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Genitourinary Assessment

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Presentation on theme: "Genitourinary Assessment"— Presentation transcript:

1 Genitourinary Assessment
NURS 347 Towson University

2 Ladies First

3 Anatomy & Physiology External Genitalia Vulva Mons pubis
Labia majora & minora Frenulum Clitoris Vestibule Urethral meatus Vaginal orifice Hymen Bartholin’s & Skene’s glands

4 Anatomy & Physiology Internal Genitalia Vagina Cervix
Squamocolumnar junction Rectouterine pouch Uterus Anterior & Posterior fornix Fallopian tubes

5 Subjective Assessment
Menstrual history Obstetric history Menopause Self-care behaviors Urinary symptoms Vaginal discharge Past history Sexual activity Contraceptive uses Sexually transmitted infections (STIs, formerly STDs) STI risk reduction

6 Female Assessment Preparation of client Lithotomy position
Empty bladder Maintain privacy

7 Objective Assessment Inspection: External Genitalia Palpation:
Skin: Even pigment, free from nodules or lesions Pubic hair: Inverted triangle Labia: Majora: Symmetric, pink, plump, and well formed in nulliparous females Minora: Dark pink and moist, symmetrical Clitoris: Urethral meatus: Stellate and slit-like, midline positioning Vaginal opening: Narrow, vertical slit Perineum: Smooth, even pigment Anus: Coarse skin, increased pigmentation Palpation: Tenderness Masses

8 Age & Situational Variations
Newborn Edematous labia Vaginal discharge

9 Tanner’s Staging Stage I: Preadolescent: No pubic hair; mons and labia covered with fine vellus hair Stage II: Growth sparse and mostly on labia, Long, downy hair, slight pigmentation, straight or slightly curly Stage III: Growth sparse and spreading over mons pubis. Hair is darker, coarser, curlier. Stage IV: Hair is adult in type, over smaller area; none on medial thigh Stage V: Adult in type and pattern; inverse triangle. Also on medial thigh

10 Older Adult Decreased estrogen Sparse pubic hair
Mons pubis smaller, labia flatter Decreased natural lubrication Pale and thin vaginal walls

11 Health Promotion Vulvar self exam PAP smear
Annually after beginning sexual intercourse 2006 developed to prevent cervical cancer FDA licensed vaccine for females ages 9-26 Targets HPV strands responsible for most cases of cervical cancer

12 Documentation

13 Documentation

14 Male Assessment

15 Anatomy & Physiology External Internal Glandular Structures Penis
Scrotum Internal Testis Epididymis Vas deferens Glandular Structures Prostate Seminal vesicle Bulbourethral glands

16 Subjective Assessment
Frequency, urgency, and nocturia Dysuria Hesitancy and straining Urine color Past genitourinary history Penis- pain, lesions, discharge Scrotum- self-care behaviors, lump Sexual activity and contraceptive use STI contact

17 Objective Assessment Inspection of external genitalia:
Penis: Skin is usually wrinkled, hairless, and without lesions Glans: Smooth, without lesions. In an uncircumcised male, retract foreskin for inspection, then return to original position Urethral meatus: Positioned centrally on the glans

18 Objective Assessment Inspect the Scrotum: Palpation Scrotum:
Asymmetry is a common finding; left generally lower than the right Inspect all surfaces of scrotum; should be wrinkles and lesion free Palpation Scrotum: Using thumb and two fingers, palpate half of the scrotum Testes are oval, firm, rubbery, and smooth bilaterally; freely moveable and tender to moderate palpation Epididymis:feels discrete, softer than the testes, smooth, and non-tender Spermatic cord: Palpate between thumb and forefinger along its length Should feel smooth and non-tender Masses: Tenderness? Distal or proximal to testes? Can you place fingers over it? Reduce while patient is supine? Auscultate bowel sounds over it?

19 Objective Assessment Inspect and Palpate for Hernia:
When standing, inspect the inguinal region for a bulge Palpate the inguinal canal, length of the spermatic cord up to the external inguinal ring If able to insert your finger into the inguinal ring, ask pt to bear down Inguinal ring feels like a triangular, slit-like opening

20 Age & Situational Variations
Newborn/infant/child Palpate the testes: Equal size bilaterally Once palpated, consider testes “distended” Older adult Thinner, graying pubic hair Decreased penis, testes size Scrotal sac more pendulous, less rugae Circumcision Do not attempt to retract foreskin until after three months of age in the uncircumcised patient

21 Sex Maturity Ratings (SMR)
1. No pubic hair, penis and scrotum maintain the size the same as in childhood 2. Straight, slightly darker hairs; penis with little enlargement; scrotal enlargement, reddens, changes in texture 3. Hair darker, coarser, and curly; penis begins to enlarge; scrotum further enlarged 4. Thick hair growth, coarse and curly; penis grows in length and diameter, glans development; testes larger, scrotum darker 5. Hair growth spreads over medial thighs; penis and scrotum adult size and shape

22 Health Promotion Testicular Self-Examination
13-14 years through adulthood T- Timing: Once a month S- Shower: Warm water relaxes scrotal sac E- Examine: Check for changes, report immediately

23 Documentation

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