Assignment: Lab Assignment: Assessing the Genitalia and Rectum ✓ Solved

Patients are frequently uncomfortable discussing issues that involve the genitalia and rectum; however, gathering an adequate history and properly conducting a physical exam are vital. Examining case studies of genital and rectal abnormalities can help prepare advanced practice nurses to accurately assess patients with problems in these areas.

In this Lab Assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.

To Prepare, review the Episodic note case study your instructor provides you for this week’s Assignment. Based on the Episodic note case study, review this week’s Learning Resources, and consider the insights they provide about the case study. Consider what history would be necessary to collect from the patient in the case study. Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis? Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

The Lab Assignment requires you to analyze the subjective portion of the note, list additional information that should be included in the documentation, analyze the objective portion of the note, and assess whether the assessment is supported by both subjective and objective information.

You are also required to determine if diagnostics would be appropriate for this case, and how the results would be used to make a diagnosis. Lastly, you must identify three possible conditions that may be considered as a differential diagnosis for this patient and explain your reasoning using at least three different references from current evidence-based literature.

Paper For Above Instructions

The assessment and evaluation of genitalia and rectal conditions are critical for healthcare practitioners, especially advanced practice nurses. Understanding the nuances of patients’ complaints and incorporating a thorough history and physical examination can lead to accurate diagnoses and effective treatment plans. This paper will analyze the provided Episodic note case study for a 21-year-old female college student (AB), focusing on the subjective and objective findings, diagnostic considerations, and possible differential diagnoses.

Subjective Analysis

The subjective portion of the note is vital, as it reflects the patient’s concerns and symptoms. The chief complaint (CC) indicates that AB has identified “bumps on my bottom” that need examination. This immediate statement provides a strong foundation for understanding AB’s discomfort and apprehension.

Further details in the history of present illness (HPI) reveal that the bumps are painless and rough, suggesting that they may be benign rather than symptomatic of an infectious condition. However, AB’s history of being sexually active with multiple partners raises the possibility of a sexually transmitted infection or a dermatological condition. The statement, “I'm unsure how long the bumps have been there but noticed them about a week ago,” emphasizes the need for further inquiry and evaluation of the duration and appearance of the bumps.

Additionally, the patient’s previous sexual health history, including a past infection of chlamydia, requires careful consideration. Given that she reported her last Pap smear exam three years ago as normal and without dysplasia, it is critical to reevaluate any potential risks for cervical cancer and other sexually transmitted diseases (STDs), as both can impact her overall health.

Objective Analysis

The objective examination findings confirm some elements from the subjective account but expand upon them. The vital signs are stable, and her general physical health appears normal. In the genital examination, the presence of a “firm, round, small, painless ulcer noted on external labia” is particularly significant. This finding could indicate several conditions, including genital warts (caused by HPV), a benign cyst, or herpes simplex virus (HSV) infection.

Moreover, the intact urethral meatus and absence of discharge minimize the likelihood of acute infections. Based on these findings, essential additional information that could be included in the documentation relates to the characteristics of the bumps, the patient's menstrual history, and any potential changes in sexual partners or practices.

Assessment Support

Evaluating whether the assessment is supported by the subjective and objective data is crucial. Given the patient's report of painless bumps and the clinician's observation of the ulcer, the assessment should emphasize potential benign lesions or STDs that require follow-up. It would be essential to highlight any psychosocial factors that might influence her health care decisions, such as stress, relationships, and sexual education.

Diagnostics and Rejection/Acceptance of Current Diagnosis

To further investigate AB’s condition, appropriate diagnostics would include obtaining a specimen for HSV testing, as the appearance of a painless ulcer may suggest the presence of HSV-1 or HSV-2. It is also advisable to perform HPV testing to rule out the possibility of genital warts. Further examination to evaluate overall sexual health, including serologic blood tests for STIs, could provide valuable information and allow for accurate diagnoses.

Given the current information, I would not accept the initial diagnosis as definitive. Instead, additional diagnostic tests are warranted to clarify the nature of the bumps and to rule out infections or malignancies. The differential diagnoses may include the following conditions:

  • Genital warts (Human Papillomavirus)

  • Herpes Simplex Virus (HSV)

  • Bacterial Vaginosis

  • Follicular Keratosis

  • Cysts or Abscesses

Conclusion

In conclusion, the assessment of genitalia and rectal abnormalities is critical in clinical practice. The history and objective findings of AB provide crucial insights into her condition. By utilizing research and applying evidence-based practice, healthcare professionals can offer more accurate assessments and better patient outcomes. Identifying the appropriate history, physical exams, and diagnostic tests are essential steps in the diagnostic process, ensuring comprehensive patient care.

References

  • 1. American Academy of Family Physicians. (2018). Issues in Genital Health: A Guide for the Family Physician. Retrieved from [https://www.aafp.org](https://www.aafp.org)

  • 2. Centers for Disease Control and Prevention. (2021). Sexually Transmitted Disease Surveillance 2020. Retrieved from [https://www.cdc.gov/std/statistics/2020/default.htm](https://www.cdc.gov/std/statistics/2020/default.htm)

  • 3. Ghanem, K. G., & Martin, D. H. (2016). The Spectrum of Genital Ulcers. Infectious Disease Clinics of North America, 30(3), 483-504.

  • 4. Lowy, F. D. (2021). Human papillomavirus infection and cervical cancer. Journal of the American College of Surgeons, 232(5), 801-810.

  • 5. Smith, K., Morrow, R. A., & Chang, S. (2019). STIs: Diagnosis and Treatment. Journal of Clinical Nursing, 28(3-4), 493-501.

  • 6. Sullivan, K. (2020). Understandingthe Female Genitalia: A Multimedia Approach. Women’s Health Insights, 14, 1-9.

  • 7. U.S. Preventive Services Task Force. (2018). Screening for Chlamydia and Gonorrhea. Retrieved from [https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/chlamydia-and-gonorrhea-screening-in-women](https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/chlamydia-and-gonorrhea-screening-in-women)

  • 8. Weinstock, H. S., & Berman, S. (2017). Sexually Transmitted Diseases in the United States. American Journal of Public Health, 107(S1), S64-S70.

  • 9. Witte, D. L., & Goldstone, S. (2019). Genital and anal warts: clinical management. Dermatologic Clinics, 37(4), 517-525.

  • 10. Zhang, J., & Kim, B. (2021). The role of clinical examination in the assessment of genital dermatological conditions. Dermatology Online Journal, 27(8), 1-10.