C-RLE 101: Health Assessment (Laboratory)

HEALTH ASSESSMENT (LECTURE) REVIEWER

NEUROLOGIC SYSTEM  Receives and interprets impulses from the ear
 Is responsible for coordinating and regulating all  Contains Wernicke’s area, responsible for
body functions. interpreting auditory stimuli
Consists of two structural components: Peripheral Nervous System
1. Central Nervous System (CNS)  Carrying information to and from the CNS
2. Peripheral Nervous System  Consists of 12 pairs of cranial nerves and 31
Central Nervous System pairs of spinal nerves

 The brain and the spinal cord are covered by  These nerve are categorized as two types of
meninges (a three layered connective tissue that fibers: Somatic and Autonomic.
protect and nourish the CNS).  Somatic fibers carry CNS impulses to voluntary
Subarachnoid space – surrounds the brain and spinal skeletal muscles;
cord, it is filled with cerebrospinal fluid (CSF).  Autonomic fibers carry CNS impulses to
*This fluid-filled space cushions the brain and spinal smooth, involuntary muscles (in the heart and
cords, nourished the CNS and removes waste materials. glands)

 Electrical activity of the CNS is governed by Cranial Nerves

neurons located throughout the sensory and  Are twelve pairs of cranial nerves evolve from
motor neuron pathways. the brain or brain stem and transmit motor or
 The CNS contains upper motor neurons that sensory messages.
influences lower motor neurons, located mostly
(OOO-TTA-FAG-VSH)
in the peripheral nervous system.
Cranial Nerve I (Olfactory)
Central Nervous System
 Sensory
Frontal Lobe
 Carries smell impulses from nasal mucous
 Directs voluntary, skeletal actions
membrane to brain.
 (left side of the lobe controls right side of the
Cranial Nerve II (Optic)
body and right side of the lobe controls the left
side of the body)  Sensory
 Influences communication (talking and writing),  Carries visual impulses from eyes to brain
emotions, intellect, reasoning ability, judgment
and behaviour Cranial Nerve III (Oculomotor)

 Contains Broca’s area, responsible for speech  Motor

Parietal Lobe  Contracts eye muscles to control eye movements

(interior, lateral. Medial and superior), constricts
 Interprets tactile sensation, including touch, pain pupils and elevates eyelids.
temperature, shapes and two-point
discrimination. Cranial Nerve IV (Trochlear)

Occipital Lobe  Motor

 Influences the ability to read with understanding  Contracts one eye muscle to control
and is primary visual receptor inferomedial eye movements

Temporal Lobe Cranial Nerve V (Trigeminal)

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  Sensory, Motor  Also promotes some movement of the larynx

 Carries sensory impulses of pain, touch and Cranial Nerve XII (Hypoglossal)
temperature from the face to the brain. Influence
 Motor
clenching and lateral jaw movement (biting,
chewing)  Innervates tongue muscles that promote the
Cranial Nerve VI (Abducens) movement of food and talking

 Motor
HEADACHES
 Controls lateral eye movements
 Do you experience head ache?
Cranial Nerve VII (Facial)
 Use COLDSPA to further explore
 Sensory, Motor
- Morning headaches that subside after arising
 Contains sensory fibers for taste on anterior two-
may be an early sign of increased intracranial
thirds of tongue and stimulates secretions from
pressure as with a brain tumor
salivary glands (submaxillary and sublingual)
and tears from lacrimal glands SEIZURES
 Supplies the facial muscles and affects facial - Seizures occur with epilepsy, metabolic
expressions (smiling, frowning, closing eyes) disorders, head injuries and high fevers.
Cranial Nerve VIII (Acoustic) DIZZINESS
 Sensory - May be related to carotid artery disease,
cerebellar abscess, Meniere’s disease or inner
 Contains sensory fibers for hearing and balance ear infection
Cranial Nerve IX (Glossopharyngeal) - Imbalance and difficulty coordinating or
 Sensory, Motor controlling movements are seen in neurologic
diseases involving the cerebellum, basal ganglia,
 Contains sensory fibers for taste on posterior extrapyramidal tracts or the vestibular part of
third of tongue and sensory fibers of the pharynx cranial nerve VIII (acoustic)
that result in gag reflex when stimulated.
- Diminished cerebral blood flow and vestibular
 Provides secretory fibers to the parotid salivary response may increase the risk of fall
glands; promotes swallowing
SENSES
Cranial Nerve X (Vagus)
- A decrease in the ability to smell may be related
 Sensory, Motor to a dysfunction of cranial nerve I (olfactory) or
a brain tumor.
 Carries sensations from the throat, larynx, heart,
lungs, bronchi, gastrointestinal tract and - A decrease in the ability to taste may be related
abdominal viscera. to dysfunction of cranial nerves VII (facial) or
IX (glossopharyngeal).
 Promotes swallowing, talking and production of
digestive juices. *OLDER ADULT CONSIDERATION

Cranial Nerve XI (Spinal Accessory) - Decreased taste and scent sensation occurs
normally in older adults
 Motor
DIFFICULTY SPEAKING
 Innervates neck muscles (sternocleidomastoid
and trapezius) that promote movement of the - Injury to the cerebral cortex can impair the
shoulders and head rotation. ability to speak or understand verbal language

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DIFFICULTY SWALLOWING
- Difficulty swallowing may relate to CVA,
Parkinson's disease, myasthenia gravis, Guillain-
Barre syndrome, or dysfunction of cranial nerves
IX (glossopharyngeal), X (vagus), or XII
(hypoglossal).
MUSCLE CONTROL
- Loss of bowel control or urinary retention and
bladder distention are seen with spinal cord EXTERNAL GENITALIA
injury or tumors. Penis
- Unilateral weakness or paralysis (loss of motor - Is the male reproductive organ
function from lesion[s] in the neurologic or
muscular systems) may result from CVA, - Attached to the pubic arch by ligaments, the
compression of the spinal cord, or nerve injury. penis is freely movable

- Progressive weakness is a symptom of several  The shaft of the penis is composed of 3

nervous system diseases. cylindrical masses of vascular erectile tissue that
are bound together by fibrous tissue – two
NUMBNESS AND TINGLING corpora cavernosa on the dorsal side and the
- Use COLDSPA to further assess corpus spongiosum on the ventral side.

- Loss of sensation, tingling, or burning  A hood like fold of skin is called the foreskin or
(paresthesia) may occur with damage to the prepuce
brain, spinal cord, or peripheral nerves.
 Center of the corpus spongiosum is the Urethra
FAMILY HISTORY (it travels through the shaft and opens as a slit at
the tip of the glans as the urethral meatus)
- These disorders may be genetic. Some tend to
run in families  Fold of foreskin that extends ventrally from the
urethral meatus is called the frenulum
- Role is both for reproduction and urination
LIFESTYLE AND HEALTH PRACTICE
Scrotum
- Prescription and non-prescription drugs can
cause various neurologic symptoms such as - A thin-walled sac that is suspended below the
tremors or dizziness, altered level of pubic bone, posterior to the penis.
consciousness, decreased response times, and
- Contains sweat and sebaceous glands and
changes in mood and temperament
consists of folds of skin (rugae) and the
- Nicotine, which is found in cigarettes, constricts cremaster muscle
the blood vessels, which decreases blood flow to
the brain. Cigarette smoking is a risk factor for  Function: protective covering for the testes,
CVA epididymis and vas deferens and help to
maintain the cooler-than-body temperature
- Peripheral neuropathy can result from a necessary for production of sperm
deficiency in niacin, folic acid, or vitamin B12.
INTERNAL GENITALIA
MALE GENITALIA AND RECTUM
Testes
- Are a pair of ovoid-shaped organs

 Function: is to produce spermatozoa and the

male sex hormone testosterone

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Spermatic Cord - Is approximately 2.5 cm in diameter,
surrounding the neck of the bladder and urethra
- The testes are suspended in the scrotum by a
spermatic cord - It lies between these structures and the rectum in
male clients
- Contains blood vessels, lymphatic vessels,
nerves and the vas deferens (or ductus deferens) - Consists of 2 lobes separated by a shallow
groove called the median sulcus
- Transports spermatozoa away from the testis
- Secrets a thin, milky substance that promotes
 Epididymis – a comma-shaped, coiled, tubular sperm motility and neutralizes female acidic
structure that curves up over the upper and vaginal secretion.
posterior surface of the testis.
- This chestnut- or heart-shaped organ can be
 Vas/ Ductus Deferens – a firm, muscular tube palpated through the anterior wall of the rectum
that is continuous with the lower portion of the
epididymis. It travels up within the spermatic
cord through the inguinal canal into the
PAIN
abdominal cavity
 Complaints of pain in these areas may indicate a
 Ejaculatory Duct – empties into the urethra hernia or an inflammatory process, such as
within the prostate gland. epididymitis
INGUINAL AREA LESIONS
- Is contained between the anterior superior iliac  Lesions may be a sign of a sexually transmitted
spine laterally and the symphysis pubis infection (STI) or cancer
medially.
DISCHARGE
*Nurse needs to be familiar with the structures of the
inguinal or groin area because hernias (protrusion of  Discharge may indicate an infection
loops of bowel through weak areas of the musculature)
LUMPS, SWELLING, MASSES
are common in this location
 Lumps, swelling or masses found in the scrotum,
 Femoral Canal is located posterior to the
genitalia or groin area may indicate infectioin,
inguinal canal and medial to and running parallel
hernia or cancer.
with the femoral artery and vein.
 Enlargement of the scrotum may indicate
 Femoral Canal is another potential spot for a
hydrocele, hematocele, hernia or cancer
hernia
OLDER ADULT CONSIDERATION:
RECTUM, ANUS AND ANAL SPHINCTER
The scrotum also enlarges with aging
 Rectum is a muscular tube about 13cm (5 in.)
long that is at the end of the large intestine URINATION
(colon)
 Difficulty urinating may indicate infection or
 Rectum connects the colon to the anus, the blockage, including prostatic enlargement
opening where stool exits the body.
 Urinating more than one time during the night
 Internal and External Anal Sphincter are may indicate prostate abnormalities. Excessive
rings of muscles at the opening of the anus. intake of fluids and some medications, such as
diuretics, may also cause nocturia.
 Sphincter keeps anus closed as stool collects in
the rectum.  Changes in urine color or odor may indicate an
infection. Blood in the urine (hematuria) should
PROSTATE be referred for medical investigation because
this may indicate infection, kidney stones,
benign prostatic hypertrophy (BPH), or cancer.

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 A decrease in amount of voided urine may  Strenuous activity and heavy lifting may
indicate prostate enlargement or kidney predispose the client to development of an
problems. inguinal hernia.
 Painful urination may be a sign of urinary tract  Male clients who do not perform testicular self-
infection (UTI), prostatitis, or an STI. examinations need to be informed about the
connection between self-examination and early
 Incontinence may occur after prostatectomy.
interventions for abnormalities
Dribbling may be a sign of overflow
incontinence  Male clients should be aware of the need for a
monthly testicular self-examination and its
SEXUAL DYSFUNCTION
importance in the early diagnosis and treatment
 A change in sexual activity or sexual desire of testicular cancer
(libido) needs to be investigated to determine the
ABNORMAL FINIDINGS:
cause
 Erectile dysfunction (ED) occurs frequently in
ABNORMALITIES OF THE PENIS
adult males and may be attributed to various Syphilitic Chancre
factors or disorders (e.g., alcohol use, diabetes,
depression, antihypertensive medications). Pain - initially small, silvery-white papule that
with ejaculation may indicate epididymitis. develops a red oval ulceration

OLDER ADULT CONSIDERATION: - a sign of primary syphilis (STI) that

spontaneously regresses
ED increases in frequency with age
- may be misdiagnosed as herpes
FAMILY HISTORY
Herpes Progenitalis
 Colorectal cancer risk is increased by a family
history of colorectal cancer and/ or polyps. - clusters of pimple-like, clear vesicles that erupt
Genetic studies also suggest that a strong family and become ulcers
history may be responsible for 5%-10% of - cause by HSV-1 or HSV-2 – disappear and the
prostate cancers infection remains dormant for varying period of
LIFESTYLE AND HEALTH PRACTICES times

 A client with multiple sexual partners increases - recurrence can be frequent or minimally episodic
his risk of contracting an STI or HIV Genital Warts
 Currently, men have five birth control options, - single or multiple, moist, fleshy papules
which include: abstinence, condoms,
outercourse, vasectomy, and withdrawal. - STI caused by the human papillomavirus
Practicing fertility awareness-based methods
Paraphimosis
may also prevent pregnancy. Using a condom
reduces the risk of STIS (Planned Parenthood, - Foreskin is so tight that, once retracted it cannot
2012). be returned back over the glans
 Concerns about fertility can increase stress and Phimos
can have a negative impact on relationships.
- Foreskin is so tight that it cannot be retracted
 The client's knowledge of STIs and their over the glans
prevention provides a basis for health education
in this area Cancer of the Glans Penis

 Exposure to radiation and certain chemicals - Appears as hardened nodule or ulcer on the
increases the risk of developing cancer. glans
- Occurs primarily in uncircumcised men

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Hypospadia - Inflammation of the testes, associated frequently
with mumps.
- Urethral meatus is locates underneath the glans
(ventral side) - Complains of pain, heaviness, and fever.
- Is a congenital defect - Scrotum appears enlarged and reddened;
swollen, tender testis is palpated.
- A groove extends from meatus to the normal
location of the urethral meatus Varicocele
Epispadias - Abnormal dilation of veins in the spermatic
cord.
- Urethral meatus is located on top of the glans
(dorsal side); occurs rarely - Complain of discomfort and testicular heaviness.
- Is a congenital defect - Tortuous veins are palpable and feel like a soft,
irregular mass or "a bag of worms," which
collapses when the client is supine.
ABNORMALITIES OF THE SCROTUM - Infertility may be associated with this condition.
Hydrocele Spermatocele
- Collection of serous fluid in the scrotum, outside - Sperm-filled cystic mass located on epididymis.
the testes within the tunica vaginalis
- Palpable as small and nontender, and movable
- Swelling in the scrotum above the testis.
Testicular Tumor - This mass will appear on transillumination
- Small, firm, nontender nodule on the testis
- Tumor grows, the scrotum appears enlarged and
the client complains of a heavy feeling
INGUINAL AND FEMORAL HERNIAS
- When palpated; testis feels enlarged and smooth
– tumor replaces testis Indirect Inguinal Hernia
Scrotal Hernia - Bowel herniates through internal inguinal ring
and remains in the inguinal canal or travels
- A loop of bowel protrudes into the scrotum to
down into the scrotum (scrotal hernia).
create what is known as an indirect inguinal
hernia - Most common type of hernia.
- Hernia appears as swelling in the scrotum - May occur in adults but is more frequent in
children.
- Palpable as a soft mass and fingers cannot get
above the mass Direct Inguinal Hernia
Epididymitis - Bowel herniates from behind and through the
external inguinal ring. It rarely travels down into
- Infection of the epididymis
the scrotum.
- Sudden pain
- Type of hernia is less common than an indirect
- Scrotum appears enlarged, reddened and hernia.
swollen; tender epididymis is palpated
- Occurs mostly in adult men older than age 40
- Usually associated with prostatitis or bacterial
Femoral Hernia
infection
Orchitis

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 - Bowel herniates through the femoral ring and - A swollen skin tag ("sentinel tag") is often
canal. It never travels into the scrotum, and the present below the fissure on the anal margin.
inguinal canal is empty.
- cause intense pain, itching, and bleeding
- Least common type of hernia.
Rectal Prolapse
- Occurs mostly in women.
- occurs when the mucosa of the rectum protrudes
out through the anal opening

ABNORMALITIES OF THE PROSTATE - It may involve only the mucosa or the mucosa
GLAND and the rectal wall.

Acute Prostatitis - Appears as a red, doughnut-like mass with

radiating folds.
- Prostate is swollen, tender, firm, and warm to
the touch. Prostatitis is caused by a bacterial Anorectal Fistula
infection. - Is evidenced by a small, round opening in the
Benign Prostatic Hypertrophy skin that surrounds the anal opening.

- Prostate is enlarged, smooth, firm, and slightly - Suggests an inflammatory tract from the anus or
elastic. rectum out to the skin.

- Median sulcus may not be palpable. - Suggests an inflammatory tract from the anus or
rectum out to the skin.
- Common in men older than 50 years.
Rectal Polyps
Cancer of the Prostate
- Are rather common and occur in varying sizes
- A hard area on the prostate or hard, fixed, and numbers.
irregular nodules on the prostate suggest cancer.
- Are two types: pedunculated (on a stalk) and
- median sulcus may not be palpable sessile (on the mucosal surface).
ABNORMALITIES OF THE ANUS AND FEMALE GENITALIA AND RECTUM
RECTUM
EXTERNAL FEMALE GENITALIA
External Hemorrhoid
- Hemorrhoids are usually painless papules caused
by varicose veins. They can be internal or
external (above or below the anorectal junction)
- External hemorrhoid has become thrombosed –
it contains clotted blood, is very painful and
swollen, and itches and bleeds with bowel
movements.
Perianal Abscess
- Is a cavity of pus, caused by infection in the skin
around the anal opening.
- It causes throbbing pain and is red, swollen,
hard, and tender Mons Pubis
Anal Fissure - Fat pad located over the symphysis
- These splits in the tissue of the anal canal are - Normal adult mons pubis is covered with pubic
caused by trauma. hair in a triangular pattern

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  Function: absorb force and to protect the  Bartholin glands – either side of or slightly
symphysis pubis during coitus (sexual posterior to the vaginal orifice; secrete mucus,
intercourse) which lubricates the area during sexual
intercourse.
Labia Majora
- Two folds of skin extend posteriorly and
inferiorly from the mons pubis to the perineum INTERNAL FEMALE GENITALIA
- Skin folds composed of adipose tissue,
sebaceous glands and sweat glands
- Outer surface is covered with pubic hair in the
adult; inner surface is pink, smooth and moist
Labia Minora
- Thinner skin fold that is joined anteriorly at the
clitoris and form a prepuce or hood; posteriorly
the two folds join to form the frenulum
- Hairless and usually darker pink; contain
numerous sebaceous glands that promote
lubrication and maintain a moist environment in
the vaginal area

Vagina
Clitoris - Muscular, tubular organ, extends up and slightly
back toward the rectum from the vaginal orifice
- Small, cylindrical mass of erectile tissue and
(external opening) to the cervix.
nerves with three parts: the glans, the corpus and
the crura - allows the passage of menstrual flow, receives
the penis during sexual intercourse, and serves
- Similar to male penis, contains many blood
as the lower portion of the birth canal during
vessels that become engorged during sexual
delivery
arousal
FOUR LAYERS
Vestibule
a) Outer layer is composed of pink squamous
- contains several openings
epithelium and connective tissue
 Urethral meatus – between the clitoris and the
*Rugae – transverse folds allow the vagina to expand
vaginal orifice.
during intercourse; they also facilitate vaginal delivery
 Opening of Skene glands – either side of the of a fetus
urethral opening and are usually not visible, b) Second layer is the submucosal layer; contains
secretes mucus that lubricates and maintains a the blood vessels, nerves, and lymphatic
moist vaginal environment. Are referred to as channels.
the lesser vestibular glands
c) Third layer is composed of smooth muscle
 Vaginal Orifice – external opening of the
vagina and has either a slit-like or irregular d) Fourth layer consists of connective tissue and
circular structure, depending on the the vascular network.
configuration of a hymen
- Normal vaginal environment acidic (pH of 3.8-
 Hymen – fold of membranous tissue that covers 4.2); environment is maintained because the
part of the vagina vaginal flora is composed of Döderlein bacilli

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 (act on glycogen to produce lactic acid) →  Functions: to develop and release ova and to
prevent vaginal infection. produce hormones such as estrogen,
progesterone, and testosterone.
Cervix
Fallopian tubes
- Separates the upper end of the vagina from the
isthmus of the uterus. - Begin near the ovaries and enter the uterus just
beneath the fundus
- Junction of the isthmus and the cervix forms the
internal os: - End of the tube near the ovary has fringe like
extensions called fimbriae
- Junction of the cervix and the vagina forms the
external os or ectocervix - Ovaries, fallopian tubes, and supporting ovarian
ligaments are referred to as the adnexa (Latin
 Functions: allow the entrance of sperm into the
for appendages)
uterus and to allow the passage of menstrual
flow. It also secretes mucus and prevents the ANUS AND RECTUM
entrance of vaginal bacteria.
Anal Canal
 External os of a woman who is nulliparous
(having borne no offspring) will appear as a - Final segment of the digestive system;
small, round depression on examination - it begins at the anal sphincter and ends at the
 External os of a woman who has given birth anorectal junction
will appear slit-like due to dilation of the cervix - Within the anus → two sphincters that normally
Uterus hold the anal canal closed except when passing
gas and feces.
- Pear-shaped muscular organ that has two
components: the corpus, or body, and the cervix, a) External sphincter is composed of skeletal
or neck muscle and is under voluntary control

- uterus is movable b) Internal sphincter is composed of smooth muscle

and is under involuntary control by the
THREE LAYERS OF THE UTERUS WALL: autonomic nervous system.
(Endometrium, myometrium, peritoneum) - Dividing the two sphincters is the palpable
intersphincteric groove
a) Endometrium - inner mucosal layer; estrogen
and progesterone influence the thickness of this - Anal canal proceeds upward toward the
tissue; portion of the endometrium sheds during umbilicus.
menses and childbirth.
Rectum
b) Myometrium - middle layer of the uterus;
functions to expel the products of conception. - Lined with folds of mucosa, known as the
columns of Morgagni.
c) Peritoneum - outer uterine layer that covers the
uterus and separates it from the abdominal - Anorectal junction is not palpable, but may be
cavity; forms anterior and posterior pouches visualized during internal examination
around the uterus (recto-uterine pouch or the cul - The folds contain a network of arteries, veins,
de-sac of Douglas) and visceral nerves.
Ovaries - Inside of the rectum contains three inward
- Pair of small, oval-shaped organs, each of which foldings called the valves of Houston
is situated on a lateral aspect of the pelvic cavity
- Connected to the uterus by the ovarian ligament (Refer to Module 16 for Assessment and Rationale)

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