NOTE: Do not palpate a pulsating midline mass; it may be a dissecting aneurysm, which
can rupture under the pressure of palpation. Report the mass to a doctor.
(4) Gather information about the patient's appetite during the interview. Ask
the patient if he has lost weight.
(5) Gather information about the patient's elimination patterns and the
character of his stools. Ask the patient when he had his last bowel movement and if he
has nausea, vomiting, diarrhea, or constipation.
(6) A routine rectal examination is performed if the patient is over age 40, if
the patient has a history of bowel elimination changes or anal discomfort, and for an adult
male with a urinary problem.
(7) If the patient is ambulatory, ask him to stand and bend his body forward
over the examination table. If the patient is unable to stand, place him in a left lateral
Sims' position with the knees drawn up and the buttocks near the edge of the bed or
(8) Put on a glove and spread the patient's buttocks to expose the anus and
surrounding area. Asks the patient to strain as though defecating. Inspect for
inflammation, discharge, lesions, scars, rectal prolapse, skin tags, and external
hemorrhoids. Apply lubricant to your index finger. Explain to the patient that you will insert
your gloved, lubricated finger a short distance into the rectum. Have the patient breathe
through the mouth and relax.
(9) Once you have inserted your finger, rotate it to palpate all aspects of the
rectal wall for nodules, tenderness, and fecal impaction. The rectal wall should feel
smooth and soft. In a male patient, assess the prostate gland when palpating the anterior
rectal wall; the prostate should feel firm and smooth.
h. Genitourinary Assessment. The male genitalia may be examined with the
patient either standing or supine. However, the patient should stand as you check for
hernias or varicoceles. Examine the female genitalia with the patient in a dorsal
(1) When assessing the urinary system, check for and evaluate edema.
Press firmly over a bony surface for 5 to 10 seconds, and then remove you finger. Note
how long the depression remains. Document your observation on a scale from +1 (barely
detectable) to +4 (a persistent pit as deep as 1 inch). When associated with fluid retention
and electrolyte imbalance, edema may indicate renal dysfunction, such as nephritis.
(2) Palpate the bladder for distention and tenderness. Press deeply in the
midline about 1 to 2 inches above the symphysis pubis. During deep palpation, the patient
may feel the need to urinate; this is a normal response. Note the size and location of the
bladder. Check for lumps and masses. The bladder normally feels firm and relatively