Answer the following questions as you respond to the 2 responses below.
There are many challenges that I will face as new FNP, especially due to the fact that I have not performed many of these types of exams before. One of the more challenging exams that I feel I will face is the female pelvic exam. This is due to the fact that it is typically an uncomfortable exam for the patient, as well as the provider. It is important for myself, as a male provider to obtain consent from the patient, as well as obtain a female chaperone for the exam (Bickley, 2016). Gaining confidence and being comfortable conducting the exam so that I can instill confidence in my patients as well. There are many changes across the lifespan that can affect how different exams are performed. This is especially apparent in the pelvic exam. For example, pelvic exams in elderly patients require different techniques that younger adults. As estrogen decreases in older adults, the epithelial lining decreases and changes in flora can occur (Medscape, 2021). This can cause the lining to become more sensitive, making the examination more uncomfortable for the patient. The provider must understand this and perform the exam with more caution than in younger adults. Due to the changes in the musculoskeletal system and mentation in some older adults, different positions and techniques such as Sim’s position and additional people to help with positioning can be useful.
One of the systems covered this week is the neurological system. This structure is amazing in function, so it is understandably very complex. A thorough assessment of the neurological system includes examining cognition, cerebellar function, cranial nerves, motor and sensory abilities, gait, reflexes, and meningeal irritation (Clark et al., 2020). It is important for the clinician be very familiar with what abnormal findings suggest and to keep in mind that some positive results may be normal variants, particularly if they are found in the absence of other positives (Shahrokhi, 2020). The challenge I anticipate in completing this assessment is being able to interpret abnormal findings quickly. I think this will get easier as I perform more neurological assessments, encounter more abnormalities, and continue to study associated material. Regarding differences across the lifespan, I expect atypical findings in adolescents and young adults may be more often related to trauma than in other age groups. One study found younger men are more likely to be victims of accidental injury (Bolandparvaz et al, 2017). Adults in hazardous may also present in the same manner. I predict the abnormal findings in older adults may be related to chronic illnesses especially if they are undiagnosed or uncontrolled, like with diabetes, or due to acute events such as a stroke. In reviewing text maternal and scholarly articles on guidance in performing this exam, they all stress the point that associating a finding to its neuroaxis will assist the provider in providing timely treatment and referrals. This takeaway reinforces the importance of knowing how to efficiently interpret findings.
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