ASSESSING THE FEMALE GENITOURINARY SYSTEM

Outcomes Identify pertinent genitourinary history questions. Obtain a female genitourinary history. Perform a female genitourinary physical assessment. (Continued)

Outcomes Document pertinent genitourinary assessment findings. Identify actual/potential health problems stated as nursing diagnosis. Differentiate between normal and abnormal findings.

Structures Mons pubis  Labia majora & minora Clitoris  Urinary meatus Perineum  Bartholin’s glands Anus  Cervix Uterus  Fallopian tubes Ovaries  Kidneys Urethra  Bladder Vagina  Skene’s gland

Functions What are the functions of… Mons pubis: Subcutaneous pad over symphysis pubis for protection Labia majora/minora: Folds of adipose and connective tissue that protect and lubricate external genitalia (Continued)

Functions What are the functions of… Clitoris: Erectile tissue for sexual stimulation Urinary meatus: Opening to urethra Skene’s glands: Lubricate and protect (Continued)

Functions What are the functions of… Vaginal introitus: Opening of the vagina Vagina: Muscular tube for copulation, birth canal, and menses Bartholin’s glands: Secretes alkaline mucus that improves viability & motility of sperm (Continued)

Functions What are the functions of… Cervix: End of the uterus into vagina Uterus: Hollow, muscular organ; site for fertilized egg implantation; protects fetus (Continued)

Functions What are the functions of… Tubes: Passage for ovum to uterus, site of fertilization Ovaries: Produce ova, estrogen and progesterone Kidneys: Filter and excrete wastes (Continued)

Functions What are the functions of… Ureter: Connects kidneys to bladder Bladder: Hollow muscular structure; holds urine Urethra: Connects bladder to urinary meatus opening

Developmental Variations What developmental variations of the female genitourinary might be seen with: Children Pregnant clients Older adults

History What can the history tell you about the female genitourinary system? Biographical data Current health status Past health history Family history Review of systems Psychosocial history

Symptoms What symptoms would signal a problem with the female genitourinary system? Vaginal discharge Lesions Vaginal bleeding, pain Amenorrhea Urinary symptoms

Physical Assessment Anatomical landmarks: external--note position of structures; internal--visualize underlying structures Approach: inspection, palpation Position: lithotomy Tools: gloves, speculum, lubricant, light, slides and swabs for specimen collection General survey and head-to-toe scan

Inspection External genitalia: color, hair distribution, condition of skin, lesions, discharge, odor, pubic pediculosis, prolapse Rectal area: condition of skin, lesions, discharge, bleeding, hemorrhoids, fissures (Continued)

Inspection Pelvic exam: color, lesions of vaginal walls; color, lesions, discharge, position, size, shape, and patency of cervical os (obtain specimens)

Palpation Skene’s and Bartholin’s glands: masses, swelling, discharge, tenderness Vaginal wall: texture, swelling, lesions, tenderness Cervix: size, shape, consistency, position, mobility, tenderness Uterus: size, shape, symmetry, position, masses, tenderness

Palpation Ovaries: size, shape, symmetry, tenderness Anus and Rectum: sphincter tone, tenderness, lesions, masses, hemorrhoids, polyps; test any stool for occult blood

Pertinent Physical Findings External genitalia pink, moist, intact; small amount of white, ordorless discharge; no lesions Vaginal walls and cervix pink, moist, intact; no lesions Uterus anteverted, no masses, non-tender Ovaries and tubes non-palpable No rectal masses; hematest negative

Nursing Diagnosis What actual or potential problems can you identify for Mrs.James?