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  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 mLs of urine in bladder will activate this process but can distend to hold 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