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Discussion
A nurse or physician can conduct a pelvic examination in several positions other than lithotomy. These positions include the V-shaped and Side-lying positions. The V-shaped position requires the patient to lie on her back and spread out her straightened legs. The side-lying position requires the patient to lie on her side with her knees bent. The patient’s top leg should be close to the chest (Perry, 2016). I will take time to explain to the adolescent the process of a pelvic examination. I will also explain to the patient the operations that will occur and encourage her to ask questions before I commence the examination.
Vaginal mucus discharge is a common phenomenon experienced with the onset of puberty. It results due to the rise in estrogen levels. Therefore, the girl should not have any fears about the discharge because it is normal. The discharge is an indicator of an impending menstruation. Vaginal discharge in newborn girls is a normal occurrence. The typical discharge has a blood-tinged mucus appearance. The discharge occurs due to the effects of the maternal estrogen on the endometrium, cervical epithelium and vagina mucosa (Fleisher & Ludwig, 2010). The discharge should disappear within two weeks. The mother should visit a doctor if the discharge persists after two weeks. A yellow vaginal discharge is often a sign of an infection. I would ask the patient about the amount and frequency of the discharge. The advancement of the infection tends to cause increased discharge. According to Kurjak and Arenas (2013), Salpingitis has four main stages. Stage I Salpingitis involves localized tenderness to adnexa while Stage II involves pelvic peritonitis. Stage III involves the formation of tubal and ovarian abscesses. Lastly, Stage IV involves the rapture of the abscesses. According to Seller and Symons (2011), I should expect the physical examination to reveal an elevated body temperature and cervical and adnexal tenderness. I would also expect to see a purulent vaginal discharge and aggravated cervical pain upon the application of cervical motion.
Men do not have a specific menopause stage after which they cannot bear children. However, a man’s fertility declines gradually after the age of 40. The decline occurs mainly due to the reduction in the body’s testosterone level. Normally, a man’s fertility declines by 10 percent every decade after 40 years. Therefore, while a 60-year-old man has reduced sperm count and motility, he can still become a father (Lowdermilk, Perry, Cashion, & Alden, 2016). Cryptorchidism is a common disorder in newborn boys. It results due to factors such as the delayed activation of the SRY gene, gonadal differentiation and hormonal effects caused by testosterone and insulin. The child’s testicle should descend into the scrotal sac by the sixth week after birth. I will implement several measures to ensure the successful examination of the child’s testicles. First, I will use warm hands during the examination to ensure that the child is relaxed and minimize the retraction of the testicles. Secondly, I will place the child in a crossed-leg position to make the examination easy. I will discuss with the 12-year-old boy the importance of the genital examination and comment frequently on the maneuvers that I implement and findings at each stage of the examination. Furthermore, I will allow the boy to ask questions and make specific requests relating to the examination process. The best response to decrease the anxiety and embarrassment due to an erection is to explain to the patient that the erection is a normal body response by males during a genital examination.
References
Fleisher, G. R., & Ludwig, S. (2010). Textbook of pediatric emergency medicine. Philadelphia:
Lippincott Williams & Wilkins.
Kurjak, A., & Arenas, J. (2013). Donald School textbook of transvaginal sonography. New
Delhi: JP Medical Ltd.
Lowdermilk, D., Perry, S. E., Cashion, K., & Alden, K. (2016). Maternity & women’s health
care. St. Louis, MO: Elsevier Health Sciences.
Perry, S. E. (2016). Maternal child nursing care. St. Louis, MO: Elsevier Health Sciences.
Seller, R. H., & Symons, A. B. (2011). Differential diagnosis of common complaints.
Philadelphia, PA: Elsevier Health Sciences.
