C-RLE 101: Health Assessment (Laboratory)
HEALTH ASSESSMENT (LECTURE) REVIEWER
NEUROLOGIC SYSTEM
 Is responsible for coordinating and regulating all
body functions.
Consists of two structural components:
1. Central Nervous System (CNS)
2. Peripheral Nervous System
Central Nervous System
 The brain and the spinal cord are covered by
meninges (a three layered connective tissue that
protect and nourish the CNS).
Subarachnoid space – surrounds the brain and spinal
cord, it is filled with cerebrospinal fluid (CSF).
*This fluid-filled space cushions the brain and spinal
cords, nourished the CNS and removes waste materials.
 Electrical activity of the CNS is governed by
neurons located throughout the sensory and
motor neuron pathways.
 The CNS contains upper motor neurons that
influences lower motor neurons, located mostly
in the peripheral nervous system.
Central Nervous System
Frontal Lobe
 Directs voluntary, skeletal actions
 (left side of the lobe controls right side of the
body and right side of the lobe controls the left
side of the body)
 Influences communication (talking and writing),
emotions, intellect, reasoning ability, judgment
and behaviour
 Contains Broca’s area, responsible for speech
Parietal Lobe
 Interprets tactile sensation, including touch, pain
temperature, shapes and two-point
discrimination.
Occipital Lobe
 Influences the ability to read with understanding
and is primary visual receptor
Temporal Lobe
 Receives and interprets impulses from the ear
 Contains Wernicke’s area, responsible for
interpreting auditory stimuli
Peripheral Nervous System
 Carrying information to and from the CNS
 Consists of 12 pairs of cranial nerves and 31
pairs of spinal nerves
 These nerve are categorized as two types of
fibers: Somatic and Autonomic.
 Somatic fibers carry CNS impulses to voluntary
skeletal muscles;
 Autonomic fibers carry CNS impulses to smooth,
involuntary muscles (in the heart and glands)
Cranial Nerves
 Are twelve pairs of cranial nerves evolve from
the brain or brain stem and transmit motor or
sensory messages.
(OOO-TTA-FAG-VSH)
Cranial Nerve I (Olfactory)
 Sensory
 Carries smell impulses from nasal mucous
membrane to brain.
Cranial Nerve II (Optic)
 Sensory
 Carries visual impulses from eyes to brain
Cranial Nerve III (Oculomotor)
 Motor
 Contracts eye muscles to control eye
movements (interior, lateral. Medial and
superior), constricts pupils and elevates eyelids.
Cranial Nerve IV (Trochlear)
 Motor
 Contracts one eye muscle to control
inferomedial eye movements
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Cranial Nerve V (Trigeminal)
 Sensory, Motor
 Carries sensory impulses of pain, touch and
temperature from the face to the brain.
Influence clenching and lateral jaw movement
(biting, chewing)
Cranial Nerve VI (Abducens)
 Motor
 Controls lateral eye movements
Cranial Nerve VII (Facial)
 Sensory, Motor
 Contains sensory fibers for taste on anterior
two-thirds of tongue and stimulates secretions
from salivary glands (submaxillary and
sublingual) and tears from lacrimal glands
 Supplies the facial muscles and affects facial
expressions (smiling, frowning, closing eyes)
Cranial Nerve VIII (Acoustic)
 Sensory
 Contains sensory fibers for hearing and balance
Cranial Nerve IX (Glossopharyngeal)
 Sensory, Motor
 Contains sensory fibers for taste on posterior
third of tongue and sensory fibers of the
pharynx that result in gag reflex when
stimulated.
 Provides secretory fibers to the parotid salivary
glands; promotes swallowing
Cranial Nerve X (Vagus)
 Sensory, Motor
 Carries sensations from the throat, larynx, heart,
lungs, bronchi, gastrointestinal tract and
abdominal viscera.
 Promotes swallowing, talking and production of
digestive juices.
Cranial Nerve XI (Spinal Accessory)
 Motor
 Innervates neck muscles (sternocleidomastoid
and trapezius) that promote movement of the
shoulders and head rotation.
 Also promotes some movement of the larynx
Cranial Nerve XII (Hypoglossal)
 Motor
 Innervates tongue muscles that promote the
movement of food and talking
HEADACHES
 Do you experience head ache?
 Use COLDSPA to further explore
- Morning headaches that subside after arising
may be an early sign of increased intracranial
pressure as with a brain tumor
SEIZURES
- Seizures occur with epilepsy, metabolic
disorders, head injuries and high fevers.
DIZZINESS
- May be related to carotid artery disease,
cerebellar abscess, Meniere’s disease or inner
ear infection
- Imbalance and difficulty coordinating or
controlling movements are seen in neurologic
diseases involving the cerebellum, basal ganglia,
extrapyramidal tracts or the vestibular part of
cranial nerve VIII (acoustic)
- Diminished cerebral blood flow and vestibular
response may increase the risk of fall
SENSES
- A decrease in the ability to smell may be related
to a dysfunction of cranial nerve I (olfactory) or a
brain tumor.
- A decrease in the ability to taste may be related
to dysfunction of cranial nerves VII (facial) or IX
(glossopharyngeal).
*OLDER ADULT CONSIDERATION
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 - Decreased taste and scent sensation occurs - Peripheral neuropathy can result from a
normally in older adults deficiency in niacin, folic acid, or vitamin B12.

DIFFICULTY SPEAKING MALE GENITALIA AND RECTUM

- Injury to the cerebral cortex can impair the

ability to speak or understand verbal language

DIFFICULTY SWALLOWING

- Difficulty swallowing may relate to CVA,

Parkinson's disease, myasthenia gravis, Guillain-
Barre syndrome, or dysfunction of cranial nerves
IX (glossopharyngeal), X (vagus), or XII
(hypoglossal).

MUSCLE CONTROL

- Loss of bowel control or urinary retention and

bladder distention are seen with spinal cord
injury or tumors.
- Unilateral weakness or paralysis (loss of motor
function from lesion[s] in the neurologic or
muscular systems) may result from CVA,
compression of the spinal cord, or nerve injury.
- Progressive weakness is a symptom of several
nervous system diseases.
NUMBNESS AND TINGLING
- Use COLDSPA to further assess
- Loss of sensation, tingling, or burning
(paresthesia) may occur with damage to the
brain, spinal cord, or peripheral nerves.
FAMILY HISTORY
- These disorders may be genetic. Some tend to
run in families
EXTERNAL GENITALIA
Penis
- Is the male reproductive organ
- Attached to the pubic arch by ligaments, the
penis is freely movable
 The shaft of the penis is composed of 3
cylindrical masses of vascular erectile tissue that
are bound together by fibrous tissue – two
corpora cavernosa on the dorsal side and the
corpus spongiosum on the ventral side.
 A hood like fold of skin is called the foreskin or
prepuce
 Center of the corpus spongiosum is the Urethra
(it travels through the shaft and opens as a slit at
the tip of the glans as the urethral meatus)

 Fold of foreskin that extends ventrally from the

LIFESTYLE AND HEALTH PRACTICE urethral meatus is called the frenulum

- Prescription and non-prescription drugs can
cause various neurologic symptoms such as
tremors or dizziness, altered level of
consciousness, decreased response times, and
changes in mood and temperament
- Role is both for reproduction and urination
Scrotum
- A thin-walled sac that is suspended below the
pubic bone, posterior to the penis.

- Nicotine, which is found in cigarettes, constricts - Contains sweat and sebaceous glands and
the blood vessels, which decreases blood flow to consists of folds of skin (rugae) and the
the brain. Cigarette smoking is a risk factor for cremaster muscle
CVA

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  Function: protective covering for the testes,  Rectum is a muscular tube about 13cm (5 in.)
epididymis and vas deferens and help to long that is at the end of the large intestine
maintain the cooler-than-body temperature (colon)
necessary for production of sperm
 Rectum connects the colon to the anus, the
INTERNAL GENITALIA opening where stool exits the body.
Testes  Internal and External Anal Sphincter are rings of
muscles at the opening of the anus.
- Are a pair of ovoid-shaped organs
 Sphincter keeps anus closed as stool collects in
 Function: is to produce spermatozoa and the
the rectum.
male sex hormone testosterone
PROSTATE
Spermatic Cord
- Is approximately 2.5 cm in diameter,
- The testes are suspended in the scrotum by a
surrounding the neck of the bladder and urethra
spermatic cord
- It lies between these structures and the rectum
- Contains blood vessels, lymphatic vessels, nerves
in male clients
and the vas deferens (or ductus deferens)
- Consists of 2 lobes separated by a shallow
- Transports spermatozoa away from the testis
groove called the median sulcus
 Epididymis – a comma-shaped, coiled, tubular
- Secrets a thin, milky substance that promotes
structure that curves up over the upper and
sperm motility and neutralizes female acidic
posterior surface of the testis.
vaginal secretion.
 Vas/ Ductus Deferens – a firm, muscular tube
- This chestnut- or heart-shaped organ can be
that is continuous with the lower portion of the
palpated through the anterior wall of the rectum
epididymis. It travels up within the spermatic
cord through the inguinal canal into the
abdominal cavity
PAIN
 Ejaculatory Duct – empties into the urethra
 Complaints of pain in these areas may indicate a
within the prostate gland.
hernia or an inflammatory process, such as
INGUINAL AREA epididymitis

- Is contained between the anterior superior iliac LESIONS

spine laterally and the symphysis pubis medially.
 Lesions may be a sign of a sexually transmitted
*Nurse needs to be familiar with the structures of the infection (STI) or cancer
inguinal or groin area because hernias (protrusion of
DISCHARGE
loops of bowel through weak areas of the musculature)
are common in this location  Discharge may indicate an infection

 Femoral Canal is located posterior to the inguinal LUMPS, SWELLING, MASSES

canal and medial to and running parallel with
 Lumps, swelling or masses found in the scrotum,
the femoral artery and vein.
genitalia or groin area may indicate infectioin,
 Femoral Canal is another potential spot for a hernia or cancer.
hernia
 Enlargement of the scrotum may indicate
RECTUM, ANUS AND ANAL SPHINCTER hydrocele, hematocele, hernia or cancer

OLDER ADULT CONSIDERATION:

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The scrotum also enlarges with aging
URINATION
 Difficulty urinating may indicate infection or
blockage, including prostatic enlargement
 Urinating more than one time during the night
may indicate prostate abnormalities. Excessive
intake of fluids and some medications, such as
diuretics, may also cause nocturia.
 Changes in urine color or odor may indicate an
infection. Blood in the urine (hematuria) should
be referred for medical investigation because
this may indicate infection, kidney stones,
benign prostatic hypertrophy (BPH), or cancer. A
decrease in amount of voided urine may indicate
prostate enlargement or kidney problems.
 Painful urination may be a sign of urinary tract
infection (UTI), prostatitis, or an STI.
 Incontinence may occur after prostatectomy.
Dribbling may be a sign of overflow incontinence
SEXUAL DYSFUNCTION
 A change in sexual activity or sexual desire
(libido) needs to be investigated to determine
the cause
 Erectile dysfunction (ED) occurs frequently in
adult males and may be attributed to various
factors or disorders (e.g., alcohol use, diabetes,
depression, antihypertensive medications). Pain
with ejaculation may indicate epididymitis.
OLDER ADULT CONSIDERATION:
ED increases in frequency with age
FAMILY HISTORY
 Colorectal cancer risk is increased by a family
history of colorectal cancer and/ or polyps.
Genetic studies also suggest that a strong family
history may be responsible for 5%-10% of
prostate cancers
LIFESTYLE AND HEALTH PRACTICES
 A client with multiple sexual partners increases
his risk of contracting an STI or HIV
 Currently, men have five birth control options,
which include: abstinence, condoms,
outercourse, vasectomy, and withdrawal.
Practicing fertility awareness-based methods
may also prevent pregnancy. Using a condom
reduces the risk of STIS (Planned Parenthood,
2012).
 Concerns about fertility can increase stress and
can have a negative impact on relationships.
 The client's knowledge of STIs and their
prevention provides a basis for health education
in this area
 Exposure to radiation and certain chemicals
increases the risk of developing cancer.
 Strenuous activity and heavy lifting may
predispose the client to development of an
inguinal hernia.
 Male clients who do not perform testicular self-
examinations need to be informed about the
connection between self-examination and early
interventions for abnormalities
 Male clients should be aware of the need for a
monthly testicular self-examination and its
importance in the early diagnosis and treatment
of testicular cancer
ABNORMAL FINIDINGS:
ABNORMALITIES OF THE PENIS
Syphilitic Chancre
- initially small, silvery-white papule that develops
a red oval ulceration
- a sign of primary syphilis (STI) that
spontaneously regresses
- may be misdiagnosed as herpes
Herpes Progenitalis
- clusters of pimple-like, clear vesicles that erupt
and become ulcers
- cause by HSV-1 or HSV-2 – disappear and the
infection remains dormant for varying period of
times
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 - recurrence can be frequent or minimally - When palpated; testis feels enlarged and
episodic smooth – tumor replaces testis

Genital Warts Scrotal Hernia

- single or multiple, moist, fleshy papules - A loop of bowel protrudes into the scrotum to
create what is known as an indirect inguinal
- STI caused by the human papillomavirus
hernia
Paraphimosis
- Hernia appears as swelling in the scrotum
- Foreskin is so tight that, once retracted it cannot
- Palpable as a soft mass and fingers cannot get
be returned back over the glans
above the mass
Phimos
Epididymitis
- Foreskin is so tight that it cannot be retracted
- Infection of the epididymis
over the glans
- Sudden pain
Cancer of the Glans Penis
- Scrotum appears enlarged, reddened and
- Appears as hardened nodule or ulcer on the
swollen; tender epididymis is palpated
glans
- Usually associated with prostatitis or bacterial
- Occurs primarily in uncircumcised men
infection
Hypospadia
Orchitis
- Urethral meatus is locates underneath the glans
- Inflammation of the testes, associated
(ventral side)
frequently with mumps.
- Is a congenital defect
- Complains of pain, heaviness, and fever.
- A groove extends from meatus to the normal
- Scrotum appears enlarged and reddened;
location of the urethral meatus
swollen, tender testis is palpated.
Epispadias
Varicocele
- Urethral meatus is located on top of the glans
- Abnormal dilation of veins in the spermatic cord.
(dorsal side); occurs rarely
- Complain of discomfort and testicular heaviness.
- Is a congenital defect
- Tortuous veins are palpable and feel like a soft,
irregular mass or "a bag of worms," which
ABNORMALITIES OF THE SCROTUM collapses when the client is supine.

Hydrocele - Infertility may be associated with this condition.

- Collection of serous fluid in the scrotum, outside Spermatocele

the testes within the tunica vaginalis - Sperm-filled cystic mass located on epididymis.
- Swelling in the scrotum - Palpable as small and nontender, and movable
Testicular Tumor above the testis.

- Small, firm, nontender nodule on the testis - This mass will appear on transillumination

- Tumor grows, the scrotum appears enlarged and

the client complains of a heavy feeling

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INGUINAL AND FEMORAL HERNIAS
Indirect Inguinal Hernia
- Bowel herniates through internal inguinal ring
and remains in the inguinal canal or travels
down into the scrotum (scrotal hernia).
- Most common type of hernia.
- May occur in adults but is more frequent in
children.
Direct Inguinal Hernia
- Bowel herniates from behind and through the
external inguinal ring. It rarely travels down into
the scrotum.
- Type of hernia is less common than an indirect
hernia.
- Occurs mostly in adult men older than age 40
Femoral Hernia
- Bowel herniates through the femoral ring and
canal. It never travels into the scrotum, and the
inguinal canal is empty.
- Least common type of hernia.
- Occurs mostly in women.
ABNORMALITIES OF THE PROSTATE GLAND
Acute Prostatitis
- Prostate is swollen, tender, firm, and warm to
the touch. Prostatitis is caused by a bacterial
infection.
Benign Prostatic Hypertrophy
- Prostate is enlarged, smooth, firm, and slightly
elastic.
- Median sulcus may not be palpable.
- Common in men older than 50 years.
Cancer of the Prostate
- A hard area on the prostate or hard, fixed,
irregular nodules on the prostate suggest
cancer.
- median sulcus may not be palpable
ABNORMALITIES OF THE ANUS AND RECTUM
External Hemorrhoid
- Hemorrhoids are usually painless papules
caused by varicose veins. They can be internal or
external (above or below the anorectal junction)
- External hemorrhoid has become thrombosed –
it contains clotted blood, is very painful and
swollen, and itches and bleeds with bowel
movements.
Perianal Abscess
- Is a cavity of pus, caused by infection in the skin
around the anal opening.
- It causes throbbing pain and is red, swollen,
hard, and tender
Anal Fissure
- These splits in the tissue of the anal canal are
caused by trauma.
- A swollen skin tag ("sentinel tag") is often
present below the fissure on the anal margin.
- cause intense pain, itching, and bleeding
Rectal Prolapse
- occurs when the mucosa of the rectum
protrudes out through the anal opening
- It may involve only the mucosa or the mucosa
and the rectal wall.
- Appears as a red, doughnut-like mass with
radiating folds.
Anorectal Fistula
- Is evidenced by a small, round opening in the
skin that surrounds the anal opening.
- Suggests an inflammatory tract from the anus or
rectum out to the skin.
- Suggests an inflammatory tract from the anus or
rectum out to the skin.
Rectal Polyps
- Are rather common and occur in varying sizes
and numbers.
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 - Are two types: pedunculated (on a stalk) and
sessile (on the mucosal surface).
FEMALE GENITALIA AND RECTUM
EXTERNAL FEMALE GENITALIA
Clitoris
- Small, cylindrical mass of erectile tissue and
nerves with three parts: the glans, the corpus
and the crura
- Similar to male penis, contains many blood
vessels that become engorged during sexual
arousal

Vestibule

- contains several openings

 Urethral meatus – between the clitoris and the

vaginal orifice.

 Opening of Skene glands – either side of the

Mons Pubis
- Fat pad located over the symphysis
- Normal adult mons pubis is covered with pubic
hair in a triangular pattern
 Function: absorb force and to protect the
symphysis pubis during coitus (sexual
intercourse)
Labia Majora
- Two folds of skin extend posteriorly and
inferiorly from the mons pubis to the perineum
urethral opening and are usually not visible,
secretes mucus that lubricates and maintains a
moist vaginal environment. Are referred to as
the lesser vestibular glands
 Vaginal Orifice – external opening of the vagina
and has either a slit-like or irregular circular
structure, depending on the configuration of a
hymen
 Hymen – fold of membranous tissue that covers
part of the vagina
 Bartholin glands – either side of or slightly
posterior to the vaginal orifice; secrete mucus,
which lubricates the area during sexual
intercourse.

- Skin folds composed of adipose tissue, INTERNAL FEMALE GENITALIA

sebaceous glands and sweat glands

- Outer surface is covered with pubic hair in the

adult; inner surface is pink, smooth and moist

Labia Minora

- Thinner skin fold that is joined anteriorly at the

clitoris and form a prepuce or hood; posteriorly
the two folds join to form the frenulum

- Hairless and usually darker pink; contain

numerous sebaceous glands that promote
lubrication and maintain a moist environment in
the vaginal area

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Vagina
- Muscular, tubular organ, extends up and slightly
back toward the rectum from the vaginal orifice
(external opening) to the cervix.
- allows the passage of menstrual flow, receives
the penis during sexual intercourse, and serves
as the lower portion of the birth canal during
delivery
FOUR LAYERS
a) Outer layer is composed of pink squamous
epithelium and connective tissue
*Rugae – transverse folds allow the vagina to expand
during intercourse; they also facilitate vaginal delivery of
a fetus
b) Second layer is the submucosal layer; contains
the blood vessels, nerves, and lymphatic
channels.
c) Third layer is composed of smooth muscle
d) Fourth layer consists of connective tissue and
the vascular network.
- Normal vaginal environment acidic (pH of 3.8-
4.2); environment is maintained because the
vaginal flora is composed of Döderlein bacilli (act
on glycogen to produce lactic acid) → prevent
vaginal infection.
Cervix
- Separates the upper end of the vagina from the
isthmus of the uterus.
- Junction of the isthmus and the cervix forms the
internal os:
- Junction of the cervix and the vagina forms the
external os or ectocervix
 Functions: allow the entrance of sperm into the
uterus and to allow the passage of menstrual
flow. It also secretes mucus and prevents the
entrance of vaginal bacteria.
 External os of a woman who is nulliparous
(having borne no offspring) will appear as a
small, round depression on examination
 External os of a woman who has given birth will
appear slit-like due to dilation of the cervix
Uterus
- Pear-shaped muscular organ that has two
components: the corpus, or body, and the
cervix, or neck
- uterus is movable
THREE LAYERS OF THE UTERUS WALL:
(Endometrium, myometrium, peritoneum)
a) Endometrium - inner mucosal layer; estrogen
and progesterone influence the thickness of this
tissue; portion of the endometrium sheds during
menses and childbirth.
b) Myometrium - middle layer of the uterus;
functions to expel the products of conception.
c) Peritoneum - outer uterine layer that covers the
uterus and separates it from the abdominal
cavity; forms anterior and posterior pouches
around the uterus (recto-uterine pouch or the
cul de-sac of Douglas)
Ovaries
- Pair of small, oval-shaped organs, each of which
is situated on a lateral aspect of the pelvic cavity
- Connected to the uterus by the ovarian ligament
 Functions: to develop and release ova and to
produce hormones such as estrogen,
progesterone, and testosterone.
Fallopian tubes
- Begin near the ovaries and enter the uterus just
beneath the fundus
- End of the tube near the ovary has fringe like
extensions called fimbriae
- Ovaries, fallopian tubes, and supporting ovarian
ligaments are referred to as the adnexa (Latin
for appendages)
ANUS AND RECTUM
Anal Canal
- Final segment of the digestive system;
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 - it begins at the anal sphincter and ends at the
anorectal junction

- Within the anus → two sphincters that normally

hold the anal canal closed except when passing
gas and feces.

a) External sphincter is composed of skeletal

muscle and is under voluntary control

b) Internal sphincter is composed of smooth

muscle and is under involuntary control by the
autonomic nervous system.

- Dividing the two sphincters is the palpable

intersphincteric groove

- Anal canal proceeds upward toward the

umbilicus.

Rectum

- Lined with folds of mucosa, known as the

columns of Morgagni.

- Anorectal junction is not palpable, but may be

visualized during internal examination

- The folds contain a network of arteries, veins,

and visceral nerves.

- Inside of the rectum contains three inward

foldings called the valves of Houston

(Refer to Module 16 for Assessment and Rationale)

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