Chapter 2. Patient Assessment

2.10 Head-to-Toe Assessment: Genitourinary Assessment

Checklist 20 provides a guide for objective and subjective data collection in a genitourinary assessment

20:  Genitourinary Assessment

Figure 2.22 Genitourinary system
Disclaimer: Always review and follow your agency policy and guidelines regarding this specific skill.
Safety considerations:
  • Perform hand hygiene.
  • Introduce yourself to patient.
  • Confirm patient ID using two patient identifiers (e.g., name and date of birth).
  • Explain process to patient.
  • Be organized and systematic in your assessment.
  • Use appropriate listening and questioning skills.
  • Listen and attend to patient cues.
  • Ensure patient’s privacy and dignity. 

Objective Data

Consider the following observations.

Steps

Additional information
Observe: Look for presence of urethral catheter, ileal conduit, nephrostomy tube(s), suprapubic catheter, and condom catheter. If present, note the colour, presence, and nature of any odour, and volume of urine in the urine collection system.

Observe the urinary meatus if urethral catheter present for signs of irritation, including skin integrity and urethral ooze.

Observe the genitalia, noting any lesions to suggest possible sexually transmitted infection

Figure 2.24 Observe genitalia for lesions
Figure 2.23 Urine drainage system
 Urine drainage systems suggest compromised urinary function. All urine drainage systems require care and attention to reduce risk of urinary tract infection and other issues.

Urine drainage tubes should be secured to avoid tension at the insertion site and/or accidental removal.

Unusual findings in voiding patterns or urinary output may indicate compromised urinary function. Follow up with a focused GU assessment.

Fever may suggest urinary tract infection. In the elderly, urinary tract infections can result in delirium and as a result present serious safety concerns for the patient.

The colour of urine might suggest hydration status.
Palpate the suprapubic abdomen to assess for pain, possible urinary retention Palpation while asking about pain or urgency may suggest urinary retention. Bladder scan if equipment is available.
Subjective Data
  • Ask if the patient is experiencing any difficulty with voiding.
  • Ask the patient about colour of their urine.
  • Ask about history of urinary tract infections, burning, frequency, presence of blood in urine, sediment, odour with urine, and history of kidney, renal, and genital health issues.
  • Ask about nocturia and incomplete bladder emptying. In older males, alterations to urinary habits (frequency, urgency, nocturia) may suggest prostate disease.
  • Ask the client if they have any concerns about their sexual health.

Focused GU assessment may also include:
Bladder scan to assess for residual urine volume Bladder scan according to manufacturer and agency guidelines.

Read this journal article for more information on bladder scanning: 
In and out urethral catheter insertion for residual urine volume Assist the patient to void and catheterize immediately following the attempt. Note the volume of the void and the volume associated with the catheterization.

Catheterize as directed by prescriber or as per nurse’s independent scope of practice and agency policy. See Chapter 10.4 Urinary Catheters
Presence of an ileal conduit (urostomy), nephrostomy

Figure 2.25 Nephrostomy drainage system
 Note amount and character of urine.

Urine via an ileal conduit passes through a piece of bowel, the character of the urine will likely be cloudy from mucous and likely foul smelling from the bacterial that lives in the ileal conduit. See Chapter 11.2 Ostomy Care

  • Ileal conduit / urostomy: Assess the stoma.
  • Nephrostomy insertion sites: Assess the drain insertion site and condition of the dressing. The insertion site should be covered with a sterile dressing.
Potential genito urinary related nursing diagnoses:

  • Altered pattern of urinary elimination (retention).
  • Risk of urinary tract infection due to urethral foley.
Data sources: Assessment Skill Checklist, 2014; BCCNP, 2018; Davis, Chrisman, & Walden, 2012; Jarvis, Browne, MacDonald-Jenkins, & Luctkar-Flude, 2014; Perry, Potter, & Ostendorf, 2018; Stephen, Skillen, Day, & Jensen, 2012; Wilson & Giddens, 2013

Critical Thinking Exercises

  1. Identify two strategies to prevent urinary tract infection in the person with an indwelling urethral catheter.
  2. A patient with an ileal conduit asks why their urine is cloudy. Explain.

Attributions:

Figure 2.21 Illus. Urinary System by US Government is in the public domain.

Figure 2.23 Closed_Urinary_Drainage by BruceBlaus is used under a CC-BY SA license.

Figure 2.24 Genital Herpes by SOA Amsterdam  is used under a CC- BY SA license.

Figure 2.25 Nephrostomy by United States Department of Health and Human Services is in the public domain.

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Clinical Procedures for Safer Patient Care Copyright © 2018 by Thompson Rivers University is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

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