Genitourinary Assessment

Competencies

To Describe information to be obtained during a genitourinary assessment

To identify techniques to use during a genitourinary assessment

To perform a genitourinary assessment on a patient

To discuss gerontological variations

Health History

Age: variations associated with age, i.e STD’s for youth, elimination problems for adults

Family history Social history: sexual practices,

substance use

Subjective Data

Does the client have difficulty urinating? Is there burning?

Does the flow start and stop? What is the frequency of urination? Do they experience incontinence or

dribbling of urine? Do they have difficulty controlling

their urine?

Subjective

For female clients: did the urinary pattern change after childbirth

Do they have spontaneous urination with coughing, sneezing etc

For male clients do they have discharge from the urethral meatus?

Objective

Common chief complaints: urinary frequency, pain on urination

Colour, odour and amount of urine

Factors affecting elimination

Aging: kidney functioning, bladder tone & contractility, neuromuscular problems.

Food & fluids – caffeine (diuretic effect), foods high in water &/or sodium content.

Psychological variables – stress, cultural issues, embarrassment

Activity and muscle tone Pathological conditions – urinary

tract abnormalities, UTI, diabetes, kidney stones

Medications – diuretics, anticoagulants

Normal Elimination

Urine should be straw coloured (pale yellow), with no offensive odour or sediment

Our total blood volume passes through the kidneys about every half hour filtering waste

Bladder is smooth muscle sac with 3 layers

Stretch receptors in the bladder signal the need to void

Usually about 200-300 mLs of urine in bladder will activate this process but can distend to hold 3000-4000 mLs of urine

Typically urinate about every 3-4 hours

Terms associated with Elimination

Anuria: no urine Dysuria: difficulty in voiding Frequency: increased incidence of

voiding Glycosuria: glucose in urine Nocturia: frequency during the night Urgency: strong desire to void

Kidneys

Located high and deep under the diaphragm

Best to assess for kidney at the costovertebral angle

Primary function of the kidneys is filtration and elimination of metabolic wastes

Inspection

Have client empty their bladder and lie on the bed

Would normally inspect the reproductive organs at this time

Looking for any noticeable deviations from normal

Most often covered as part of reproductive exam

Inspection

Assessing for any visible signs of infection from the urinary meatus

With men must assess whether or not the person has been circumcised

Palpation

To palpate for urethral discharge gently squeeze the glans between the index finger and the thumb

The urinary meatus is normally free from discharge

Any discharge should be cultured

Prostate Gland

An important part of the exam for men

The prostate is palpated on the anterior surface of the rectum

An enlarged prostate my indicate benign prostatic hypertrophy, a condition that affects men as they age and may cause urinary difficulties

Lifespan Variations

Bladder capacity decreases to 250 mL owing to periurethral atrophy

May have 1-2 periods of nocturia Increasing chance of men

developing prostate disease that may impact on urinary functioning