Real-World Nursing Assessment

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Specializes in Med-Surg.

I hope I will get some gentle tips/assistance with an issue that came up during my first pediatric clinical rotation. I am a junior in a BSN program, and naturally we are expected to do a head-to-toe assessment of each patient.

My first pedi patient was a 13-year-old male recovering from a laparoscopic appendectomy. This young man had his underwear on, and I did not even consider asking him to remove it, feeling this to be an unnecessary intrusion. I was quite surprised to find out in post-conference that I was expected to evaluate his sexual maturity according to the Tanner Scale! When I expressed my surprise, my instructor explained that by failing to assess his genitals, I was not doing my job.

Feedback is requested: Is this is a real-world expectation? If so, then I request help in how to approach this with my patients. . .Thanks in advance for any assistance!

Finally, I want to hasten to add that I assessed for abdominal pain, rebound and guarding, and I auscultated bowel sounds X 4 quadrants, evaluated the laparoscopic appendectomy dressings for drainage, and the like . . .but I really can't come up with a justification for checking under the poor kid's underwear!

I want to learn to be a good nurse, and I treasure this forum for helping me learn the ropes!

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Specializes in Transplant/Surgical ICU.

Although I too am a nursing student I think the reason why you were meant to check his "sexual development" is because at this age kids are going throw a lot of physical changes and it would be important for you to know if they are indeed underoing the normal process of physical maturity. For instance if a 17year old female had not started her menstrual periods it may be signs of some development problem, and as a nurse it would be under your responsibility to catch that on time. However, I would have probably limited my assessment to what u did too. Hope a nurse would answer ur question, cause I'm dying to know what they would have done also. CIAO

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Specializes in Hospice, Med/Surg, ICU, ER.

I'm going to disagree.

Your goal in this assessment is to "focus" on the reasons the Pt. is in your care in the first place; i.e., his appendectomy and s/s related thereto. The "development" of his equipment has nothing whatever to do with that.

It is for the kid's physician to determine if his "sexual maturity" is on par with the norm. He is not a LTC pt you are assessing for risk of skin integrity issues - he is a kid in postop for an appendix for God's sake!

Were I the boy's father, and I heard that your were checking his equipment just because your instructor wanted you to, you, the instructor, the school, the doctor, and the hospital would have gotten more trouble than this assessment was worth as a learning exercise.

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Specializes in Pediatrics Only.

I used to work peds med surg and took care of many kids ranging from RSV,gastro and a ton of appys. I have never once during an assessment examined the genital region. Now this isnt to say that during my patients initial assessment, I would ask questions re: sexual activity, but I would never examine unless absolutely necessary.

I can honestly tell you that none of the nurses I had worked with on that floor examined genitals during a head to toe assessment. I'm assuming that your instructor actually meant that you should remove the underwear to do your assessment?

Since this patient already had his surgery, I would assume their is an initial assessment form in the chart. On this form they should have check boxes for sexually active, drugs, smoke, etc. These are never things that are to be asked in front of parents. At least I never did. I waited til the parents left to ask those types of questions, or there were times that we would pull the curtain to do a quick abdominal assessment (numerous people in the room and didnt want to have the patient show everyone their skin), and we would ask very quietly about those types of things.

I should mention though, that I have never examined the genital region on a 13 year old patient (unless necesary ie:surgery). If its a baby or small toddler, changing a diaper was easy enough and gave you a quick assessment.

Love-D-OR:

Although you bring up a valid point that we should questions if a 17year old hasnt started menstrating, there is no need for you as a nurse to do an examination. You can ask questions regarding the subject, but you are not going to examine her genital area.

I wish you both luck in clinicals! You have both brought up great questions!

-Meghan :nurse:

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Specializes in Med-Surg.
Were I the boy's father, and I heard that your were checking his equipment just because your instructor wanted you to, you, the instructor, the school, the doctor, and the hospital would have gotten more trouble than this assessment was worth as a learning exercise.

Wow, Clee1, that's a strong response, but it does a lot to validate my own instincts regarding the issue.

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Specializes in Hospice, Med/Surg, ICU, ER.
Wow, Clee1, that's a strong response, but it does a lot to validate my own instincts regarding the issue.

A newly pubescent boy is every bit as self-conscious about his anatomy as a girl is about hers.

How would your instructor feel if it were her daughter having her privates examined by a male nursing student - all other factors being the same? I rest my case. :D

Your instincts were right on in this case. Good for you.

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Specializes in Med-Surg.
I'm assuming that your instructor actually meant that you should remove the underwear to do your assessment?

Well, your assumption is close, because when I expressed my incredulity that I was expected to examine the genitals, my instructor said that while I was assessing his abdominal region, I should have lifted up the elastic waist band of his underwear and taken a quick look.

I should mention though, that I have never examined the genital region on a 13 year old patient (unless necesary ie:surgery). If its a baby or small toddler, changing a diaper was easy enough and gave you a quick assessment.

Thank you for your feedback. This is exactly the kind of information I was looking for: what exactly is and isn't done in real-world nursing.

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Did you ask the instructor if you were a MALE nursing student and you "peeked" into a 13 yr old FEMALE patients panties pot appendectomy if that would be appropriate? I am disgusted with the lack of real life skills some instructors have. I have NEVER done that on any patient unless they had a Foley and then I explain why I am peeking.

Such drivel

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By the way, you did a great job on a focused assessment appropriate for the patients condition!

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Specializes in Emergency, Trauma.

Your instructor must be way out of touch with the real world; NO, I would not have inspected his genitals unless they were the reason he was in the hospital, which obviously wasn't the case here. Can you imagine how mortified a boy of this age would have been if you had done so?

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Wow, you did exactally what I would have done. It is an awkward situation and in the event that it were my own SON or DAUGHTER at 13 years and the need to "go there" isn't really the priority it is completely understandable the direction you went. I removed sutures from a fiesty 16 y/o guy that required him to drop his jeans so i could access his upper thigh, b/c it was winter he had on long jeans, I insisted the I had another nurse with me to for both our sakes.:nono:

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Specializes in Transplant/Surgical ICU.

GRAZIE!!!

Thanks marvelous nursing for sharing ur knowledge on this subject. As I said earlier I would have only conducted a focused as the OP did, but then again I'm still a student willing to soak up wathever is thrown at me. THank u again. and clinicals went GREAT. CIAO

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