Health assessment on the genitourinary system both male and female examination

1. PREPARED BY:
USHA RANI KANDULA,
ASSISTANT PROFESSOR,
DEPARTMENT OF ADULT HEALTH NURSING,
ARSI UNIVERSITY, ASELLA, ETHIOPIA,
EAST AFRICA.

2.  In most practice settings, nurses assess only the
patient’s external genitalia and inguinal lymph
nodes.

3.  Nurse practitioners and physicians perform
comprehensive examinations of the female and
male reproductive and urinary systems, as do
nurses working in specialty areas.

4.  However, even as a novice nurse you may assist
with exams or just be present as a witness or to
provide emotional support to the client.

5.  The genitourinary system includes both the
reproductive system and the urinary system.

6.  Because assessment focuses on elimination and
sexual and reproductive function, it might be
embarrassing or uncomfortable for many people.

7.  A competent, professional approach is needed.
Your confidence and ease with these topics will
help the client to feel more relaxed.

9.  A complete examination includes assessment of
the external genitalia, evaluation for hernias,
and a rectal exam for prostate screening.

10.  The penis and scrotum are examined by
inspection and palpation.

11.  You will assess some of the urinary system organs
when examining the back (kidneys, ureters) and
the abdomen (bladder);

12.  The prostate gland is palpated during the exam
of the rectum and anus (discussed later in this
chapter).

13.  As a result of the scarcity of clear, scientific
evidence,
 the American Academy of Pediatrics no longer
recommends newborn male circumcision
(excision of the foreskin of the penis) as a
routine practice.

14.  However, circumcision is tied to some religious
and cultural beliefs (e.g., among Jews and
Muslims), so it is still common.

15.  A hernia is a protrusion of the intestine (or other
organ) through the wall that contains it.

16.  In men, this is most likely to be a protrusion of
the intestine either through the abdominal wall
(direct hernia) or into the inguinal canal and
possibly into the scrotum (indirect hernia).

17.  A hernia may be a small protrusion or it may
cause pain and distention as a loop of bowel
extends into the scrotum.

18.  A hernia may be a small protrusion or it may
cause pain and distention as a loop of bowel
extends into the scrotum.

19.  An umbilical hernia (fairly common in infants) is
an outward bulging due to delayed closure
around a small muscle around the umbilicus
(belly button).

21.  The Female Genitourinary System
 You may be called upon to assist with a
comprehensive examination.

22.  For adolescents and young women who are not
sexually active, an external GU examination
includes the inspection of the amount and
distribution of pubic hair, the skin of the pubic
area, and the external genitalia; and palpation of
the inguinal lymph nodes.

23.  Women who are sexually active; who have
abnormal findings on external examination; who
have abdominal, pelvic, or genitourinary
complaints;

24.  or who are on hormone therapy require an
internal genital examination.
 The exam includes the following:

25.  ■ Assessment of vaginal muscle tone and pelvic
musculature
 ■ Speculum examination
 ■ Bimanual examination,

26.  wherein the examiner palpates the cervix,
uterus, and adnexal tissues using one or two
fingers within the vagina and the other hand on
the outside to help bring the inner structures
toward the two hands.

27.  Recent changes to major guidelines recommend,
in general, less frequent routine Papanicolaou
tests (Pap smears) to screen for cervical and
uterine cancer.

28.  They recommend the following for women:
 ■ Younger than age 21: Do not be screen,
regardless of whether they are sexually active or
have other risktaking behaviors.

29.  Ages 21 through 29: Screen every 3 years.
 ■ Ages 30 to 65: Screen every 3 to 5 years (and
follow the advice of their provider).

30.  Older than age 65: Do not routinely screen
unless they are at high risk.

31.  However, a recent study states that the cancer
incidence rates used for guidelines do not
account for high prevalence of hysterectomy in
the United States.
 This has the largest impact on older, black
women.

32.  Those with certain vulnerabilities (e.g.,
weakened immune system, HIV-positive) should
have a Pap test every year
 (Agency for Healthcare Research and Quality
[AHRQ], 2005, last revised 2013; American
Cancer Society, n.d.b, revised 2013)

33.  Key Point: National screening guidelines vary,
and they change frequently.

34.  Additional cultures or screens may be done if
there is unusual discharge or risk of sexually
transmitted infection.

35.  A speculum examination is performed to collect
specimens and assess the cervix.

36.  The Anus, Rectum, and Prostate
 Examining the rectum and anus is the last aspect
of a comprehensive examination.

37.  For the female client, this exam is usually
performed at the end of a bimanual pelvic
examination while the client is still in the
lithotomy position.

38.  Usually a male client assumes the Sims’ position,
and you perform the exam after completing your
examination of the genitals.

39.  Inspect the anus and rectum for skin condition
and hemorrhoids and palpate for muscle tone,
masses, and tenderness.

40.  Skin irritation and erythema are common in
clients who have diarrhea and infants and
toddlers who wear diapers.

41.  Hemorrhoids (dilated, usually painful, anal
vessels) may be seen in clients with a history of
constipation.

42.  Many women develop hemorrhoids with
pregnancy and childbirth.

43.  A comprehensive examination for a man should
include a digital rectal examination to assess for
prostate enlargement.

44.  An enlarged prostate may indicate benign
enlargement of the prostate, which is common in
men older than age 50; or it may indicate
prostatitis.

45.  A hard nodule or multiple nodules may indicate
prostate cancer.