Genitourinary system Assessment
Dr. Nafisa Omer
May 4, 2024 1
Objectives
Analyze the
data from the
Describe the interview and
findings physical
Differentiate frequently assessment of
between seen with
Perform a genitalia, to
normal and assessing the
physical formulate
abnormal older male
Interview a assessment of valid nursing
findings of and female
client for an male and diagnoses,
Describe the male and client’s
accurate female
structure and female genitalia
nursing genitalia,
the function genitalia
history of the using the
of male and male and correct
female female techniques.
genitalia, genitalia,
anus, rectum. anus, rectum.
May 4, 2024 2
Male Genitourinary System
The Male
Genitalia
External Internal Inguinal Anus and
genitalia genitalia area rectum
Penis Scrotum. Testes. Spermatic Cord. Prostate
May 4, 2024 3
Health Assessment
Collecting subjective data: The nursing health history
History of Present Health Concern
• Pain
• Lesion
• Discharge
• Lumps, Swelling, Masses
• Urination
• Sexual Dysfunction
• Bowel Patterns
• Itching and Pain
Past Health History
• Describe any prior medical problems or trauma or surgery
Family History
• Is there a history of polyps or colon, rectal, or prostate cancer in your family?
Lifestyle and Health Practices
May 4, 2024 4
Collecting objective data:
Preparing the
Client
Position the
Before the Wearing an
Explain to the client according
examination, examination
client to the needed
instruct the gown or drape
examination
client to empty
his bladder
Standing Knee-chest Squatting Left latera
May 4, 2024 5
Collecting objective data:
Equipment
Stethosc Specime
Stool Gown Disposable Light ope (for Water
n card
non-latex possible soluble
gloves auscultat lubricant
ion)
May 4, 2024 6
During the examination, remember these key points:
Inspect and
palpate penis,
scrotum, and Understand the
Perform the
Wear disposable inguinal area for structures and
examination
gloves. inflammation, functions of the
professionally
infestations, anorectal region.
rashes, lesions,
and lumps.
During the testicular
Prepare the client examination, describe
thoroughly for the Preserve client’s the importance of
physical privacy. testicular self-
examination examination and
explain how to
perform the
examination as you
are performing it.
May 4, 2024 7
Inspection and palpation
Penis: Inspect the base of the penis and pubic hair
Normal
• Pubic hair is coarser than scalp hair
• No erythema, or infestation
Abnormal
• Absence of pubic hair may be seen in clients receiving chemotherapy
• Lice or nit (eggs) infestation at the base of the penis or pubic hair is
known as pediculosis pubis
May 4, 2024 8
Inspect the skin of the shaft
Observe for rashes, lesions, or lumps.
Normal:
• The skin of the penis is wrinkled and hairless no rashes, lesions, or
lumps
Abnormal:
• Rashes, lesions, or lumps may indicate STI or cancer
• Drainage indicates infection.
May 4, 2024 9
Palpate the shaft
Palpate any abnormalities.
Note the location of the
Also note any hardened or
urinary meatus on the glans.
tender areas
• Normal: • Normal: The urinary meatus
• The penis usually soft, is found in the center of the
flaccid, and nontender glans
• Abnormal: • Abnormal:
• Tenderness may indicate • Hypospadias is displacement
inflammation or infection. of the urinary meatus to the
ventral surface of the penis
• Epispadias is displacement
of the urinary meatus to the
dorsal surface of the penis
May 4, 2024 10
Palpate for urethral discharge
Normal: Abnormal:
The urinary A yellow A clear or white
Any discharge
meatus is discharge is discharge is
should be
normally free of usually associated usually associated
cultured
discharge with gonorrhea. with urethritis.
May 4, 2024 11
Inspect the size, shape, and position
of the scrotum.
Normal:
Scrotum • Varies in size according to temperature
Abnormal: An enlarged scrotal sac
may result from
• Fluid (hydrocele)
• Blood (hematocele)
• Bowel (hernia)
• Tumor (cancer)
Normal:
• Testes are ovoid, 3.5–5 cm long, 2.5 cm wide, and
2.5 cm deep, and equal bilaterally in size and shape.
• They are smooth, firm, rubbery, mobile, free of
nodules
Palpate the scrotal Abnormal:
contents. • Absence of a testis suggests cryptorchidism (an
undescended testicle).
• Painless nodules may indicate cancer.
• Tenderness and swelling indicate acute orchitis,
torsion of the spermatic cord, a strangulated hernia,
or epididymitis
Inguinal Area
Inspect for inguinal and
Palpate
femoral hernia. Inspect the
inguinal lymph
inguinal and femoral areas for
nodes
bulges
Normal: Abnormal: Normal: Abnormal:
Bulges that appear Enlarged or tender lymph
when the client bears No enlargement nodes may indicate an
No bulges
down may signal a or tenderness inflammation or infection of
hernia the penis or scrotum
May 4, 2024 14
Anus and Rectum
Inspect the perianal
area for the Normal: Abnormal:
following:
• • Opening should • Lesions may
Lumps
• appear hairless, indicate STIs,
Ulcers
moist, and tightly cancer, or
• Lesions
closed hemorrhoids.
• Rashes • A thrombosed
• • No redness, lumps,
Redness external
• ulcers, lesions, and
Fissures rashes in the hemorrhoid appears
• Thickening of the perianal area swollen
epithelium
May 4, 2024 15
Prostate Gland
The prostate can be
palpated on the anterior Normal: Abnormal:
surface of the rectum
• The prostate is • A swollen, tender
nontender prostate may indicate
• Its lobes are smooth, 2.5 acute prostatitis.
cm long, and heart- • An enlarged smooth,
shaped. firm, slightly elastic
prostate suggests benign
prostatic hypertrophy
(BPH).
• A hard area on the
prostate or hard, fixed,
irregular nodules on the
prostate suggest cancer
May 4, 2024 16
Assessing female Genitalia
Structure and Function
External genitalia
• The area is sometimes referred to as the vulva or it is extends from the
mons pubis to the anal opening it contain:
• Mons pubis
• Labia majora
• Labia majora
• Vestibule
• Vaginal orifice is the urethral meatus
Internal genitalia:
• Vagina, the cervix, the uterus, the fallopian tubes, and the ovaries.
May 4, 2024 17
Nursing Assessment
Collecting subjective data:
History of Present Health Concern
Menstrual Cycle
• What was the date of your last menstrual period?
• Do your menstrual cycles occur on a regular schedule?
• What other symptoms do you experience before or during your period ?
Menopause
• Are you still having periods? Have your periods changed?
Vaginal Discharge, Pain, Masses
Urination
Bowel Pattern
Itching and Pain
Lifestyle and Health Practices
May 4, 2024 18
Collecting objective data:
Preparing the Client Equipment
• Ask her to urinate before the • Light
examination • Vaginal Speculum
• Ask her to remove her the • Water-soluble lubricant
dresses and to put on a gown • Large swabs for vaginal
• Assist the client into the examination
dorsal lithotomy position. • Specimen container
• She should relax her arms at • Gloves (non-sterile)
her sides • pH paper
May 4, 2024 19
During the examination, remember these key points:
Respect the client’s privacy.
Perform the examination professionally.
Prepare the client for the physical examination.
Have a chaperone in the room with you when examining the female genitalia, rectum, and anus.
Wash hands, wear gloves, and make sure equipment is between room temperature.
Inspect and palpate female external and internal structures correctly.
Use examination and laboratory equipment properly.
Understand the difference between common variations and abnormal findings
May 4, 2024 20
External Genitalia
Observe and
Inspect the palpate
mons pubis. inguinal lymph
nodes
Normal Abnormal Normal Abnormal
No enlargement Enlarged inguinal
Pubic hair is distributed Absence of
or swelling of nodes may
in an inverted triangular, pubic hair in the
the lymph indicate a vaginal
no signs of infestation. adult .
nodes infection
May 4, 2024 21
External Genitalia
Inspect the labia
majora and Normal: Abnormal:
perineum:
• for lesions, swelling, • The labia majora are • Lesions may be
and excoriation equal in size and from an infectious
free of lesions, disease, such as
swelling, and herpes or syphilis
excoriation. Findings
• A healed episiotomy • Excoriation and
scar may be visible swelling may be
on the perineum from scratching
May 4, 2024 22
External Genitalia
Inspect the labia minora, clitoris, urethral meatus, and
vaginal opening.
• Normal:
• The labia minora appear symmetric, dark pink, and moist
• The normal size of the clitoris varies.
• The urethral meatus is small.
• The vaginal opening is positioned below the urethral meatus
• Abnormal:
• Asymmetric labia may indicate abscess.
• Lesions, swelling, bulging in the vaginal opening, and discharge are abnormal
findings
Palpate Bartholin’s glands.
• Normal:
• Usually soft, nontender, and drainage free
• Abnormal:
• Swelling, pain, and discharge may result from infection and abscess
May 4, 2024 23
External Genitalia
Palpate the urethra:
• Normal:
• No drainage should be noted from the urethral meatus.
• The area is normally soft and nontender
• Abnormal:
• Drainage from the urethra indicates possible urethritis. Any
discharge should be cultured.
• Urethritis may occur with infection with Neisseria
gonorrhoeae or Chlamydia trachomatis.
May 4, 2024 24
Internal Genitalia
Inspect the size of the vaginal opening and the angle of
the vagina. P/V Note Size, thinning or feels dry.
Normal:
• The normal vaginal opening varies in size
• The vagina is typically tilted posteriorly at a 45-degree angle and should
feel moist.
Abnormal:
• A condition in which the vagina becomes thinner and dryer is vaginal
atrophy.
• This occurs when the body lacks Strogen.
• Some causes may include: menopause, breast feeding, surgical removal of
the ovaries, and cancer treatments. The risk increases if you smoke or with
the absence of vaginal birth
May 4, 2024 25
Internal Genitalia
Inspect the cervix: using a speculum
Normal:
• The surface of the cervix is normally smooth, pink, and even. Normally, it is midline in position
and projects 1–3 cm into the vagina.
• In pregnant clients, the cervix appears blue (Chadwick’s sign).
Abnormal:
• In a nonpregnant woman, a bluish cervix may indicate cyanosis;
• Pale cervix may indicate anemia.
• Redness may be from inflammation.
• Cervical lesions may result from polyps, cancer, or infection.
• Cervical enlargement or projection into the vagina more than 3 cm may be from prolapse or
tumor
After inspecting the cervix, obtain specimens for the Pap smear and, if indicated
May 4, 2024 26
Internal Genitalia
Inspect the vagina.
• Note the vaginal color, surface, consistency, and any discharge
Normal:
• Appear pink, moist, smooth, and free of lesions and irritation.
• Free of any colored or smelly discharge
Abnormal:
• Reddened areas, lesions, and colored, smelly discharge are abnormal and may
indicate vaginal infections, STIs, or cancer
• Altered pH may indicate infection.
May 4, 2024 27
Internal Genitalia
palpating the vaginal walls
Bimanual Examination:
for texture and tenderness
• Placing your nondominant • Normal:
hand on the client’s lower • The vaginal wall should
abdomen, insert your index feel smooth.
and middle fingers into the • No tenderness
vaginal opening • Abnormal:
• Tenderness or lesions may
indicate infection
May 4, 2024 28
Internal Genitalia
Palpate the cervix.
Normal Abnormal
Palpate for:
• Contour • The cervix should • A hard, immobile
• Consistency feel firm and soft cervix may
• Mobility (like the tip of indicate cancer.
• Tendernes your nose). It is • Pain with
rounded, and can movement of the
be moved from cervix may
side to side indicate infection
without eliciting (Chandelier’s sign)
tenderness.
May 4, 2024 29
Internal Genitalia
Palpate the uterus.
• Normal:
• The fundus, the large, upper end of the uterus, is normally round,
firm, and smooth
• It is at the level of the pubis
• Abnormal:
• An enlarged uterus above the level of the pubis is abnormal; an
irregular shape suggests abnormalities such as myomas (fibroid
tumors) or endometriosis
May 4, 2024 30
Anus and Rectum
Inspect the perianal area.
• for the following: Lumps, Ulcers, Lesions, Rashes, Redness,
Fissuresm,Thickening of the epithelium
Normal:
• The anal opening should appear hairless, moist, and tightly closed
• The skin around the anal opening is darkly pigmented
• No redness, lumps, ulcers, lesions, and rashes
Abnormal:
• A painful mass that is hardened and reddened suggests a perianal abscess.
• A swollen skin may indicate a fissure in the anal canal.
• Redness and excoriation may be infected by fungi or pinworms.
• A small opening in the skin that surrounds the anal opening may be an anorectal
fistula
May 4, 2024 31
Older adult Considerations
Pubic hair may be gray and sparse
The penis becomes smaller, and the testes hang
Testes do not get smaller with normal aging, although they may decrease in size
with long-term illness.
In older women, the cervix appears pale after menopause
The cervical os normally appears as a small, round opening in nulliparous
women
May 4, 2024 32
Selected nursing diagnoses
Health Promotion Diagnoses Actual Diagnoses
• Readiness for enhanced self- • Fear of ovarian cancer related
health management: Requests to high incidence of risk
information on birth control factors
• Readiness for Enhanced • Fear of testicular cancer
Health Management - related to existing risk factors
Requests information on
testicular self-examination
(TSE)
May 4, 2024 33
Thanks
May 4, 2024 34
