Assignment No.

Name: Kamran Dost

Subject: Health Assessment
Date: 15th Feb. 2023

Q No. 1: Discuss the history questions pertaining to male and female breast and Genitalia assessment.

The nurse may ask about the following:

Male genitalia:

 Urinary symptoms: Is there dysuria? frequency of micturition? Is there any nocturia? any terminal dribbling
of micturition? Is there hesitancy of micturition? Have symptoms developed gradually or suddenly? Is there
any incontinence or urgency of micturition? There may be stress incontinence, detrusor instability, detrusor
underactivity or urethral obstruction.
 Urethral discharge: Possible exposure to sexually transmitted infections.
 Testicular pain: Possible causes include trauma, infection, torsion and epididymitis.
 Genital ulcers: Genital ulcers are likely to be caused by sexually transmitted infection.
 Impotence: Impotence covers a number of different conditions and causes. Consider:

 Emotional and psychological factors.

 Drugs and alcohol.

 Whether there is loss of libido, erectile failure.

 Subfertility: This may be primary (no conception) or secondary (past conception). Subfertility history should
cover conception history and Length of subfertility.

 Sexual history:
 Timing and frequency of intercourse.
 Impotence and ejaculation.
 Medication history.
 Medical history: Any chemotherapy or cancer treatment, history of sexual development. Any association with
other relevant diseases (diabetes mellitus, neurological disease, cardiovascular disease).

 Other symptoms include:

Loin pain; urinary calculi can cause ureteric obstruction and lead to severe loin pain , a renal tumour,
haematuria or incontinence.
Systemic symptoms of acute kidney injury or chronic kidney disease - eg, anorexia, vomiting, fatigue, pruritus
and peripheral oedema.
Recent onset of back pain in an elderly patient may be indicative of prostate cancer with bone metastases.

 Occupational history: Exposure to chemical carcinogens such as 2-naphthylamine or benzidine in the

chemical or rubber industries may induce bladder cancer many years later.
 Family history: A family history of kidney failure or polycystic kidney disease may be relevant to the
underlying problem.
 Past medical history: Neurological diseases may cause abnormal bladder function - eg, Parkinson's
disease, multiple sclerosis or cerebrovascular disease.

 Any history of kidney disease, hypertension, diabetes, gout or past back injury may also be relevant.
Abdominal or pelvic surgery can cause denervation injury to the bladder.
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 Previous surgery - eg, for prostatic hypertrophy.

 Ureteric injury may occur in abdominal operations.

Female genitalia:

Gynaecological history
Menstrual history
 Last menstrual period (LMP) - date of first day of bleeding.
 Cycle length and frequency - eg, 5/28, five days of bleeding every 28 days.
 Heaviness of bleeding. (Number of tampons per day/clots/flooding/need for double protection.)
 Presence or absence of intermenstrual bleeding (IMB).
 Presence or absence of postcoital bleeding (PCB).
 Age of menarche/menopause.
 Presence or absence of postmenopausal bleeding (PMB).
Vaginal discharge
Presence or absence of vaginal discharge, Colour, Amount, Smell, Itchiness, Duration, Timing within
menstrual cycle, Rash, Any symptoms in a partner.
Pain or discomfort
Urinary symptoms
Leakage, Cloudiness, Haematuria, Hesitancy, Dysuria, Frequency, Strangury (slow, painful urination, caused
by muscular spasms of the urethra and bladder).Stress or urge incontinence.

Sexual history: Whether sexually active.

Past gynecological history:
 Any past history of pelvic inflammatory disease (PID).
 Any known contact with sexually transmitted infections.
 Assessment of the risk of HIV and hepatitis B.
 Gynecological operations.

Breast:
The key features to determine in the breast history include:

 Breast lump
 Mastalgia (breast pain): bilateral or unilateral.
 Nipple discharge
 Altered appearance: skin, size, asymmetry. Usually in association with a lump.

Consider the following features in the history of a breast lump:

 Site: the actual location of the lump

 Size: rough estimation
 Timing: when was the lump first noticed?
 Change in size: has the lump changed in size? In what time frame?
 Consistency: does the lump feel soft or soft? Is it mobile or fixed?
 Pain: is the lump painful or painless?
 Preceding injury
 Associated lumps or bumps: are there any lymph nodes present or adjacent lumps?
 Associated features: any change to surrounding skin? Any distortion of the breast appearance?
 These changes may occur in association with enlarged lymph nodes and nipple discharge.
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Nipple discharge
Ensure you clarify whether the discharge is unilateral or bilateral and then focus on the colour, consistency, and
volume. Determine whether the discharge is bloody. Bloody nipple discharge is concerning for a more sinister
pathology.

OBGYN history
Establishing a proper obstetric and gynaecological history is important to work out any risk factors for breast disease.
An obstetric and gynaecological history are needed to determine the risk of certain breast diseases and is needed to
guide further management and treatment options.

Ask about any obstetric history and whether they are currently breastfeeding. Patients who are breastfeeding are at
increased risk of mastitis and breast abscess.

Past medical history

Ask about any previous history of breast cancer and determine the timeline of treatments.
It is critical that you ask about any previous breast disease, but particularly focusing on previous cancer. Make sure
you ask about previous treatments, which may include:

 Breast surgery (e.g. mastectomy, lumpectomy, breast reconstruction)

 Chemoradiotherapy: was this neoadjuvant (i.e. before surgery) or adjuvant (i.e. post-surgery)
 The intention of treatment (e.g. curative or palliative)
 Last follow-up or treatment
 Side-effects (e.g. chemotherapy side-effects, lymphoedema)

Drug history
Hormone replacement therapy (HRT) increases the risk of breast cancer.
Clarify current medications including prescribed, over-the-counter and herbal remedies. Also, enquire about any recent
medications, for example, has the patient had any recent antibiotics for a breast abscess?

Make sure you enquire about hormonal therapies:

 Contraceptive use (e.g. oral, subcutaneous, IUS)

 Hormone-replacement therapy (HRT)

Ask about the type of hormonal therapy and the duration of use. All types of systemic HRT increase the risk of breast
cancer after 1 year of use, but some more than others. It is important to ask about hormonal use even if the patient is no
longer using them.

Family history
Breast cancer may be hereditary due to the inheritance of an abnormal gene (e.g. BRCA).
Q No. 2. Perform a breast examination including axillary nodes and interpret findings.

Inspection:

Breast Exam
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During the inspection of the breasts observe for any asymmetric findings, especially:

- Abnormalities in the overall shape of the breasts

- Changes in skin color

- Skin dimpling / retractions

- Spontaneous nipple discharge

Palpation:

When palpating the breasts, it is important to pay attention to the following features of any identified masses:

o Shape: the most common benign lesions, like a cyst or a fibroadenoma, have very regular borders while cancerous
nodules tend almost always to be irregular in shape

o Consistency: a mass that feels rock hard or otherwise very firm is probably malignant, while a rubbery or elastic
consistency is typical of a benign lesion

o Relation to the skin: a lesion that is very fixed to skin is usually malignant

o Changes over time: rapid changes of a lesion over weeks to months raise suspicion for cancer

o Tenderness: cancerous nodules tend to be nontender, while benign lesions are often particularly tender. A mass
that changes in tenderness during the menstrual cycle is most likely benign

Palpation Technique:

It is important to keep in mind the following points about the correct palpation technique:

- Palpation is best done by using the finger pads rather than the fingertips

- One hand palpates the breast for any abnormalities while the other one sustains and stabilizes the breast

- It is important to thoroughly and systematically palpate all the areas of the breast, including the tail of spence in
the upper outer quadrant

- There are different ways to move across the breast. However, the most effective strategy based on available
evidence is the “lawnmower” method where the hand moves up and down, from one side to the other, describing
vertical lines all across the breast

- Remember to press the nipple against the chest wall to elicit any discharges if not spontaneously present

- If tenderness is present on one side, always start the exam on the nontender side

Lymph Node Exam

Breast Exam
It is important to conclude the breast exam with a thorough examination of the axillary lymph nodes to check for any
metastatic lesions, when breast cancer is suspected.
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At this point palpate the axilla with your free hand using the tips of your 2 nd, 3rd and 4th fingers.

Remember to check the supraclavicular and infraclavicular lymph nodes, too, which may be sites of spreading for
breast cancer, even if less commonly than the axillary nodes.

Q No. 3: Discuss components of a genital exam on a male or female.

Female genital exam:

For obvious reasons, women should schedule their pelvic exam to take place on days when they are not having their
periods, when examination is not urgent. However, when worrisome symptoms are present, such as abnormal
discharge, or burning during urination, the pelvic exam should be scheduled as soon as possible

A proper pelvic examination requires preparation. Women should not douche, use tampons or vaginal sprays or
powders, or insert anything into their vagina (including a penis or any other sexual object!) for 24 hours before their
scheduled examination.

Upon the start of the exam, women should tell their doctor all about their symptoms, and be able to report the first day
of their last period, as well as the length of that period. Women should also report if they believe they may be
pregnant, if they are using any birth control (and what sort), and whether this is their first pelvic examination.

Once a woman has removed her clothes from the waist down and been draped with a sheet/gown, the pelvic exam
begins with the health care provider looking at the genitals on the outside of the body. A speculum (an instrument that
looks a little like a duck's beak) is then inserted into the vagina and then expanded so as to dilate the opening of the
vagina.

Next, the doctor positions the speculum and examines the cervix looking for abnormalities. A small brush will be used
to collect cells from the cervix (this is the "pap smear"). The doctor may also use large cotton swabs to collect samples
for later STD testing (for Chlamydia, Gonorrhea and related conditions). This first part of the pelvic exam concludes
with the doctor collapsing and then removing the speculum.

Following the speculum examination, the doctor does a "bimanual" examination, meaning that he or she uses his or her
hands to examine the internal reproductive organs.

A "rectovaginal" examination may follow the bimanual examination. During the rectovaginal exam, in which the
doctor's fingers are inserted into both the vagina and the anus/rectum, the doctor examines the internal space between
the rectum and the vagina, making sure that this tissue is healthy and free from abnormalities.

If the woman being examined is over 50 years old, the doctor may recommend that her stool be tested for blood.

Though the doctor's visual findings can be immediately communicated to the patient, any collected fluid or tissue
samples requiring testing may take a few days to be processed and interpreted.

Male Genital Exam:

During the male genital exam a doctor performs a visual and manual examination of the male genitals which includes
the penis, testicles, epididymis, spermatic cord, and vas deferens. If indicated, the doctor will also examine the
rectum/anal area, and the prostate gland.

It is important for male patients to tell their doctor about any worrisome sores or ulcers, discharge, pain or other
symptoms they may be experiencing before the actual examination is underway, so that the doctor knows what to look
for during the examination.

Prior to the examination, patient will be asked to remove their clothing from the waste down (they are given a sheet or
gown for privacy). The doctor then examines the genitals, examining the skin for any abnormalities, the testicles for
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symmetry (that they are the same size and shape), and the penis for any odd discharge. Next the doctor palpitates
(touches) the testicles and the cords connecting the testicles to the body to make sure they are the proper shape and
size.

Depending on what the presenting problems are, the doctor may conduct additional examinations. For example, the
doctor may insert a small swab into the the urethra (the hole at the tip of the penis) so as to sample fluids found therein
for STDs. This swab insertion stings, and may cause soreness while urinating for the next several days. The doctor
may also feel the muscles in the groin area in search of hernias (which occur when a part of the intestines poke through
a hole in the muscles of the groin and stomach area).

If appropriate, a rectal examination may be done. The doctor will insert one or two gloved and lubricated fingers into
the patient's anus so as to examine the tissues found there for abnormalities. The doctor may also manually examine
the prostate gland (which is accessible from within the rectum) for abnormal bumps and overall enlargement. The
examination process can be embarrassing for some men, and at times, physically uncomfortable. At no time should the
exam be particularly painful, however. A man can take deep breaths to help make the situation better.

Q No. 4: Review components of a comprehensive reproductive history.

A woman’s reproductive health is assessed according to not just her physical health but also her mental well-being.

Reproductive health is a critical aspect of a woman’s overall health. Here are the components of reproductive health
that every nurse should ask about.

 Any gynecological services acquired that include advise on how to care for her reproductive health,
menstruation counseling, and safe sex education.

 Any sessions of breast exams, vaginal exams, and health screenings throughout life.

 Any Knowledge and health education on safe sex, contraceptive use and birth control.

 Information about healthy sexual life and any problems or concerns encountered.

 Any treatment such as fertility treatments and assistive reproductive technologies.

Previous obstetric history:

It is important to ask about a woman’s previous obstetric history, as this may help inform the assessment of risk in the
current pregnancy and have implications for the mode of delivery.

Gravidity and parity:

Gravidity is the number of times a woman has been pregnant, regardless of the outcome.

Parity is the total number of pregnancies carried over the threshold of viability (typically 24 + 0 weeks).

Pregnancies (>24 weeks)

Gestation at delivery: Previous pre-term labour increases the risk of pre-term labour in later pregnancies.

Birth weight:
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 A high birth weight in previous pregnancies raises the possibility of previous gestational diabetes.
 A low birth weight (small for gestational age) in a previous pregnancy increases the risk of a further small for
gestational age baby.

Mode of delivery:

 Spontaneous vaginal delivery, assisted vaginal delivery (e.g. forceps), Caesarean section(s).

Complications:

 Antenatal period: pre-eclampsia, gestational diabetes, gestational hypertension, placenta praevia and shoulder
dystocia.
 Postnatal period: post-partum haemorrhage, perineal/rectal tears during delivery and retained products of
conception.

Assisted reproduction: Clarify if IVF or other assisted reproductive techniques were used.

Stillbirth

Other details of the pregnancy:

 Check if this is a singleton or multiple gestation.

 Clarify if the patient took folic acid prior to conception and during the first trimester.
 Explore the planned mode of delivery (e.g. vaginal or Caesarean section).
 Ask about any medical illness during pregnancy (clarify what type of illness and if the patient is still receiving
any treatment).

Immunization history:

Check the patient is currently up to date with their vaccinations including Flu vaccination, Whooping cough
vaccination and Hepatitis B vaccination (if at risk).

Mental health history:

Pregnancy can have a significant impact on maternal mental health, therefore it is essential that patients are screened
for symptoms suggestive of psychiatric illness (e.g. depression, bipolar disorder, schizophrenia).

Ask about previous mental health diagnoses and any current thoughts of self-harm and/or suicide if relevant.

Q No. 6 List the changes in breast, male & female genitalia that are characteristics of aging process.
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Aging changes in the breast:

With age, a woman's breasts lose fat, tissue, and mammary glands. Many of these changes are due to the decrease in
the body's production of estrogen that occurs at menopause. Without estrogen, the gland tissue shrinks, making the
breasts smaller and less full. The connective tissue that supports the breasts becomes less elastic, so the breasts sag.

Changes also occur in the nipple. The area surrounding the nipple (the areola) becomes smaller and may nearly
disappear. The nipple may also turn in slightly.

Breast lumps are common around the time of menopause. These are usually noncancerous cysts. However, if you
notice a lump, make an appointment with your health care provider, because breast cancer risk increases with age.
Women should be aware of the benefits and limitations of breast self-exams.

Aging changes in the female reproductive system:

Aging changes in the female reproductive system result mainly from changing hormone levels. One clear sign of aging
occurs when menstrual periods stop permanently. This is known as menopause.

The time before menopause is called perimenopause. It may begin several years before last menstrual period. Signs of
perimenopause include:

 More frequent periods at first, and then occasional missed periods

 Periods that are longer or shorter
 Changes in the amount of menstrual flow

Eventually periods will become much less frequent, until they stop completely.

Along with changes in periods, physical changes in reproductive tract occur as well.

Aging changes in the male reproductive system may include changes in testicular tissue, sperm production, and erectile
function. These changes usually occur gradually.

Aging changes in the male reproductive system:

Unlike women, men do not experience a major, rapid (over several months) change in fertility as they age (like
menopause). Instead, changes occur gradually during a process that some people call andropause.

Aging changes in the male reproductive system occur primarily in the testes . Testicular tissue mass decreases. The
level of the male sex hormone, testosterone decreases gradually. There may be problems getting an erection. This is a
general slowing, instead of a complete lack of function.
FERTILITY

The tubes that carry sperm may become less elastic (a process called sclerosis). The testes continue to produce sperm,
but the rate of sperm cell production slows. The epididymis, seminal vesicles, and prostate gland lose some of their
surface cells. But they continue to produce the fluid that helps carry sperm.
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The prostate gland enlarges with age as some of the prostate tissue is replaced with a scar like tissue. This condition,
called benign prostatic hyperplasia (BPH), affects about 50% of men. BPH may cause problems with slowed urination
and ejaculation.

In both men and women, reproductive system changes are closely related to changes in the urinary system

References:

(https://patient.info/doctor/genitourinary-history-and-examination-male)

(https://patient.info/doctor/gynaecological-history-and-examination)

(https://app.pulsenotes.com/clinical/histories/notes/breast-history)

(https://stanfordmedicine25.stanford.edu/the25/BreastExam.html)

(https://www.mentalhelp.net/sexuality/std/examination/)

(https://geekymedics.com/obstetric-history-taking)

(https://medlineplus.gov/ency/article/003999.htm#:~:text)

(https://medlineplus.gov/ency/article/004016.htm#:~:text)

(https://www.stlukes-stl.com/health-content/health-ency-multimedia/1/004017.html)

(https://www.nursetogether.com/pregnancy-nursing-diagnosis-care-plan/)
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