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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.
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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
