Genitourinary System

CHAPTER 11

LEARNING OUTCOMES

Upon completion of this chapter, the nurse will:

1. Outline the areas to include when assessing the genitourinary system

2. Identify appropriate questions to assess the genitourinary system

3. Analyze approaches to gather more information about the genitourinary system

THE GENITOURINARY SYSTEM

The genitourinary system contains the systems needed to produce urine, the process of urination, and reproductive organs. For both males and females, the urinary system includes:

Kidneys

Ureters

Bladder

Urethra

For the female reproductive system, the organs include:

Breasts

Ovaries

Fallopian tubes

Uterus

Cervix

Vagina

And for the male reproductive system, the organs include:

Prostate

Testes

Penis

ASSESMENT OVERVIEW

Other than renal failure, the number of clients enrolled in a disease management or wellness program having a primary problem involving the genitourinary system will be minimal. It is more likely for clients to have issues with this body system in addition to another health problem. Similar to the other body systems, the techniques to assess this system are limited. You will not be able to:

Observe urine color

Observe skin color

Palpate skin turgor

Palpate for bladder distention

Palpate the breasts

Percuss the kidneys

Auscultate for renal blood flow

This body system is inherently private. Many clients will not want to discuss issues with urine output or problems with reproductive organs. Your assessment questions, at times, may seem vague; however, using this approach reduces involuntary client resistance to providing assessment information.

A general question to begin the assessment of this body system might be “do you have any problems passing urine/water?” This can be followed by “are you able to make it to the bathroom in time to empty your bladder?” For an older female client, asking about children would be an appropriate opening to assess the reproductive system. For an older male client, a general question such as “have you ever been told you have a problem with your prostate or other private body parts” is less intrusive. Then, plan your assessment according to the responses.

QUESTIONS TO ASSESS THE GENITOURINARY SYSTEM

Body Area	Question
Kidneys/Ureters	Have you ever had a problem with your kidneys? If so, what was the problem? Kidney stones Renal failure
	How was/is the problem being treated? Lithotripsy Other treatment Dialysis
	Have you had to change your diet or fluid intake because of: Kidney stones? Dialysis?
	What medicines are you taking specifically for the: Kidney stones? Dialysis?
	Are you having/or had changes in your skin?If so, Is your skin drier/moist? Has it changed in color (for example, does it look more yellow)? Does it feels itchy?
Bladder/Urethra	How often do you go to the bathroom to urinate?
	What does your urine look like? Is it: Clear? Yellow? Cloudy? Dark (like tea)? Pink (blood-tinged)?
	Are you able to make it to the bathroom to urinate?
	Do you ever wake up in the middle of the night to urinate? If so, How many times each night?
	Do you ever have a problem starting to urinate?
	Do you ever feel like you still have urine in your bladder after going to the bathroom?
	Do you ever experience: Burning? Pain? When urinating? If so, How often does this occur? What have you done about it?
Female reproductive: Breasts	When was your last mammogram? (This will depend on the age of the client.)
	Do you routinely examine your breasts? If so, How often?
	Have you ever had a problem with your breasts? If so, what was the problem? Cysts Cancer
	How was your breast problem treated? Draining of the cysts Biopsy Surgery/chemotherapy/radiation (cancer)
Ovaries/Fallopian tubes/Uterus	Are you (still) having regular menstrual periods? If so, When was your last menstrual period? If not, when did you stop having menstrual periods?
	Are you experiencing any changes or issues with your menstrual period? or Are you experiencing any changes or issues since not having menstrual periods?
	Have you ever had surgery to your female organs? If so, When was it done? What type of surgery was it? What was it for? Are you having any problems since having the surgery?
Cervix/Vagina	When was your last gynecologic (gyne) examination?
	Did you have a Pap smear done? Were there any problems with the Pap smear? If so, What was the problem? What was the treatment?
	(Depending on the age of the client, this next question might be appropriate.) Have you received the vaccination to prevent the development of cervical cancer? If so, When did you receive the vaccination?
	Have you had/do you have any open sores or lumps on the skin around your vagina? If so, When does this occur? How often does it occur? What has been done about the lumps/sores?
Male reproductive: Prostate	Have you ever had a prostate exam? If so, When was it done last? Were there any problems found?
	Have you ever had a problem with your prostate (gland)? If so, what was the problem? Enlarged prostate Infection (prostatitis)
	Have you ever had surgery on your prostate gland? If so, do you remember the name of the surgery? When was it done?
Testes	Have you had an examination of your testicles? If so, When was it done? Were there any problems?
	Do you perform a self-examination of your testicles? If so, How often?
	Have you ever had surgery on your testicles? If so, What was it for? When was it done?
Penis	Have you had any problems with your penis such as: Drainage? If so, describe the type of drainage How often does it occur? Open sores? If so, where are they located? What is done to help them heal? What have you been told about the drainage/open sores? What is the cause?
	Do you have any problems with intimacy (this is one way of asking if the male client is able to have an erection)? If so, How long has this been going on? What has been done about it? Do you take medication for it?

ALGORITHM FOR ASSESSING THE GENITOURINARY SYSTEM

If you are calling a patient/client who is experiencing a new set of symptoms, the following questions might be helpful:

Finding	Action
Blood in the urine	Assess for urine color such as: Frank red blood Pink tinged
	Assess for presence of pain with bleeding
	Assess for location of pain with bleeding such as: Side of the back (flank pain) Groin Urethra
	Assess for any other symptoms such as: Nausea/vomiting Fever
	For hematuria associated with pain, suspect a urinary tract infection or kidney stone.
	For painless hematuria, suspect undiagnosed neoplasm.
	Encourage to seek medical attention for any new onset of symptoms.
Dark urine	Assess for color such as: Tea colored Cola colored
	Assess for associated symptoms such as: Flank pain Foam in the urine
	Assess for changes in fluid intake
	Suspect dehydration, kidney stone, or renal failure
	Encourage to seek medical attention for any new onset of symptoms
Flank pain	Assess for length of time pain has been occurring
	Assess for associated symptoms such as: Change in urine output Characteristics of urine (mucous threads, pus, blood) Groin pain
	Suspect kidney stone
	Encourage to seek medical attention for any new onset of symptoms
Burning with urination	Assess for length of time burning has been occurring
	Assess for urine characteristics to include: Dark urine Blood in urine Pus/mucus in urine
	Assess for other symptoms such as: Flank pain Fever
	Suspect a urinary tract infection
	Encourage to seek medical attention for any new onset of symptoms
No urine output	Assess for length of time since the last voiding occurred
	Assess for associated symptoms such as: Edema of the feet/ankles/hands/around the eyes Itchy skin Change in skin color Nausea/vomiting Flank or groin pain
	Suspect kidney stone or acute onset of renal failure
	Encourage to seek medical attention for any new onset of symptoms
Inability to void but “feels the need”	Assess for length of time since the last voiding occurred
	Assess for associated symptoms such as: Groin pain Fever Nausea/vomiting Flank pain
	Suspect enlarged prostate or kidney stone
	Encourage to seek medical attention for any new onset of symptoms
Incontinence (inability to make it to the bathroom in time)	Assess for length of time this has been occurring
	Assess for any associated symptoms
	Assess for any recent injuries or falls
	Suspect stress/urge/overflow/functional incontinence
	Encourage to seek medical attention for any new onset of symptoms
Groin pain	Assess for length of time pain has been occurring
	Assess for any associated symptoms such as: Blood in the urine No urine output Flank pain
	Suspect kidney stone
	Encourage to seek medical attention for any new onset of symptoms
Drainage/bleeding from the vagina	Assess for length of time drainage/bleeding has been occurring
	Assess for last menstrual period; if postmenopausal, assess when menopause occurred
	Assess for associated symptoms such as: Abdominal pain Abdominal bloating Abdominal cramping Change in urine output, volume, and frequency
	Suspect ovarian/fallopian/or uterine problem
	Encourage to seek medical attention for any new onset of symptoms
Drainage/blood from the penis	Assess for length of time drainage/bleeding has been occurring
	Assess for associated symptoms such as: Abdominal pain Abdominal bloating Abdominal cramping Change in urine output, volume, and frequency
	Suspect prostate/bladder problem
	Encourage to seek medical attention for any new onset of symptoms
Open sore on the vagina	Assess for location of the sore
	Assess for length of time sore has been present
	Assess for associated symptoms such as: Itchiness Vaginal drainage Fever
	Suspect sexually transmitted infection
	Encourage to seek medical attention for any new onset of symptoms
Open sore on the penis	Assess for location of the sore
	Assess for length of time sore has been present
	Assess for associated symptoms such as: Drainage from the penis Swelling of the scrotum Fever
	Suspect sexually transmitted infection
	Encourage to seek medical attention for any new onset of symptoms
Extended erection (priapism)	Assess for length of time penis has been erect
	Assess for use of performance enhancing medication to include: Time of last dose Number of doses taken
	Assess for scrotal pain
	Suspect acute priapism
	Encourage to seek immediate medical attention
Inability to have an erection	Assess for length of time since last erection
	Assess for associated symptoms
	Assess for any changes in current medication schedule
	Suspect new onset erectile dysfunction
	Encourage to seek medical attention for any new onset of symptoms

See Chapter 18 for additional information about genitourinary system disorders.

TIPS FOR ASSESSING THE GENITOURINARY SYSTEM

Always begin the assessment by asking if the patient/client is experiencing any problems with the body system. If not, then a general assessment would be appropriate.