Chapter 2. Patient Assessment
Checklist 20 provides a guide for objective and subjective data collection in a genitourinary assessment
Disclaimer: Always review and follow your agency policy and guidelines regarding this specific skill.
Consider the following observations.
|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
|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.
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
|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
|Potential genito urinary related nursing diagnoses:
|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
- Identify two strategies to prevent urinary tract infection in the person with an indwelling urethral catheter.
- A patient with an ileal conduit asks why their urine is cloudy. Explain.
Figure 2.21 Illus. Urinary System by US Government is in the public domain.
Figure 2.25 Nephrostomy by United States Department of Health and Human Services is in the public domain.