess or tumor
✔ Friction rub
6. Abdominal Percussion
● Percuss for tone – Sequences
● Generalized tympany
● Dull- Liver, Spleen, Sigmoid
a. Suspect Ascites:
1. Shifting dullness test - Wait for 30-60
seconds
2. Fluid wave test- Client in supine.
Ask client to help:
o Place the ulnar side of the hand and
the lateral side of the forearm firmly
along the midline of the abdomen
o Place palmar surface (fingers and
hands) against one side of abdomen.
o Use other hand to tap opposite side.
o Abnormal: fluid wave is transmitted.
● Percuss the span or height of the liver
● Determine its lower and upper borders.
b. Percussing the liver:
● Lower border: begin in RLQ at MCL and
percuss upward.
● Note the change from tympany to dullness.
● Mark this point (lower border of liver
dullness)
● Assess descent. Have patient breathe
deeply and hold then repeat procedure. After
percussing remind client to EXHALE.
o Normally descends 1- 4 cm below the
costal margin
● Upper border: percuss over the upper right
chest at MCL and go downward.
o Resonance to dullness. MARK this
point – upper border of liver dullness
o Normal liver span at MCL: 6 to 12 cm
o Abnormal: hepatomegaly, tumors,
abscess
o Abnormal: A liver displaced in a lower
position:
 5 | HEALTH ASSESSMENT

o Emphysema – A liver displaced in a ● Ask client to turn to right side.

high position: ● Moves spleen downward and forward.
● Abdominal mass ● Normally not palpable. If palpable usually w/
o Ascites - Paralyzed diaphragm rounded edge (infection) and sharp edge
o MIDSTERNAL LINE (4-8 CM) If (chronic disease)
cannot accurately percuss, do
scratch test. g. Palpate the kidneys
o The Scratch Test Normal findings: NOT PALPABLE, if palpated firm,
o Auscultate over the liver and smooth and rounded
starting RLQ scratch lightly over Deviation from normal: ENLARGED
the abdomen, progressing upward
● CYST
the liver.
● COMPRESS DURING PEAK INHALATION
o Normal: scratching becomes more
intense over the liver. AND ASK CLIENT TO EXHALE AND HOLD
o spleen is an oval area of dullness BREATH BRIEFLY – RELEASE
approx. 7 cm wide near the left
10th rib and slightly posterior to h. Palpate urinary bladder
MAL ● Begin at the symphysis pubis and move
o Abnormal: splenomegaly (trauma, upward and outward to estimate bladder
portal hypertension) borders.
● Normally nonpalpable.
c. Performs blunt percussion on the liver and ● Abnormal: smooth, round, firm mass; dull
kidneys percussion tones.
● Liver – left hand flat against the lower right
anterior rib cage
SPECIAL TESTS
● Ulnar side R fist - strike
● Kidney - CVA 1. Tests of appendicitis
Normal findings: ● Rebound tenderness
● Liver and Kidneys- No Tenderness ● Palpate deeply where the client has pain.
Deviation from normal: ● Tenderness greater when you quick
Tenderness withdraw your hand from the point of the
● Hepatitis pain.
● cholecystitis
● Tenderness 2. Test for Psoas sign
● Raise right leg.
d. Palpate for masses ● Place hand over lower thigh and apply
● PALPATE THE UMBILICUS AND pressure downward against lower thigh.
SURROUNDING AREA FOR SWELLINGS, ● Extend the R leg at the hip to stretch the
BULGES OR MASSES iliopsoas muscle
● (SINGLE HANDED DEEP PALPATION) ● RLQ pain= + test for psoas sign
Normal findings: (appendicitis)
● No palpable mass
● No swellings, bulges or masses 3. Test for obturator sign
● Abnormal findings - MASS ● Raise right leg.
● Flex the hip and knee and rotate leg
e. Palpate the liver internally and externally – stretches the
Hooking technique: internal obturator muscle
● Curl fingers of both hands over the edge of ● RLQ pain = (+) obturator sign (Inflamed
the costal margin. appendix)
● Ask the client to breathe deeply and gently ● Rovsing’s sign (positive)- pain that is felt
pull inward and upward. in the RLQ when deep palpation (5 seconds)
in the LLQ is made.
f. Palpate the spleen ● Pressing the LLQ traps air within the large
● Place right hand below left costal margin, intestine and increases the pressure in the
pointing toward the client’s head. cecum
● Ask client to inhale deeply and press ● Appendix is inflamed, this increase in
inward and upward. pressure causes pain
● Spleen seldom palpable.
● Abnormal: splenomegaly
 6 | HEALTH ASSESSMENT

4. Hypersensitivity Test ✔ Hot flashes and night sweats

● Stroke abdomen with sharp object or grasp
fold of skin with thumb and index finger and
quickly let go.
● Positive test: pain or exaggerated sensation
felt in the RLQ - Appendicitis
5. Test for Abdominal Aortic Aneurysm
● Patient complains of tearing pain.
● Auscultation reveals bruits or exaggerated
pulsation. A mass may be palpable over the
aorta.
✔ Irregular vaginal bleeding
✔ Spotting
✔ Mood swings
✔ Appetite – decreased
✔ Dryness – vagina
✔ On hormone replacement therapy
2. Vaginal discharge, pain and masses
✔ Unusual vaginal discharge – infection
✔ Pain, itchiness - genital or groin
✔ Lumps, swelling, masses – genitals

6. Test for Cholecystitis 3. Urination

● Press fingertips under liver margin and ask ✔ Difficulty – blockage
client to inhale deeply. ✔ Pain – infection (UTI, STD)
● Murphy’s sign: accentuated sharp pain ✔ Blood in urine – infection
when client hold his or her breath ✔ Difficult in controlling urine –
incontinence
7. Ballotement technique -Test for ascites
8. Single Hand Method – using a tapping or 4. Sexual Dysfunction:
bouncing motion of the finger pads over the ✔ Sexual performance
abdominal wall, feeling for a floating mass. ✔ Change in sexual activity/libido – frigid
✔ Fertility problems
9. Bimanual Method – Place one hand under the
✔ Gynecologic problems
flank (Feeling hand) and push the anterior ✔ Pelvic and rectal examination – masses
abdominal wall with the other hand ✔ Pap Smear – screening test for cervical
cancer
FEMALE GENITALIA ✔ History of STD? Treatment?
✔ Pregnant. At present? How many times?
a. Ovary - Develop and release ova and produce
Miscarriage or abortions?
hormones progesterone, estrogen, testosterone
b. Uterus
5. Diabetes mellitus – risk: Vaginal yeast infection
c. Fallopian Tube
✔ Family history of cancer
d. Cervix - Prevents entrance of vaginal bacteria
✔ Lifestyle
o passage of menstrual flow
✔ Smoking
o allows entrance of sperm to the uterus
o birth canal - delivery ✔ Sexual partners
✔ Contraceptives
e. Vagina ✔ Sexual preference
o Acidic – pH of 3.8-4.2, Prevents vaginal ✔ Sexual likes/dislikes discussed with partner
infection ✔ Fears related to sex. Stress
o passage of menstrual flow 6. Lifestyle
o receives the penis-sexual intercourse ✔ Fertility problems
o birth canal - delivery ✔ Monthly genital examinations
✔ HIV testing
COLLECTING SUBJECTIVE DATA ✔ STD
1. Menstrual Cycle ✔ Cotton underwear, tight jeans
Date: Last Menstrual Period ✔ Wipe from front to back – urination,
✔ Regular or not defecation
✔ Amount of blood flow ✔ Vaginal douche
✔ Symptoms experience before or during
period 7. Tampon Use - mass of absorbent material that is
Age: started her period (10-16 y/o) used to absorb the menstrual fluid during
Stopped menstruating: menstruation.
✔ MENOPAUSE ✔ Toxic shock syndrome (TSS) – tampon
✔ Ask if still having her periods use
Symptoms of menopause:
 7 | HEALTH ASSESSMENT

✔ worn inside the vagina, where it absorbs the ● Ask the client to squeeze around the finger
menstrual fluid right after it is released from ● NORMAL FINDINGS: Able to squeeze
the uterus ● Deviation from normal: Absent or
✔ should not be left inside the vagina for more decreased ability
than 6 hours
Inspect the cervix
PHYSICAL EXAMINATION ● Observe the cervical color, size and position.
● Embarrassment - patient ● Observe the surface and the appearance of
● Explain – details of procedure the os
● Encourage – her to ask questions ● Check for discharge
● Eye contact – elevate head of the bed, use
mirror to teach normal anatomy and get her NORMAL FINDINGS:
involvement ● Smooth, pink, and even
● Equipment - ready ● Midline position
● Smooth, small, round opening
PREPARATION ● Clear or white without unpleasant odor and
lesions
INSPECT NORMAL FINDINGS DEVIATION
ION FROM DEVIATION FROM NORMAL:
NORMAL ● Bluish, pale or redness
Mons Pubic hair distribution Absence of ● Cervical enlargement project into the vagina
pubis - o inverted triangle pubic hair >3 cm (prolapse or tumor)
Palpate ● Asymmetric, reddened areas, malodorous or
inguinal Old clients – Enlarged irritating discharge
lymph o gray hair inguinal
nodes o No L.N. - Inspect the vagina
enlargement/swelling swelling ● As you remove the speculum observe the
color, surface, consistency and any
discharge of the vagina
1. Inspection - Labia majora and perineum ● NORMAL FINDINGS: Pink, moist, smooth
● labia minora - symmetric, moist, dark pink no lesions and irritation
● Clitoris - erectile tissue, sensitive to touch ● DEVIATION FROM NORMAL: Reddened
● Urethral meatus - slit like areas, presence of lesions and malodorous
● vaginal opening - size depends on sexual discharge
activity/ deliver
Normal findings: 2. Palpation
● Labia majora – equal in size, free of lesions Palpate Bartholin’s glands
● Healed episiotomy scar – NSD ● Place your index finger in the vaginal
opening and your thumb on the labia majora.
Deviation from normal: Lesions = Infections ● Gentle pinching motion, palpate from the
● Pediculosis Pubis – pubic hair lice inferior portion of the posterior labia majora
to the anterior portion.
● Repeat on the opposite side
Inspection of Internal Genitalia: Inspect the size of ● Normal findings: Soft, nontender, and
the vaginal opening and the angle of the vagina drainage free
● Normal findings: Varies in size according to ● Deviation from normal: Swelling, pain, and
client’s age, sexual history and OB history presence of discharge
o Tilted posteriorly at a 45-degree Palpate the urethra
angle ● Insert your gloved index finger into the
● Deviation from normal: Any loss of superior portion of the vagina
hymenal tissue between 3 o’clock position ● Milk the urethra from the inside, pushing up
and the 9 o’clock position (children) and out.
● Normal findings: No discharge, soft and
Inspect the vaginal musculature nontender
● Keep your index finger inserted in the client’s ● Deviation from normal findings: Presence
vaginal opening. of discharge from the urethra

Palpate the vaginal wall, cervix, uterus using
bimanual examination
● Normal findings: smooth, non-tender, soft
● Fundus is round, firm and smooth; at the
level of the pubis
● Deviation from normal:
o Tender, presence of lesions
o Enlarged uterus above the level of
the pubis
o irregular shape
ABNORMALITIES – FEMALE GENITALIA
1. Condylomata acuminata – warts on the
genitalia and perianal areas.
o Sexually transmitted
2. Syphilis
3. Candidiasis
4. Herpes simplex
5. Bartholin’s cyst abscess
6. Dropped or prolapsed bladder (cystocele)
o occurs when the bladder wall bulges
into the vaginal space. It results when
supporting muscles and tissues between
a woman's bladder and vaginal wall
weakens and stretches, allowing the
bladder to bulge into the vagina.
7. Rectocoele – bulging in the posterior vaginal
wall caused by weakening of the pelvic
musculature.
8. Uterine Prolapse – uterus protrudes into the
vagina
9. Uterine myoma
10. Ectopic pregnancy
11. Ovarian cyst
Medico – legal: Sixteen days after assault. The
“starburst” appearance created by the multiple
lacerations of the hymenal rim become apparent
during this examination method
Genital piercing
✔ Triangle
✔ Vertical Clitorial Hood
MALE GENITALIA
Reproductive and urination
● Scrotum – protective covering of the testes
and maintain a cooler than body
temperature: sperm production
● Smegma - the secretion of a sebaceous
gland; specifically: the cheesy sebaceous
8 | HEALTH ASSESSMENT
matter that collects between the glans penis
and the foreskin or around the clitoris and
labia minora.
● Testes – produce sex hormone testosterone
Collecting Subjective Data:
✔ Pain – inflammation, hernia
✔ Lesions – STD, cancer
✔ Discharge – color, odor, (infection)
✔ Lumps, swelling, masses – infection,
cancer, testicular tumor, hernia
✔ Urination – difficulty (infection, blockage)
color (blood), odor
SEXUAL DYSFUNCTION:
✔ change in sexual pattern/desire
✔ erectile dysfunction
✔ ejaculation problems – epididymitis
✔ fertility problems
✔ Past Medical problems – recurrence of
cancer, DM – impotence
✔ Testicular exam
✔ Tested for HIV, herpes, gonorrhea. Why
tested?
✔ Family history of cancer
✔ No. of sexual partners
✔ Kind of birth control used
✔ Satisfaction on current sexual function
✔ Infertility and relationship
✔ Sexual preference & Fears related to sex
✔ Sexual likes/dislikes communicated to
partner
✔ Knowledge on STDs and its prevention
✔ Exposure to chemicals or radiation- past and
present
✔ ADL – lifting heavy objects
✔ Testicular examination
Preparation:
● Empty his bladder
● Container – if urine specimen is needed
● Gown or drape – for privacy
● Lower pants/underwear – examined
standing
Equipment: stool, gown, disposable gloves,
flashlight
✔ Inspect the base of the penis and pubic
hair pubic hair
● free of excoriation, erythemata and
infestation.
● Abnormal findings – scarcity of
pubic hair (CHEMOTHERAPY),
Pediculosis pubis
✔ Skin of the shaft – wrinkled, hairless, no
rashes, lesions, lumps

✔ Palpate the shaft – non erect state (soft,
flaccid and nontender)
✔ Inspect the foreskin – intact and uniform in
color
✔ Inspect the glans penis – smooth, free of
lesions and redness
o if uncircumcised – ask client to retract
and if not able the nurse will retract it
for examination
✔ Palpating for urethral discharge – free of
discharge
SCROTUM: client holds his penis out of the way
● shape and position
● Inspect the scrotal skin
● Observe: color, integrity, and lesions or
rashes
● Spread out the scrotal folds (rugae) of the
skin
● Lift the scrotal sac to inspect the posterior
skin
Normal findings: Ovoid, approximately 3.5 to 5 cm
long, and 2.5 cm wide and 2.5 cm deep
● Equal in size and shape
● Smooth, firm, rubbery, mobile, free of
nodules, tender to pressure
● Epididymis is nontender, smooth, softer than
the testes
Deviation from normal:
● Cryptorchidism (undescended testicle)
● Painless nodules
● Tenderness and swelling
● STRANGULATED HERNIA
Inspect the size, shape and position:
Normal findings:
● Varies in size (according to temperature) and
shape
● Left side of the scrotal sac lower than the
right side
Deviation from normal: Enlarged scrotal sac,
hydrocele, hematocele, hernia, tumor
Inspect the scrotal skin:
Normal findings:
● Thin, rugated with hair dispersion
● Slightly darker than the penis
● No lesions or rashes
Deviation from normal: Rashes, lesions and
inflammation
Palpate the scrotal contents
● Palpate each testis and epididymis between
your thumb and 1st two fingers
● Note size, shape, consistency, nodules and
tenderness
9 | HEALTH ASSESSMENT
Palpate each spermatic cord and vas deferens
from the epididymis to the inguinal ring.
● Lies between your thumb and finger
● Note any nodules, swelling, or tenderness
Transilluminate the scrotal contents
● Darken the room and shine a light from the
back of the scrotum through the mass
● Look for a red glow
Normal findings:
● Uniform on both sides.
● The cord is smooth, nontender and ropelike
● No transillumination
Deviation from normal:
● Tortuous veins (varicocele) - Beaded or
thickened cord
● Swellings or masses
● Presence of red glow (fluid)
● Solid masses do not light up with a red glow
INGUINAL HERNIA
Cause:
● Muscle weakness (congenital or aging) – it
cannot be prevented, but exercises can be
performed to strengthened weak muscles.
● Defect muscle wall - trauma
● Increase in intra-abdominal pressure
o weight lifting
o coughing
o obesity - weight control
o pregnancy
Palpate for inguinal hernia and inguinal nodes
✔ Client to shift his weight to the left for
palpation for the right inguinal canal
✔ Palpate up the spermatic cord external
inguinal ring
✔ Once the index finger is in the canal ask
client to bear down or cough
✔ Feel for any bulges against your finger
✔ NORMAL FINDINGS: No Bulges or masses
✔ D FROM NORMAL: Bulge or masses
(hernia)
Palpate inguinal lymph nodes, femoral hernia
● Note the size, consistency, mobility and
tenderness
● NORMAL: No enlargement or tenderness,
bulge or masses
● D. From Normal: Enlarged and tender nodes
- bulge or mass hernia
Inspect and palpate for scrotal hernia
✔ If you discovered a mass; ask client to lie
down
✔ Note whether the bulge disappears
● Gently palpate the mass and try to
push it upward into the

● Normal: NO bulging when standing
● Deviation from normal: Bulge
disappear when lie down
Indirect inguinal hernia - Occurs through the
inguinal ring and follows the spermatic cord through
the inguinal canal.
Hernia – enlarges and descends to the scrotum
Direct Inguinal Hernia - WEAK ABDOMINAL
LAYER - Congenital deficiency in the number of
fibers it contains.
Femoral Iguinal Hernia - often present as an
incarcerated or strangulated hernia.
ASSESSMENT
✔ Reducible: can be manually placed back in
the abdominal cavity.
✔ Irreducible: cannot be place back in the
abdominal cavity
Position:
● Standing - examiner palpates the inguinal
ring
● Supine – check if it is reducible
1. Inguinal hernia: Painless inguinal swelling that is
reducible.
● Swelling may disappear during periods of
rest and is most noticeable when the patient
coughs
2. Irreducible/Incarcerated hernia - Occurs when
the descended portion of the bowel becomes tightly
caught in the hernia sac, compromising blood
supply.
● Represents a medical emergency requiring
surgical repair.
3. Strangulated hernia
● Protruding part - blood supply is cut off
4. Femoral hernia - protrusion through the femoral
ring, more common in females
ABNORMALITIES OF THE PENIS AND SCROTUM
1. Venereal warts – genital mucosa
2. Syphilis
3. Penile wart
4. Penile cancer
5. Paraphymosis – foreskin becomes trapped
behind the glans penis, and cannot be pulled
back to its normal flaccid position covering the
glans penis.
6. Epispadias
7. Hypospadias – A circumscribed collection of
fluid, especially in the tunica vaginalis of the
testis or along the spermatic cord.
8. Varicocoele – dilated, tortous varicose veins
most often affect the left spermatic cord. When
10 | HEALTH ASSESSMENT
the patient is upright- palpate “BAG OF
WORMS”
9. Spermatocele – sperm filled cystic mass
located on epididymis. Mass will appear on
transillumination.
10. Cryptorchidism – failure of one or both
testicles to descend into scrotum
11. Epididymo-orchitis – is an inflammation of
both the epididymis and the testicle. Viruses
commonly cause the infection (e.g., MUMPS)
GENITAL PIERCING: Frenum, Prince Albert
ANUS, RECTUM and PROSTATE
● Sim’s position
Inspect the perianal area (side – lying position)
✔ Lumps, Ulcers
✔ Lesions, Rashes, Redness
✔ Fissures
✔ Thickening of epithelium
Normal findings: Appear hairless, moist, and tightly
closed
● No redness, lumps, ulcers, lesions and
rashes
Deviation from normal:
● Lesions – STD, cancer or hemorrhoids
● Thrombosed external hemorrhoids –
itchy, painful and bleeds when passing stool
● Perineal abscess, anorectal fistula (small
opening in the skin surrounding anal
opening)
Ask client to perform Valsalva’s maneuver then
inspect anal opening for bulges or lesions
● Normal findings: no bulging or lesions
● Deviation from normal:
o Bulging - rectal prolapse
o Hemorrhoids - anal fistula
Inspect sacroccygeal area – for swelling, redness,
dimpling or hair
● Normal findings: smooth, no redness, and
hair
● Deviation from normal:
o Pilonodal cyst – reddened, swollen,
or dimpled area covered by small tuft
of hair located midline on lower
sacrum
PALPATION
Palpate the anus:
✔ Inform client
✔ Lubricate gloved index finger
✔ Ask client to bear down
✔ Place pad of finger on anal opening

✔ Normal findings: Sphincter relaxes,
permitting entry
✔ Deviation from normal: sphincter tightens
✔ When sphincter relaxes, insert finger with
pad facing down
✔ If with pain, spread gluteal fold with hands in
close approximation with anus, visualize a
lesion (causing the pain)
o Normal findings: Finger enters
anus
o Deviation from normal: Finger
cannot enter the anus
o If with severe pain, don’t force the
examination
✔ Ask client to tighten external sphincter, note
the tone
✔ Rotate finger to examine muscular anal ring
for tenderness, nodules, hardness
o Normal findings: Client can
normally close sphincter around the
gloved finger
o Smooth, non–tender, no nodules,
and hardness
✔ Deviation from normal:
o Poor sphincter tone – spinal cord
injury, previous surgery, trauma or
prolapsed rectum
o Tenderness – hemorrhoids, fistula
o Nodules – polyps or cancer
o Hardness – scarring or cancer
Hemorrhoids - Dilated varicose veins of the anal
canal which may be internal, external, or prolapsed.
● Above the anal sphincter, not seen on
inspection
● Below the anal sphincter, seen on inspection
● Prolapsed hemorrhoids can become
thrombosed or inflamed. Seen in pregnant
women - VAGINAL DELIVERIES (4
pregnancies with vaginal deliveries)
● Anoscopy - Polyp Hemorrhoid
Palpate the rectum
● Insert finger further into rectum as far as
possible
● Turn hand clockwise then counterclockwise
● Normal findings: Mucosa soft, smooth,
nontender, no nodules
● Deviation from normal:
o Hardness – scarring, cancer
o Nodules – polyps or cancer
● Proctoscopy
Palpate peritoneal cavity
● Male – this area may be palpated above the
prostate gland in the area of seminal
vesicles on anterior surface of rectum
11 | HEALTH ASSESSMENT
● Female – anterior rectal surface (behind the
cervix and the uterus)
● Normal findings: Smooth and nontender
● Deviation from normal: Rectal shelf –
peritoneal protrusion which may indicate a
cancerous lesion or peritoneal metastasis
Palpate the prostate (male)
● Turn hand counterclockwise so the pad of
finger faces umbilicus
● Palpate prostate gland, feel the sulcus
between lateral lobes
● Note size, shape and consistency, nodules
or tenderness
● Note: may need to move away from client for
proper examination angle
● Normal findings:
o Prostate – nontender and rubbery with
2 lateral lobes divided by median
sulcus
o Lobes – smooth, 2.5 cm long and
heart shaped
● Deviation from normal:
o Swollen and tender – acute prostatitis
o Benign prostatic hypertrophy
(BPH): enlarged smooth, firm prostate
with no median sulcus
o Nodules – cancer
1. Digital rectal examination (DRE) - Check stool
Inspect the stool
● Normal findings: Stool – semi-solid, brown
and free of blood
● Deviation from normal:
o Black stool – upper GI bleeding
o Yellow – steatorrhea (increased fat
content)
o Blood – cancer of rectum or colon
(endoscopy should be performed)
2. Fecal analysis - The stool is examined for its
amount, consistency, and color (Normal - light to
dark brown)
● Hemoglobin and bleeding affect the stool
● Upper G.I. Bleeding – tarry black (melena)
● Bulky, greasy, foamy, foul in odor, gray in
color with silvery gloss - Steatorrhea
3. Fecal occult blood test: Hemocult Guaiac slide
test - blood in the stool that is not visible to the
naked eye.
Uses: To detect G.I. Bleeding and early cancer
● 3 stool specimen (3 successive days)
Interpretation of results:
✔ Positive Result: BLUE COLOR presence of
occult blood.
ABNORMALITIES OF ANUS AND RECTUM:
 12 | HEALTH ASSESSMENT

✔ Pilonidal cyst
✔ Rectal prolapse – when the mucosa of the
rectum protrudes out through the anal
opening.
✔ Rectal polyps
✔ Rectal cancer
✔ Hemorrhoids
✔ Perineal laceration from blunt trauma
✔ Prostatitis
✔ BPH – surgical procedure (T.U.R.P.)