CHAPTER 18
Disorders of the Genitourinary System
LEARNING OUTCOMES
Upon completion of this chapter, the nurse will:
1. Summarize the different disorders of the genitourinary system
2. Examine approaches to assess different disorders of the genitourinary system
3. Determine approaches that can be used for more than one genitourinary system disorder
GENITOURINARY SYSTEM DISORDERS
Disorders within the genitourinary system can be acute, chronic, or an adverse effect caused by a medication or other health problem. The disorders that would be the most appropriate for telephonic care include:
Acute renal failure (recovery from)
Chronic renal failure
Kidney stones
Urinary tract infection
Prostatitis
Benign prostatic hyperplasia (BPH)
Prostate cancer
Benign breast disease
Breast cancer
Disorders that “might come up” in the course of a conversation that would not necessarily be considered a reason for disease management include:
Urinary incontinence
Erectile dysfunction
Menstrual difficulties
Menopausal difficulties
ASSESSING DISORDERS OF THE GENITOURINARY SYSTEM
Remember that the client has been diagnosed with a genitourinary system problem. The assessment should focus on the client’s current status and if there have been any changes in symptoms.
Health Problem | Changes |
Acute renal failure | When were you told you had a kidney problem? |
| What caused it, such as:
|
| How are you feeling right now? |
| Has your urine output returned to the amount prior to the problem? |
| What medicines have you been taking for the problem? |
| When are you supposed to see your doctor or health care provider again for the kidney problem? |
| For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the kidney problem? |
Chronic renal failure | When were you told that you have chronic kidney problems? |
| What treatment are you having?
|
| (If hemodialysis) On which arm is your fistula for the treatments? |
| How does the skin over the fistula look? |
| Can you feel anything when you touch the skin over the fistula like a buzzing or vibration? |
| When do you have treatments, such as:
|
| (If peritoneal dialysis) Do you do the treatments at home or at the kidney center? How often do you have treatments? Are you having any problems, such as:
|
| What medicine are you taking because of the kidney failure?
|
| What diet changes have you had to make because of the kidney failure, such as:
|
| Are you considering or being considered for a kidney transplant?
|
| When are you supposed to see your doctor or health care provider again for the kidney problem? |
| For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the kidney problem? |
Kidney stones (renal calculi) | When were you told that you have kidney stones? |
| What symptoms are you having right now, such as:
|
| What treatment are you having/had for the kidney stones?
|
| Have you been directed to strain your urine? If so, what has been strained out? |
| Have you been directed to make dietary or fluid intake changes? If so, what changes have you made?
|
| When are you supposed to see your doctor or health care provider again for the kidney stones? |
| For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the kidney stones? |
Urinary tract infection | When were you told that you have a urinary tract infection? |
| What symptoms are you having right now, such as:
|
| What medicine are you taking for the infection, such as:
|
| What information were you told about the medicine, such as:
|
| How often do you take the medicine for the bladder spasms? Is the medication helping? |
| What other information were you told to help prevent future infections, such as:
|
| When are you supposed to see your doctor or health care provider again for the infection? |
| For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the infection? |
Prostatitis | When were you told that you have prostatitis? |
| Is this the first time that you have had the problem or have you had it before? |
| What symptoms are you having right now, such as:
|
| What medicine are you taking for the prostatitis, such as:
|
| What else have you been directed to do to help with the problem, such as:
|
| When are you supposed to see your doctor or health care provider again for the problem? |
| For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the problem? |
Benign prostatic hyperplasia (BPH) | When were you told that you have BPH? |
| What tests did you have done?
|
| What symptoms are you having right now, such as:
|
| What medicine are you taking for the BPH?
|
| Were you or are you using anything else for the symptoms, such as:
|
| Are you going to have/had surgery for the problem?
(Postoperative: When was it done?)
|
| When are you supposed to see your doctor/health care provider again for the BPH? |
| For what reasons have you been directed by your doctor/health care provider to seek additional medical care because of the BPH? |
Prostate cancer | When were you told that you have prostate cancer? |
| What tests did you have done, such as:
|
| What symptoms are you having right now, such as:
|
| What treatment are you having for the prostate cancer, such as:
|
| When are you supposed to see your doctor/health care provider again for the prostate cancer? |
| For what reasons have you been directed by your doctor/health care provider to seek additional medical care because of the prostate cancer? |
Benign breast disease | When were you told that you have a breast condition? |
| What were you told that you have? |
| What symptoms are you having right now, such as:
|
| What have you been directed to do to help with the breast condition, such as:
|
| When are you supposed to see your doctor/health care provider again for the breast condition? |
| For what reasons have you been directed by your doctor/health care provider to seek additional medical care because of the breast condition? |
Breast cancer | When were you told that you have breast cancer? |
| When was your last mammogram? |
| When was the biopsy done? |
| What were you told when you received the results of the biopsy? |
| What treatment are you having/going to have:
|
| What information were you given about the treatments, such as:
|
| How are you feeling right now? (The client with breast cancer can have many psychosocial issues. The best approach would be to ask: What can I do to help you right now?) |
| When are you supposed to see your doctor/health care provider again? |
| For what reasons have you been directed by your doctor/health care provider to seek additional medical care? |
ADDITIONAL DISORDERS
It is unlikely that a client will be enrolled in a disease management program for problems with urinary incontinence, menstruation, menopause, or erectile dysfunction; however, these problems may be identified during the course of a regular care call.
Problem | Questions |
Urinary incontinence | Assess when the problem started |
| Assess when the problem occurs:
|
| Assess the frequency that this occurs |
| Assess what has been done about it:
|
| Assess if medication has been prescribed and the effectiveness of the medication |
| Encourage to adhere to prescribed treatment plan or seek medical attention for any new onset of symptoms. |
Erectile dysfunction | Assess for length of time the problem has been occurring |
| Assess if the problem has been discussed with a health care professional |
| Assess if the problem can be associated with taking a newly prescribed medication (such as antihypertensives, other cardiac medications) or disease process (diabetes) |
| Suggest to discuss the problem with a health care professional |
Menstrual difficulties | Assess for the type of difficulty:
|
| Assess for the length of time the problem has been occurring |
| Assess for what has been done to help with the problem:
|
| Suggest discussing the problem with a health care professional |
Menopausal difficulties | Assess for the type of difficulty:
|
| Assess for the length of time the problem has been occurring |
| Assess for what has been done to help with the problem:
|
| Suggest to discuss the problem with a health care professional |
SUGGESTIONS FOR GENITOURINARY DISORDERS
Use the same terminology that the client uses to describe the problem.
Always ask how the patient/client is feeling right now.
Genitourinary disorders can adversely affect activities of daily living. The patient may restrict leaving the home and change routine activities because of the fear of becoming incontinent during an inopportune time. Assess how the problem has affected regular activities.
Remember that talking about this body system and problems can cause the patient embarrassment. Keep the conversation “matter of fact” and do not proceed if the patient refuses to discuss any problems further.
Ask about the prescribed treatment for a health problem and reinforce the treatment. Do not recommend a complementary or alternative therapy. If asked about something that is not mainstream treatment, encourage the patient to discuss the approach with the health care professional.
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