Required Readings

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

• Chapter 18, “Female Genitalia” (pp. 416-465)In this chapter, the authors explain how to conduct an examination of female genitalia. The chapter also describes the form and function of female genitalia.
• Chapter 19, “Male Genitalia” (pp. 466-484)The authors explain the biology of the penis, testicles, epididymides, scrotum, prostate gland, and seminal vesicles. Additionally, the chapter explains how to perform an exam of these areas.
• Chapter 20, “Anus, Rectum, and Prostate” (pp. 485-500)This chapter focuses on performing an exam of the anus, rectum, and prostate. The authors also explain the anatomy and physiology of the anus, rectum, and prostate.

Case 3: Genitalia

A 21-year-old college student reports to your clinic with external bumps on her genital area. The bumps are painless and feel rough. The patient is sexually active and has had more than one partner over the past year. Her initial sexual contact occurred at age 18. The patient reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She had one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.

• Consider what history would be necessary to collect from the patient in the case study you were assigned.
• 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.
• Post a description of the health history you would need to collect from the patient in the case study to which you were assigned. Explain what physical exams and diagnostic tests would be appropriate and how the results would be used to make a diagnosis. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.
• Example
• A 15-year-old male reports dull pain in both knees. Sometimes one or both knees click, and the patient describes a catching sensation under the patella. In determining the causes of the knee pain, what additional history do you need? What categories can you use to differentiate knee pain? What are your specific differential diagnoses for knee pain? What physical examination will you perform? What anatomic structures are you assessing as part of the physical examination? What special maneuvers will you perform?
  S.
  CC: “Knee pain”
  HPI: the patient is a 15 year old male who reports pain on both knees. The pain is described as being dull. Patient also states that at times he has clicking in one or both knees. The patient also describes a catching sensation under the patella. Patient with 5/10 pain at rest but pain elevated to 8/10 with movement.
  O: Alert and oriented X4, denies any numbness or tingling in extremities, no loss of sensation noted, positive pulses. BP-130/65, HR-101, RR-24, Temp.-98.1. Mother states the patient’s blood is out of norm for him. X-ray to be done in office.
  A:
  Differential diagnosis
  1. Patellar tendonitis is a common overuse injury, caused by repeated stress on your patellar leading to injury to the tendon connecting your kneecap (patella) to your shinbone and pain is found in between that area. At first be present only as you begin physical activity or just after an intense workout.
  2. Patellofemoral joint syndrome- Probable diagnosis- is one of the most common knee complaints of both the young active sportsperson and the elderly. Patients may report a painful catching sensation and a painful giving way of the knee and is mainly due to overuse or a change in exercise intensity
  3. Osteoarthritis- Obesity in children and adolescents has been linked to musculoskeletal disorders and excess force or joint loading may lead to osteoarthritis in overweight teens. High-impact, high-intensity, and repetitive athletics have a strong association with the occurrence of osteoarthritis in teenagers.
  4. Bursitis- Bursae reduce friction and cushion pressure points between your bones and the tendons, muscles and skin near your joints and when inflamed pain is felt with activity or rest.
  5. Meniscus tear-The meniscus can tear with forceful twisting or rotation of the knee causing pain, swelling, and difficulty extending that extremity. Commonly associated with sports.
  P.
  -Use ice as needed for pain or inflammatory relief, especially following activity. Apply ice for 10-15 minutes, 4-6 times per day. This should be weaned off as progress permits.
  -Patient may have to modify his activity level by decreasing activities that increase pressure to the patellofemoral. Ergonomic postures may have to be taught.
  -Physical therapy to Increase muscle strength and increase flexibility.
  -Use a patellofemoral brace or McConnell taping as needed for activity.
  Analgesics such as acetaminophen as well as NSAIDs, should be utilized for consistent pain and weaned off.
  •
  To carry out any examination the doctor must have solid understanding of the knee anatomy. Some physical examinations include palpation, patellofemoral assessment, anterior drawer test and posterior drawer test. X-rays will help in finding out which part of the knee is abnormal or injured and therefore narrow down to specific health conditions
  Due to the fact that the knee has the biggest articulating surface and that it is the joint that bears the largest weight, it is therefore no surprise that it is the most vulnerable joint to injuries. Most knee pains are caused by musculoskeletal injuries from chronic overuse or acute trauma, or both; and commonly occur in active and/or athletic adults and teenagers.
  More often experiencing pain in the knees could be as a result of physical injury or exhaustion. Also, knee pain can be a symptom of a serious health condition. To be able to categorically diagnose the condition the practitioner will have to run some historical check on the patient before proceeding. Health history will be useful. In this case, the doctor might want to know if the patient is involved in any sporting activities and if he wears protective pads. This information is usually very invaluable in the diagnosis of knee pains particularly in young athletes. Also, the practitioner will look at the medical history to establish if the patient has been diagnosed with rheumatoid arthritis, pseudo gout, gout or any other joint disease. Finally, the practitioner will be interested in knowing if the patient has had any physical injuries or surgeries to the knees.
  Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
  Halabchi, F., Mazaheri, R., & Seif-Barghi, T. (2013, February 12). Patellofemoral Pain Syndrome and Modifiable Intrinsic Risk Factors; How to Assess and Address? Retrieved October 18, 2017, fromhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC36907…
  Mayo Clinic. (2015, January 08). Patellar tendinitis, also known as jumper’s knee. Retrieved October 18, 2017, fromhttps://www.mayoclinic.org/diseases-conditions/pat…
  Physiopedia. (n.d.). Osteoarthritis in young people. Retrieved October 18, 2017, fromhttps://www.physio-pedia.com/Osteoarthritis_in_you…

  DISCUSSION 2

• Ethical Concerns

  As an advanced practice nurse, you will run into situations where a patient’s wishes about his or her health conflict with evidence, your own experience, or a family’s wishes. This may create an ethical dilemma. What do you do when these situations occur?In this Discussion, you will explore evidence-based practice guidelines and ethical considerations for specific scenarios.Scenario 1:The parents of a 5-year-old boy have accompanied their son for his required physical examination before starting kindergarten. His parents are opposed to him receiving any vaccines.Scenario 2:A 49-year-old woman with advanced stage cancer has been admitted to the emergency room with cardiac arrest. Her husband and one of her children accompanied the ambulance.Scenario 3:A 27-year-old man with Crohn’s disease has been admitted to the emergency room with an extreme flare-up of his condition. He explains that he has not been able to afford his medications for the last few months and is concerned about the costs he may incur for treatment.Scenario 4:A single mother has accompanied her two daughters, aged 15 and 13, to a women’s health clinic and has requested that the girls receive a pelvic examination and be put on birth control. The girls have consented to the exam but seem unsettled.Scenario 5:A 17-year-old boy has come in for a check-up after a head injury during a football game. He has indicated that he would like to be able to play in the next game, which is in 3 days.Scenario 6:A 12-year-old girl has come in for a routine check-up and has not yet received the HPV vaccine. Her family is very religious and believes that the vaccine would encourage premarital sexual activity.Scenario 7:A 57-year-old man who was diagnosed with motor neuron disease 2 years ago is experiencing a rapid decline in his condition. He prefers to be admitted to the in-patient unit at a hospice to receive end-of-life care, but his wife wants him to remain at home.To prepare:

  • Select three scenarios, and reflect on the material presented throughout this course.
  • What necessary information would need to be obtained about the patient through health assessments and diagnostic tests?
  • Consider how you would respond as an advanced practice nurse. Review evidence-based practice guidelines and ethical considerations applicable to the scenarios you selected.

  By Day 3Post the explanation of the health assessment information required for a diagnosis of your selected patients (include the scenario numbers). Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. Justify your responses.