in general, genital exams aren't done by general practice nurses, especially on kids. being a male, i wouldn't advise you to ever attempt to do one on a female without their consent and another female present. and, then, you better have a real good reason for it because it is going to be questioned. for a general nurse any genital exam amounts to nothing more than inspection. as a male that's about all any male patient would expect from you too--period. anything beyond that should be deferred to the doctor. now, if your instructor is at your side and is telling you something different, use your best judgment, but as a male i think you need to be careful with this part of any physical exam. most doctors don't even do genital exams either and write on their history and physical "deferred" for that part of the exam.
i can also tell you that doing a genital or vaginal exam on a child is not an easy thing. when i was a supervisor i happened to be making rounds in the er when a 3 or 4-year old girl was brought in with a laceration of the vaginal area that she got when she somehow got mangled in the top of a fence she was climbing over. she wasn't about to let anyone touch her! what ultimately ended up happening was that she had to be taken to the or and given a general anesthetic where the wound could then be adequately examined and properly sutured.
with teenagers you can ask them if they're sexually active (have another female with you if you are talking to a teenage girl) and if they are, are they using any kind of protection or birth control. this is just a question that is part of the history taking.
you will find lots of resources on physical assessment including videos from some of the medical schools on this thread:
the basic nursing assessment
goes quickly and is not as detailed as what the doctors do. here are a couple of links. the first one is one that most students really like because it gets right to the point and is focused at the general nurse:
- this is a great guide to physical assessment. it is called head to toe assessment in 5 minutes (well, maybe a little longer than that)
- the u.s. navy's shipwreck's go-by physical examination guide used by naval corpsmen. an excellent source for learning how to do a physical assessment
- taking a history. a brief discussion about talking with a patient while performing a history and review of systems and how to actively listen.
you need to keep in mind that when you are assessing children what stage of emotional and life stage development they are at.
here is an example of narrative charting: