Genitourinary System


CHAPTER 11






Genitourinary System


 

 





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.


  Expect hesitancy in responses when asking questions about this body system.


  This is not an assessment of sexuality or sexual practices. It focuses on current functioning and helps identify any potential or current problems.


 

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Oct 5, 2017 | Posted by in NURSING | Comments Off on Genitourinary System
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