In lateral knee–chest position, the patient lies on their side, torso lies diagonally across the table, hips and knees are flexed. In prone knee–chest position, the patient kneels on the table and lower shoulders on to the table so chest and face rests on the table.

Diamond shape position is when the women lies on her back with her knees bent and positioned with both legs spread flat and her heels meet at the foot of the table. The speculum must be inserted with the handle up and the exam performed from the side or the foot of the bed.  

M-shape position is when you have the woman lie on her back with her knees bent and apart feet resting on the exam table close to her buttocks.  Speculum inserted with the handle up and exam takes place from the foot of the bed.  

V-shape position  the women lies on her back with her straightened legs opened wide with each leg opened to each corner of the table.  Speculum to be inserted with handle up and exam can take place from the side or the foot of the table.  

Women are at a higher risk of developing UTI’s than that of male’s because the urethra is shorter in women than in men.  Bacteria has a shorter distance to travel in women than in men.  Education for women needs to include:

1. Wiping from front to back when cleaning can help reduce risk of infection.

2. Increase fluid intake.  

3. Good hygiene.

4. Education

5. Monitor for signs and symptoms of infection.  

Pro’s and Con’s of circumcision: Mayo Clinic Review is 100:1 benefits outweigh risk.

Pro’s:  Con’s:

Reduced risk of acquiring HIV.   Post surgical pain, bleeding, swelling, 

Reduces amount of UTI’s   or inadequate skin removal.  

Reduces risk of getting STI’s

Decreased risk of Bacterial Vaginosis

• Goodell-Softening of the cervix and vagina caused by increased vascular congestion with pregnancy. 
• Hegar’s-Softening of the isthmus of the uterus at about 6-8 weeks of pregnancy.
• McDonald’s-results from the cervical softening, the ability of the flex the body of the uterus against cervix.  
• Chadwick-Violet blue mucosa and cervix due to increased vascularity. 
• Indirect inguinal-Sac herniates through internal inguinal ring: can remain in canal or pass into scrotum.  Pain with straining; soft swelling that increases with increased intra-abdominal pressure; may decrease when lying down.
• Direct inguinal-Directly behind and through external inguinal ring, above inguinal ligament; rarely enters scrotum.  Usually painless, round swelling, close to the pubis in area of internal inguinal ring easily reduced when supine.
• Femoral-Through femoral ring and canal, below inguinal ligament, more often in the right side.  Pain may be more severe; may become strangulated. 

REPLY 2

Pelvic examination involves the routine medical screening of a woman’s reproductive organs, both internal and external organs. The routine examination is essential to assess gynecological health and the diagnosis of medical conditions (Bialy & Wray., 2020). The procedure is often uncomfortable for patients. Other than lithotomy, which involves bimanual evaluation processes, the physician may perform urine tests on a patient to check whether they manifest any urinary tract infections in a procedure known as urinalysis.

Women are at a higher risk of developing UTIs due to several reasons. First, based on anatomy, women’s urethras are located closer to their anuses, making it easier for bacteria to infiltrate. Besides, due to their short urethra compared to men, bacterial infections are highly likely to reach the bladder. Lastly, women’s physiological processes involve changes in hormones, such as during the menstrual cycle, increasing the susceptibility to infections (Tan & Chlebicki, 2016). For any disease, it is better to prevent it than to wait for treatment after contracting. To prevent UTI, one can observe their reproductive health by urinating as soon as there is the urge, drinking plenty of fluids, urinating after sexual intercourse and swiping from front to back after bowel movements. These procedures reduce the likelihood of developing UTI. For instance, drinking plenty of fluids such as water dilutes urine and thus keeps it moving through the urinary tract and therefore makes it hard for bacteria to stay at the wall of the urethra or bladder (Anon, 2021).

Newborn circumcision is essential to decrease the risk of urinary tract infections, skin conditions such as phimosis and penile cancer. It is also essential for hygiene purposes as it allows for ease when cleaning. However, the procedure is painful and the child may be subjected to excessive bleeding, and at times death. The procedure may also expose the newborn to infections and damage to the penis, which may manifest later in life. Even though this is a procedure done for religious and cultural beliefs, parents and physicians should weigh the pros and cons of each case before performing the procedure.

Pregnancy attaches several signs that are visible through examination. For instance, one might have a blue discoloration of the mucous membranes vagina and cervix (Chadwick’s sign), the softening of the cervix (Goodell’s sign), softening uterus (Hegar’s sign) and the McDonald’s sign, which involves the flexing of the uterus’ body against the cervix (The Brookside Associates Medical Education Division, 2016).

A hernia occurs when an internal organ’s part or tissue bulges through a weak muscle, mostly around the abdomen. An inguinal hernia is the most common and affects the groin. A direct inguinal hernia occurs when the abdomen’s walls become weak, allowing a part of the intestines to push through. The weakening may be a result of daily activities, including lifting things improperly. On the other hand, an indirect inguinal hernia results from the close-up of the inguinal ring. Essentially, this often occurs as a congenital condition in infants (U.S. Department of Health and Human Sciences, 2019). A femoral hernia is less frequent than inguinal hernias and appears in the femoral canal (Goethals, Azmat, & Adams, 2020). It is characterized by a bulge below the inguinal ligaments and can lead to strangulation.

References 

Anon. (2021, January 28). Urinary Tract Infection. Retrieved February 16, 2021, from Labs Tests Online: https://labtestsonline.org/conditions/urinary-tract-infection

Bialy, A., & Wray., A. A. (2020). Gynecologic Examination. Treasure Island: StatPearls Publishing. Retrieved February 16, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK534223/

Goethals, A., Azmat, C. E., & Adams, C. T. (2020). Femoral Hernia. Treasure Island: StatPearls Publishing. Retrieved February 16, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK535449/

Tan, C. W., & Chlebicki, M. P. (2016). Urinary tract infections in adults. Singapore Medical Journal, 57(9), 485-490. Retrieved February 16, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027397/

The Brookside Associates Medical Education Division. (2016). Operational Obstetrics & Gynecology. Retrieved February 16, 2021, from https://www.operationalmedicine.org/ed2/Enhanced/Pregnancy.htm

U.S. Department of Health and Human Sciences. (2019, September). Inguinal Hernia. Retrieved February 16, 2021, from U.S. Department of Health and Human Sciences: https://www.niddk.nih.gov/health-information/digestive-diseases/inguinal-hernia

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