Assessing the Genitalia and Rectum Patients

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Lab Assignment: Assessing the Genitalia and Rectum Patients are frequently uncomfortable discussing with healthcare professional’s 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. Please see the “Course Announcements” section of the classroom for your Episodic note case study. -Based on the Episodic note case study: Review this week’s Learning Resources, and consider the insights they provide about the case study. Refer to Chapter 3 of the Sullivan resource to guide you as you complete your Lab Assignment. Search the Walden library or the Internet for evidence-based resources to support your answers to the questions provided. —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 Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature. -Analyze the subjective portion of the note. List additional information that should be included in the documentation. -Analyze the objective portion of the note. List additional information that should be included in the documentation. -Is the assessment supported by the subjective and objective information? Why or why not? -Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis? -Would you reject/accept the current diagnosis? Why or why not? -Identify five possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least FIVE different references from current evidence-based literature. Learning Resources Required Readings (click to expand/reduce) Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby. Chapter 17, “Breasts and Axillae” This chapter focuses on examining the breasts and axillae. The authors describe the examination procedures and the anatomy and physiology of breasts. Chapter 19, “Female Genitalia” 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 20, “Male Genitalia” The authors explain the biology of the penis, testicles, epididymides, scrotum, prostate gland, and seminal vesicles. Additionally, th​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​e chapter explains how to perform an exam of these areas. Chapter 21, “Anus, Rectum, and Prostate” 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. Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby. Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center. Chapter 5, “Amenorrhea” Amenorrhea, or the absence of menstruation, is the focus of this chapter. The authors include key questions to ask patients when taking histories and explain what to look for in the physical exam. Chapter 6, “Breast Lumps and Nipple Discharge” This chapter focuses on the important topic of breast lumps and nipple discharge. Because breast cancer is the most common type of cancer in women, it is important to get an accurate diagnosis. Information in the chapter includes key questions to ask and what to look for in the physical exam. Chapter 7, “Breast Pain” Determining the cause of breast pain can be difficult. This chapter examines how to determine the likely cause of the pain through diagnostic tests, physical examination, and careful analysis of a patient’s health history. Chapter 27, “Penile Discharge” The focus of this chapter is on how to diagnose the causes of penile discharge. The authors include specific questions to ask when gathering a patient’s history to narrow down the likely diagnosis. They also give advice on performing a focused physical exam. Chapter 36, “Vaginal Bleeding” In this chapter, the causes of vaginal bleeding are explored. The authors focus on symptoms outside the regular menstrual cycle. The authors discuss key questions to ask the patient as well as specific physical examination procedures and laboratory studies that may be useful in reaching a diagnosis. Chapter 37, “Vaginal Discharge and Itching” This chapter examines the process of identifying causes of vaginal discharge and itching. The authors include questions on the characteristics of the discharge, the possibility of the issues being the result of a sexually transmitted infection, and how often the discharge occurs. A chart highlights potential diagnoses based on patient history, physical findings, and diagnostic studies. Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis. Chapter 3, “SOAP Notes” (Previously read in Week 8) Mealey, K., Braverman, P. K., & Koenigs, L. M. (2019). Why a pelvic exam is needed to diagnose cervicitis and pelvic inflammatory disease. Annals of Emergency Medicine, 73(4), 424–425. https://doi.org/10.1016/j.annemergmed.2018.11.028 Sanchez, C., Israel, R., Hughes, C., & Gorman, N. (2019). Well-woman examinations: Beyond cervical cancer screening. The Journal for Nurse Practitioners, 15(2), 189–194.e2. https://doi.org/10.1016/j.nurpra.2018.09.005 Centers for Disease Control and Prevention. (2021, April 13). Sexually transmitted disease surveillance, 2019. https://www.cdc.gov/std/# This section of the CDC website provides a range of information on sexually transmitted diseases (STDs). The website includes reports on STDs, related projec​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​ts and initiatives, treatment information, and program tools.

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of mind to one excluding mental, we deduct the importance of experience in understanding a phenomenon. Jackson explains that “mental states are inefficacious in respect to the physical world” (Jackson). Qualia only impact other mental states rather than physical states. Jackson reiterates this by providing three reasons. The first being causality. Just because A follows B does not mean B can follow A. The B follows A hypothesis can be refuted by proving there is a common underlying causal process for each distinct effect. Second, Jackson uses evolution to prove his dualism. Polar bears have evolved to have a thick coat. This thickness makes the coat heavy. Thus, the polar bears experience what it is like to carry a heavy coat. This is clearly not conducive to survival. Therefore, from Darwin’s Theory we know that any evolved characteristics are either conducive to survival or a by-product of an evolutionary action that is conducive to survival. Jackson uses this support his argument against physicalism: “qualia are a by-product of certain brain processes that are conducive to survival” (Jackson). Third, Jackson emphasizes the relationships between how we know our minds through behavior. We only know about others’ minds through observing their behavior. So, we must ask: how can a person’s behavior accurately reflect that he has qualia unless they conclude that behavior is an outcome of qualia? This gives rise to the main weakness of Jackson’s view – there is no proper evidence for the refutation of epiphenomenal qualia. Another weakness of Jackson’s view is the lack of clarity of source. Where do these qualia come from? If not physical, then where? This brings into questions spirits and “upper powers,” such as God, the existence of which are heavily debated in the scientific community. Despite this, the validity of dualism (and the lack of proving dualism to be incorrect), is a strong argument and will continue to allow Jackson’s argument to be considered valid. Because Jackson clearly refutes any existence of physicalism in his explanation of phenomenal qualia, and his argument is overall less problematic than the arguments of his opponents, I align more with Jackson’s knowledge argument than that of Lewis. Until the existence of the actual physical matter behind “what it is like” information is found, Jackson’s argument proves to be more valid than that of Lewis. Although I would like to think that everything involving humans can be linked back to the brain, I do believe that some things may never be explained.

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