Genitourinary (GU) Assessment

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Outline

Overview

  1. Genitourinary (GU)  assessments may be deferred:
    1. Some facilities state that if there is no complaint and it is not their primary diagnosis, genital assessments can be deferred
    2. Defer until performing bed bath or perineal care – so as to preserve the patient’s dignity
    3. Utilize interview-style assessment until it is appropriate to perform physical inspection/assessment

Nursing Points

General

  1. Assessment of:
    1. External genitalia/perineum
    2. Urinary symptoms
    3. Symptoms related to reproductive function

GU Assessment Overview

  1. MALE
    1. Ask
      1. Any bleeding or discharge
      2. Burning with urination
    2. Inspect
      1. Scrotum
        1. Lesions, masses, hair
        2. Symmetry
          1. Normal for left to be lower than right
      2. Penis
        1. Shape
        2. Vasculature
        3. Discharge or bleeding
      3. Inguinal region
        1. Visible mass may indicate hernia
    3. Palpate
      1. Testes
        1. Palpate testes gently between thumb and forefinger.
        2. Should be oval, freely movable, and only slightly tender
      2. Inguinal region
        1. Palpate for hernia/mass
        2. Palpate inguinal lymph nodes
    4. Advanced
      1. Prostate exam
        1. Insert one finger with lubricant into rectum
        2. Palpate anteriorly
        3. Should not be enlarged
        4. Should be no signs of blood on finger
  2. FEMALE
    1. Ask
      1. Any burning with urination
      2. Last menstrual period
      3. Menstrual symptoms
        1. Severity of cramping and bleeding
        2. How many days
        3. How long is average cycle
    2. Inspect
      1. External
        1. Labia majora should be symmetrical and well-formed
        2. Skin color
        3. Hair distribution
        4. Lesions or cysts
      2. Spread labia majora
        1. Clitoris
        2. Labia minora should be symmetrical, dark pink, and moist
      3. Urethral
        1. Note any discharge or redness/swelling
      4. Vaginal canal
        1. Observe any drainage
        2. Note any foul odor
    3. Palpate
      1. Labia majora – should feel no masses or lumps
        1. This may indicate clogged Bartholin’s gland
      2. All actions should be nontender, but may be sensitive
    4. Advanced
      1. Speculum used to inspect cervix and take pap smear
      2. In nulligravida patient, cervical opening should be small and round
      3. In a patient who has been pregnant, cervical opening may be a horizontal slit
      4. Cervix should be midline

Nursing Concepts

  1. It is fully appropriate and expected that you will get the patient’s permission before performing these assessments, especially if there are no primary genitourinary complaints.
  2. Utilize a chaperone as requested and appropriate, especially for opposite gender patients
  3. Maintain dignity at all times

Patient Education

  1. Purpose for assessments
  2. Describe everything you will do before you do it

Transcript

In this video we’re going to show you a couple of techniques for genitourinary assessments. Now, it’s really important to note that these assessments are usually deferred – either completely because the patient has no GU complaints – or at least until time for their bed bath or perineal care. Make sure you know your facility’s policy on this, but also just make sure you’re preserving your patient’s dignity at all times. That usually why we defer – so that we don’t have to expose them multiple times when that is not necessary.

For both male and female patients you want to start by just asking them if they have had any issues or any burning with urination. This will be your first clue that something’s up. You also should ALWAYS tell the patient what you’re doing, get permission to do the assessment, and use a chaperone whenever necessary.
For males, you want to start with inspection. You’re looking for any discharge or bleeding at the tip of the penis. You’re looking for any lesions on the penis or scrotum, looking at the vasculature, and hair distribution, as well as the general shape for any abnormalities. You also want to look at the inguinal region for any bulging or masses that could indicate a hernia.
Then you’ll move to palpation. Gently palpate the testes between your thumb and first finger on both sides. They should be oval, they should move freely, and they should only be a little tender.
RN palpates testes on both sides.
When assessing a female patient, it’s also important to ask about their menstrual history and when their last menstrual period was. You’ll start by examining the external genitalia – the labia majora should be symmetrical and well-formed with equal hair distribution. You also want to palpate the labia for any masses that could indicate blocked ducts
Then you’ll want to use two fingers to gently spread the labia major to inspect the clitoris and the labia minora. They should be dark pink, moist, and also symmetrical.
Then you should inspect the urethral opening and vaginal canal for any drainage, bleeding, redness, or swelling. Make sure you also make note of any odor.
When you’re done, make sure you cover the patient back up to protect their privacy and dignity.
Make sure we’re always being respectful of our patients when we’re doing these assessments that are a bit more sensitive and private. Sometimes, if we just ask the right questions, we’ll know whether the physical portion of the assessment can be deferred or not.

Now, go out and be your best selves today. And, as always, happy nursing.