Special Examinations—Breast, Genital, Prostate, and Rectal

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GENITALIA ASSESSMENT
Subjective:
• CC: “I have bumps on my bottom that I want to have checked out.”
• HPI: AB, a 21-year-old WF college student reports to your clinic with external
bumps on her genital area. She states the bumps are painless and feel rough.
She states she is sexually active and has had more than one partner during the
past year. Her initial sexual contact occurred at age 18. She 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 reports one sexually
transmitted infection (chlamydia) about 2 years ago. She completed the
treatment for chlamydia as prescribed.
• PMH: Asthma
• Medications: Symbicort 160/4.5mcg
• Allergies: NKDA
• FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD
• Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)
Objective:
• VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs
• Heart: RRR, no murmurs
• Lungs: CTA, chest wall symmetrical
• Genital: Normal female hair pattern distribution; no masses or swelling. Urethral
meatus intact without erythema or discharge. Perineum intact. Vaginal mucosa
pink and moist with rugae present, pos for firm, round, small, painless ulcer noted
on external labia
• Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney
• Diagnostics: HSV specimen obtained
Assessment:
• Chancre
PLAN: This section is not required for the assignments in this course (NURS 6512) but
will be required for future courses.

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 three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

Sample Solution

allowing the parents to have free reign over their children’s genetic traits and enhancements may result in problems arising, with the aforementioned negative consequences outweighing the parents’ satisfaction. Furthermore, while we say that allowing the parents to change their children is free will, we also need to consider the free will of the child that is soon to be born. If the child does not like the changes that were made to them, this will result in conflict. While gene editing is reversible, as recently discovered (Frederick, 2021), this is still likely a long process that the child has to undergo. Additionally, maybe it is not safe to allow this free will over the distribution and use of gene editing technology. According to a study conducted by the University of Missouri-Columbia, most teenagers prioritise appearance over health (University of Missouri- Columbia, 2012). While libertarianism means the people can choose what they do with CRISPR/ CAS9, in the grand scheme of things, it is more important that people stay healthy. This is why so many anti- smoking campaigns are promoted by governments around the world, for example.

To conclude, it is very rare that a discovery as revolutionary as gene editing graces the field of genetic research. However, using it for personal gain and for one’s own vanity will undermine the potential for greater good. If gene editing remained purely for medical use, it will have a much more widespread impact on the world around us. It should also be kept exclusively in the laboratory, as there will be accessibility issues, if, for example, it is patented, and less people have access to it. There are many issues associated with how it will likely be used by people, so I argue for increased regulation of the distribution and the access of this technology, even if that may involve gene editing only being used in the laboratory for medical research.

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