{"id":3722,"date":"2018-11-12T20:32:15","date_gmt":"2018-11-13T01:32:15","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/?post_type=chapter&#038;p=3722"},"modified":"2019-09-30T13:00:20","modified_gmt":"2019-09-30T17:00:20","slug":"2-10-head-to-toe-assessment-genitourinary-assessment","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-10-head-to-toe-assessment-genitourinary-assessment\/","title":{"raw":"2.10 Head-to-Toe Assessment: Genitourinary Assessment","rendered":"2.10 Head-to-Toe Assessment: Genitourinary Assessment"},"content":{"raw":"Checklist 20 provides a guide for objective and subjective data collection in a genitourinary assessment\r\n<table style=\"border-collapse: collapse;width: 99.9268%\" border=\"1\">\r\n<tbody>\r\n<tr>\r\n<td style=\"border: 1px solid #000000;width: 49.9634%\" colspan=\"2\">\r\n<h3 style=\"text-align: center\"><span style=\"color: #000000\"><a id=\"checklist20\"><\/a> 20:\u00a0 G<\/span>enitourinary Assessment<\/h3>\r\n[caption id=\"attachment_340\" align=\"aligncenter\" width=\"300\"]<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Illu_urinary_system-1.jpg\" rel=\"noopener\" target=\"_blank\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Illu_urinary_system-1-300x256.jpg\" alt=\"\" width=\"300\" height=\"256\" class=\"wp-image-340 size-medium\" \/><\/a> Figure 2.22 Genitourinary system[\/caption]\r\n<h5 style=\"text-align: center\"><em>Disclaimer: Always review and follow your agency policy and guidelines regarding this specific skill.<\/em><\/h5>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000;width: 49.9634%\" colspan=\"2\">\r\n<h5><span style=\"color: #000000\">Safety considerations:<\/span><\/h5>\r\n<ul>\r\n \t<li><span style=\"color: #333333\">Perform hand hygiene.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Introduce yourself to patient.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Explain process to patient.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Be organized and systematic in your assessment.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Use appropriate listening and questioning skills.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Listen and attend to patient cues.<\/span><\/li>\r\n \t<li><span style=\"color: #333333\">Ensure patient's privacy and dignity.\u00a0<\/span><\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<table style=\"border-collapse: collapse;width: 99.9268%\" border=\"1\">\r\n<tbody>\r\n<tr>\r\n<td style=\"border: 1px solid #000000;width: 49.9634%\" colspan=\"2\">\r\n<h3 style=\"text-align: center\">Objective Data<\/h3>\r\n<h5 style=\"text-align: center\">Consider the following observations.<\/h5>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000;width: 49.9634%\">\r\n<h4 style=\"text-align: center\">Steps<\/h4>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000;width: 49.9634%\">\r\n<h4 style=\"text-align: center\">Additional information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000;width: 49.9634%\"><strong>Observe<\/strong>: L<span style=\"font-size: 1.05rem;font-family: inherit\">ook for presence of urethral catheter, ileal conduit, nephrostomy tube(s), suprapubic catheter, and condom catheter. If present, note the c<\/span><span style=\"font-size: 1.05rem;font-family: inherit\">olour, presence, and nature of any odour, and volume of urine in the urine collection system.<\/span>\r\n\r\nObserve the u<span style=\"font-size: 1.05rem\">rinary meatus if urethral catheter present for signs of irritation, including skin integrity and urethral ooze.<\/span>\r\n\r\nObserve the genitalia, noting any lesions to suggest possible sexually transmitted infection\r\n\r\n[caption id=\"attachment_4177\" align=\"aligncenter\" width=\"250\"]<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/genital-herpes.jpg\" rel=\"noopener\" target=\"_blank\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/genital-herpes-300x223.jpg\" alt=\"\" width=\"250\" class=\"wp-image-4177\" \/><\/a> Figure 2.24 Observe genitalia for lesions[\/caption]\r\n\r\n[caption id=\"attachment_4180\" align=\"aligncenter\" width=\"250\"]<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/Closed_Urinary_Drainage.png\" rel=\"noopener\" target=\"_blank\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/Closed_Urinary_Drainage.png\" alt=\"\" width=\"250\" class=\"wp-image-4180\" \/><\/a> Figure 2.23 Urine drainage system[\/caption]<\/td>\r\n<td style=\"border: 1px solid #000000;width: 49.9634%\">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.\r\n\r\nUrine drainage tubes should be secured to avoid tension at the insertion site and\/or accidental removal.\r\n\r\nUnusual findings in voiding patterns or urinary output may indicate compromised urinary function. Follow up with a focused GU assessment.\r\n\r\nFever may suggest urinary tract infection.\u00a0In the elderly, urinary tract infections can result in delirium and as a result present serious safety concerns for the patient.\r\n\r\nThe colour of urine might suggest hydration status.<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000;width: 49.9634%\"><strong>Palpate<\/strong> the suprapubic abdomen to assess for pain, possible urinary retention<\/td>\r\n<td style=\"border: 1px solid #000000;width: 49.9634%\">Palpation while asking about pain or urgency may suggest urinary retention. Bladder scan if equipment is available.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<table style=\"border-collapse: collapse;width: 100%\" border=\"1\">\r\n<tbody>\r\n<tr>\r\n<td style=\"border: 1px solid #000000;width: 50%\" colspan=\"2\">\r\n<h5 style=\"text-align: center\"><strong>Subjective Data<\/strong><\/h5>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\r\n<ul>\r\n \t<li>Ask if the patient is experiencing any difficulty with voiding.<\/li>\r\n \t<li>Ask the patient about colour of their urine.<\/li>\r\n \t<li>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.<\/li>\r\n \t<li>Ask about nocturia and incomplete bladder emptying. In older males, alterations to urinary habits (frequency, urgency, nocturia) may suggest prostate disease.<\/li>\r\n \t<li>Ask the client if they have any concerns about their sexual health.<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000;width: 50%\" colspan=\"2\">\r\n<h4 style=\"text-align: left\">Focused GU assessment may also include:<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000;width: 50%\"><strong>Bladder scan<\/strong> to assess for residual urine volume<\/td>\r\n<td style=\"border: 1px solid #000000;width: 50%\">Bladder scan according to manufacturer and agency guidelines.\r\n\r\nRead this\u00a0<span style=\"font-family: inherit;font-size: inherit\">journal article\u00a0<\/span><span style=\"font-family: inherit;font-size: inherit\">for more information on bladder scanning:\u00a0<\/span>\r\n<ul>\r\n \t<li><span>Davis, C.,<\/span><span>\u00a0Chrisman, J.,<\/span><span>\u00a0&amp; Walden, P. (2012).\u00a0<\/span><a href=\"http:\/\/journals.lww.com\/nursingmadeincrediblyeasy\/Fulltext\/2012\/07000\/To_scan_or_not_to_scan__Detecting_urinary.13.aspx\" style=\"font-size: 1.05rem;text-indent: 1em;font-family: inherit\">To scan or not to scan? Detecting urinary retention<\/a>.<em style=\"font-size: 1.05rem;text-indent: 1em;font-family: inherit\">\u00a0Nursing Made Incredibly Easy!<\/em><span style=\"font-size: 1.05rem;text-indent: 1em;font-family: inherit\">\u00a0doi: 10.1097\/01.NME.0000415016.88696.9d.\u00a0\u00a0<\/span><\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000;width: 50%\"><strong>In and out urethral catheter insertion<\/strong> for residual urine volume<\/td>\r\n<td style=\"border: 1px solid #000000;width: 50%\">Assist the patient to void and catheterize immediately following the attempt. Note the volume of the void and the volume associated with the catheterization.\r\n\r\nCatheterize as directed by prescriber or as per nurse\u2019s independent scope of practice and agency policy. See <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/10-4-urinary-catheters\/\">Chapter 10.4 Urinary Catheters<\/a><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000;width: 50%\"><strong>Presence of an ileal conduit (urostomy), nephrostomy<\/strong>\r\n\r\n[caption id=\"attachment_4179\" align=\"aligncenter\" width=\"151\"]<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/nephrostomy.jpg\" rel=\"noopener\" target=\"_blank\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/nephrostomy-217x300.jpg\" alt=\"\" width=\"151\" height=\"209\" class=\"wp-image-4179\" \/><\/a> Figure 2.25 Nephrostomy drainage system[\/caption]<\/td>\r\n<td style=\"border: 1px solid #000000;width: 50%\">Note amount and character of urine.\r\n\r\nUrine 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 <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/11-2-ostomy-care\/\">Chapter 11.2 Ostomy Care<\/a>\r\n<ul>\r\n \t<li><strong>Ileal conduit \/ urostomy<\/strong>: Assess the stoma.<\/li>\r\n \t<li><strong>Nephrostomy insertion sites<\/strong>: Assess the drain insertion site and condition of the dressing. The insertion site should be covered with a sterile dressing.<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000;width: 50%\" colspan=\"2\">Potential genito urinary related nursing diagnoses:\r\n<ul>\r\n \t<li>Altered pattern of urinary elimination (retention).<\/li>\r\n \t<li>Risk of urinary tract infection due to urethral foley.<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000;width: 50%\" colspan=\"2\">Data sources: Assessment Skill Checklist, 2014; BCCNP, 2018; Davis, Chrisman, &amp; Walden, 2012; Jarvis, Browne, MacDonald-Jenkins, &amp; Luctkar-Flude, 2014; Perry, Potter, &amp; Ostendorf, 2018; Stephen, Skillen, Day, &amp; Jensen, 2012; Wilson &amp; Giddens, 2013<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<div class=\"bcc-box bcc-info\">\r\n<h3 style=\"text-align: center\">Critical Thinking Exercises<\/h3>\r\n<ol>\r\n \t<li>Identify two strategies to prevent urinary tract infection in the person with an indwelling urethral catheter.<\/li>\r\n \t<li>A patient with an ileal conduit asks why their urine is cloudy. Explain.<\/li>\r\n<\/ol>\r\n<\/div>\r\n<h2>Attributions:<\/h2>\r\nFigure 2.21\u00a0<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Illu_urinary_system.jpg\">Illus. Urinary System<\/a> by US Government is in the public domain.\r\n\r\nFigure 2.23\u00a0<a href=\"https:\/\/en.wikipedia.org\/wiki\/Urinary_catheterization#\/media\/File:Closed_Urinary_Drainage.png\">Closed_Urinary_Drainage<\/a> by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/User:BruceBlaus\">BruceBlaus<\/a> is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC-BY SA license.<\/a>\r\n\r\n<span style=\"text-indent: 1em;font-size: 14pt\">Figure 2.24\u00a0<\/span><a href=\"https:\/\/en.wikipedia.org\/wiki\/Genital_herpes\" style=\"text-indent: 1em;font-size: 14pt\">Genital Herpes<\/a><span style=\"text-indent: 1em;font-size: 14pt\"> by <\/span><a href=\"https:\/\/aidsfonds.nl\/\" style=\"text-indent: 1em;font-size: 14pt\">SOA Amsterdam<\/a><span style=\"text-indent: 1em;font-size: 14pt\">\u00a0 is used under a <\/span><a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\" style=\"text-indent: 1em;font-size: 14pt\">CC- BY SA <\/a><span style=\"text-indent: 1em;font-size: 14pt\">license.<\/span>\r\n\r\nFigure 2.25\u00a0<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:N01224_H_nephrostomy.jpg?uselang=fr\">Nephrostomy<\/a> by\u00a0<a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_Department_of_Health_and_Human_Services\" class=\"extiw\" title=\"w:United States Department of Health and Human Services\">United States Department of Health and Human Services<\/a>\u00a0is in the public domain.","rendered":"<p>Checklist 20 provides a guide for objective and subjective data collection in a genitourinary assessment<\/p>\n<table style=\"border-collapse: collapse;width: 99.9268%\">\n<tbody>\n<tr>\n<td style=\"border: 1px solid #000000;width: 49.9634%\" colspan=\"2\">\n<h3 style=\"text-align: center\"><span style=\"color: #000000\"><a id=\"checklist20\"><\/a> 20:\u00a0 G<\/span>enitourinary Assessment<\/h3>\n<figure id=\"attachment_340\" aria-describedby=\"caption-attachment-340\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Illu_urinary_system-1.jpg\" rel=\"noopener\" target=\"_blank\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Illu_urinary_system-1-300x256.jpg\" alt=\"\" width=\"300\" height=\"256\" class=\"wp-image-340 size-medium\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Illu_urinary_system-1-300x256.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Illu_urinary_system-1-65x56.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Illu_urinary_system-1-225x192.jpg 225w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Illu_urinary_system-1-350x299.jpg 350w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/Illu_urinary_system-1.jpg 356w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><figcaption id=\"caption-attachment-340\" class=\"wp-caption-text\">Figure 2.22 Genitourinary system<\/figcaption><\/figure>\n<h5 style=\"text-align: center\"><em>Disclaimer: Always review and follow your agency policy and guidelines regarding this specific skill.<\/em><\/h5>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000;width: 49.9634%\" colspan=\"2\">\n<h5><span style=\"color: #000000\">Safety considerations:<\/span><\/h5>\n<ul>\n<li><span style=\"color: #333333\">Perform hand hygiene.<\/span><\/li>\n<li><span style=\"color: #333333\">Introduce yourself to patient.<\/span><\/li>\n<li><span style=\"color: #333333\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\n<li><span style=\"color: #333333\">Explain process to patient.<\/span><\/li>\n<li><span style=\"color: #333333\">Be organized and systematic in your assessment.<\/span><\/li>\n<li><span style=\"color: #333333\">Use appropriate listening and questioning skills.<\/span><\/li>\n<li><span style=\"color: #333333\">Listen and attend to patient cues.<\/span><\/li>\n<li><span style=\"color: #333333\">Ensure patient&#8217;s privacy and dignity.\u00a0<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<table style=\"border-collapse: collapse;width: 99.9268%\">\n<tbody>\n<tr>\n<td style=\"border: 1px solid #000000;width: 49.9634%\" colspan=\"2\">\n<h3 style=\"text-align: center\">Objective Data<\/h3>\n<h5 style=\"text-align: center\">Consider the following observations.<\/h5>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000;width: 49.9634%\">\n<h4 style=\"text-align: center\">Steps<\/h4>\n<\/td>\n<td style=\"border: 1px solid #000000;width: 49.9634%\">\n<h4 style=\"text-align: center\">Additional information<\/h4>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000;width: 49.9634%\"><strong>Observe<\/strong>: L<span style=\"font-size: 1.05rem;font-family: inherit\">ook for presence of urethral catheter, ileal conduit, nephrostomy tube(s), suprapubic catheter, and condom catheter. If present, note the c<\/span><span style=\"font-size: 1.05rem;font-family: inherit\">olour, presence, and nature of any odour, and volume of urine in the urine collection system.<\/span><\/p>\n<p>Observe the u<span style=\"font-size: 1.05rem\">rinary meatus if urethral catheter present for signs of irritation, including skin integrity and urethral ooze.<\/span><\/p>\n<p>Observe the genitalia, noting any lesions to suggest possible sexually transmitted infection<\/p>\n<figure id=\"attachment_4177\" aria-describedby=\"caption-attachment-4177\" style=\"width: 250px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/genital-herpes.jpg\" rel=\"noopener\" target=\"_blank\"><img decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/genital-herpes-300x223.jpg\" alt=\"\" width=\"250\" class=\"wp-image-4177\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/genital-herpes-300x223.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/genital-herpes-65x48.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/genital-herpes-225x167.jpg 225w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/genital-herpes.jpg 350w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><figcaption id=\"caption-attachment-4177\" class=\"wp-caption-text\">Figure 2.24 Observe genitalia for lesions<\/figcaption><\/figure>\n<figure id=\"attachment_4180\" aria-describedby=\"caption-attachment-4180\" style=\"width: 250px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/Closed_Urinary_Drainage.png\" rel=\"noopener\" target=\"_blank\"><img decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/Closed_Urinary_Drainage.png\" alt=\"\" width=\"250\" class=\"wp-image-4180\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/Closed_Urinary_Drainage.png 240w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/Closed_Urinary_Drainage-150x150.png 150w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/Closed_Urinary_Drainage-65x65.png 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/Closed_Urinary_Drainage-225x225.png 225w\" sizes=\"(max-width: 240px) 100vw, 240px\" \/><\/a><figcaption id=\"caption-attachment-4180\" class=\"wp-caption-text\">Figure 2.23 Urine drainage system<\/figcaption><\/figure>\n<\/td>\n<td style=\"border: 1px solid #000000;width: 49.9634%\">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.<\/p>\n<p>Urine drainage tubes should be secured to avoid tension at the insertion site and\/or accidental removal.<\/p>\n<p>Unusual findings in voiding patterns or urinary output may indicate compromised urinary function. Follow up with a focused GU assessment.<\/p>\n<p>Fever may suggest urinary tract infection.\u00a0In the elderly, urinary tract infections can result in delirium and as a result present serious safety concerns for the patient.<\/p>\n<p>The colour of urine might suggest hydration status.<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000;width: 49.9634%\"><strong>Palpate<\/strong> the suprapubic abdomen to assess for pain, possible urinary retention<\/td>\n<td style=\"border: 1px solid #000000;width: 49.9634%\">Palpation while asking about pain or urgency may suggest urinary retention. Bladder scan if equipment is available.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<table style=\"border-collapse: collapse;width: 100%\">\n<tbody>\n<tr>\n<td style=\"border: 1px solid #000000;width: 50%\" colspan=\"2\">\n<h5 style=\"text-align: center\"><strong>Subjective Data<\/strong><\/h5>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\n<ul>\n<li>Ask if the patient is experiencing any difficulty with voiding.<\/li>\n<li>Ask the patient about colour of their urine.<\/li>\n<li>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.<\/li>\n<li>Ask about nocturia and incomplete bladder emptying. In older males, alterations to urinary habits (frequency, urgency, nocturia) may suggest prostate disease.<\/li>\n<li>Ask the client if they have any concerns about their sexual health.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000;width: 50%\" colspan=\"2\">\n<h4 style=\"text-align: left\">Focused GU assessment may also include:<\/h4>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000;width: 50%\"><strong>Bladder scan<\/strong> to assess for residual urine volume<\/td>\n<td style=\"border: 1px solid #000000;width: 50%\">Bladder scan according to manufacturer and agency guidelines.<\/p>\n<p>Read this\u00a0<span style=\"font-family: inherit;font-size: inherit\">journal article\u00a0<\/span><span style=\"font-family: inherit;font-size: inherit\">for more information on bladder scanning:\u00a0<\/span><\/p>\n<ul>\n<li><span>Davis, C.,<\/span><span>\u00a0Chrisman, J.,<\/span><span>\u00a0&amp; Walden, P. (2012).\u00a0<\/span><a href=\"http:\/\/journals.lww.com\/nursingmadeincrediblyeasy\/Fulltext\/2012\/07000\/To_scan_or_not_to_scan__Detecting_urinary.13.aspx\" style=\"font-size: 1.05rem;text-indent: 1em;font-family: inherit\">To scan or not to scan? Detecting urinary retention<\/a>.<em style=\"font-size: 1.05rem;text-indent: 1em;font-family: inherit\">\u00a0Nursing Made Incredibly Easy!<\/em><span style=\"font-size: 1.05rem;text-indent: 1em;font-family: inherit\">\u00a0doi: 10.1097\/01.NME.0000415016.88696.9d.\u00a0\u00a0<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000;width: 50%\"><strong>In and out urethral catheter insertion<\/strong> for residual urine volume<\/td>\n<td style=\"border: 1px solid #000000;width: 50%\">Assist the patient to void and catheterize immediately following the attempt. Note the volume of the void and the volume associated with the catheterization.<\/p>\n<p>Catheterize as directed by prescriber or as per nurse\u2019s independent scope of practice and agency policy. See <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/10-4-urinary-catheters\/\">Chapter 10.4 Urinary Catheters<\/a><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000;width: 50%\"><strong>Presence of an ileal conduit (urostomy), nephrostomy<\/strong><\/p>\n<figure id=\"attachment_4179\" aria-describedby=\"caption-attachment-4179\" style=\"width: 151px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/nephrostomy.jpg\" rel=\"noopener\" target=\"_blank\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/nephrostomy-217x300.jpg\" alt=\"\" width=\"151\" height=\"209\" class=\"wp-image-4179\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/nephrostomy-217x300.jpg 217w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/nephrostomy-65x90.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/nephrostomy-225x311.jpg 225w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/03\/nephrostomy.jpg 253w\" sizes=\"auto, (max-width: 151px) 100vw, 151px\" \/><\/a><figcaption id=\"caption-attachment-4179\" class=\"wp-caption-text\">Figure 2.25 Nephrostomy drainage system<\/figcaption><\/figure>\n<\/td>\n<td style=\"border: 1px solid #000000;width: 50%\">Note amount and character of urine.<\/p>\n<p>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 <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/11-2-ostomy-care\/\">Chapter 11.2 Ostomy Care<\/a><\/p>\n<ul>\n<li><strong>Ileal conduit \/ urostomy<\/strong>: Assess the stoma.<\/li>\n<li><strong>Nephrostomy insertion sites<\/strong>: Assess the drain insertion site and condition of the dressing. The insertion site should be covered with a sterile dressing.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000;width: 50%\" colspan=\"2\">Potential genito urinary related nursing diagnoses:<\/p>\n<ul>\n<li>Altered pattern of urinary elimination (retention).<\/li>\n<li>Risk of urinary tract infection due to urethral foley.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000;width: 50%\" colspan=\"2\">Data sources: Assessment Skill Checklist, 2014; BCCNP, 2018; Davis, Chrisman, &amp; Walden, 2012; Jarvis, Browne, MacDonald-Jenkins, &amp; Luctkar-Flude, 2014; Perry, Potter, &amp; Ostendorf, 2018; Stephen, Skillen, Day, &amp; Jensen, 2012; Wilson &amp; Giddens, 2013<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"bcc-box bcc-info\">\n<h3 style=\"text-align: center\">Critical Thinking Exercises<\/h3>\n<ol>\n<li>Identify two strategies to prevent urinary tract infection in the person with an indwelling urethral catheter.<\/li>\n<li>A patient with an ileal conduit asks why their urine is cloudy. Explain.<\/li>\n<\/ol>\n<\/div>\n<h2>Attributions:<\/h2>\n<p>Figure 2.21\u00a0<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Illu_urinary_system.jpg\">Illus. Urinary System<\/a> by US Government is in the public domain.<\/p>\n<p>Figure 2.23\u00a0<a href=\"https:\/\/en.wikipedia.org\/wiki\/Urinary_catheterization#\/media\/File:Closed_Urinary_Drainage.png\">Closed_Urinary_Drainage<\/a> by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/User:BruceBlaus\">BruceBlaus<\/a> is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC-BY SA license.<\/a><\/p>\n<p><span style=\"text-indent: 1em;font-size: 14pt\">Figure 2.24\u00a0<\/span><a href=\"https:\/\/en.wikipedia.org\/wiki\/Genital_herpes\" style=\"text-indent: 1em;font-size: 14pt\">Genital Herpes<\/a><span style=\"text-indent: 1em;font-size: 14pt\"> by <\/span><a href=\"https:\/\/aidsfonds.nl\/\" style=\"text-indent: 1em;font-size: 14pt\">SOA Amsterdam<\/a><span style=\"text-indent: 1em;font-size: 14pt\">\u00a0 is used under a <\/span><a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\" style=\"text-indent: 1em;font-size: 14pt\">CC- BY SA <\/a><span style=\"text-indent: 1em;font-size: 14pt\">license.<\/span><\/p>\n<p>Figure 2.25\u00a0<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:N01224_H_nephrostomy.jpg?uselang=fr\">Nephrostomy<\/a> by\u00a0<a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_Department_of_Health_and_Human_Services\" class=\"extiw\" title=\"w:United States Department of Health and Human Services\">United States Department of Health and Human Services<\/a>\u00a0is in the public domain.<\/p>\n","protected":false},"author":397,"menu_order":10,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-3722","chapter","type-chapter","status-publish","hentry"],"part":102,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/3722","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/users\/397"}],"version-history":[{"count":25,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/3722\/revisions"}],"predecessor-version":[{"id":5116,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/3722\/revisions\/5116"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/parts\/102"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/3722\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/media?parent=3722"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapter-type?post=3722"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/contributor?post=3722"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/license?post=3722"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}