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?
|
| How was/is the problem being treated?
|
| Have you had to change your diet or fluid intake because of:
|
| What medicines are you taking specifically for the:
|
| Are you having/or had changes in your skin?If so,
|
Bladder/Urethra | How often do you go to the bathroom to urinate? |
| What does your urine look like? Is it:
|
| 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,
|
| 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:
When urinating? If so,
|
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,
|
| Have you ever had a problem with your breasts? If so, what was the problem?
|
| How was your breast problem treated?
|
Ovaries/Fallopian tubes/Uterus | Are you (still) having regular menstrual periods? If so,
|
| 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,
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?
|
| (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,
|
| Have you had/do you have any open sores or lumps on the skin around your vagina? If so,
|
Male reproductive: Prostate | Have you ever had a prostate exam? If so,
|
| Have you ever had a problem with your prostate (gland)? If so, what was the problem?
|
| Have you ever had surgery on your prostate gland? If so, do you remember the name of the surgery?
|
Testes | Have you had an examination of your testicles? If so,
|
| Do you perform a self-examination of your testicles? If so,
|
| Have you ever had surgery on your testicles? If so,
|
Penis | Have you had any problems with your penis such as:
What have you been told about the drainage/open sores?
|
| 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,
|
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:
|
| Assess for presence of pain with bleeding |
| Assess for location of pain with bleeding such as:
|
| Assess for any other symptoms such as:
|
| 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:
|
| Assess for associated symptoms such as:
|
| 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:
|
| 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:
|
| Assess for other symptoms such as:
|
| 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:
|
| 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:
| |
| 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:
|
| 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:
|
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:
|
| 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:
|
| 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:
|
| 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:
|
| 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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