2. Genitourinary Tract
• a.k.a. urogenital system
• are the organs of the reproductive system and the
urinary system
• grouped together because of their proximity, their
common embryological origin, and the use of
common pathways, like the male urethra.
4. Urinary System
• It consist of the kidneys, ureters, bladder, and
urethra.
• Kidneys form urine to remove waste from the body;
maintain acid-base, fluid, and electrolyte balance;
and assist in blood pressure control.
• Each kidney contains roughly one million nephrons.
Urine gathers in the collecting tubules and ducts of
the nephrons and eventually drains into the ureters,
down into the bladder and, when urination occurs,
out through the urethra.
7. Female Reproductive System
✤ External genitalia
✓ collectively called the
vulva, include the mons
pubis, labia majora, labia
minora, clitoris, vaginal
orifice, urethra, and
Skenes’ and Bartholin’s
glands.
13. INSPECTION OF ABDOMEN
✓ Inspect the abdomen with
the patient lying supine.
The abdomen should be
symmetrical and smooth,
flat, or concave.
✓ Observe the color and
shape of the area around
the kidneys and bladder.
The skin should be free
from lesions, bruises,
discolorations, and
14. PERCUSSING THE KIDNEYS
✓ Percuss the kidneys to
check for costo-vertebral
angle and tenderness that
occurs with inflammation.
- Have the patient sit up.
- Place the ball of your non-
dominant hand on the patient’s
back of the 12th rib
- Strike the ball of that hand with
the ulnar surface of your other
hand. Use just enough force to
cause a painless but perceptible
thud.
15. PERCUSSING OF BLADDER
✓Percuss the area over the
bladder (5cm) above the
symphysis pubis.
- To percuss the bladder, first ask
the patient to empty it. Then have
the patient lie in the supine
position.
- To detect difference in sound,
percuss toward the base of the
bladder.
- Percussion normally produces a
tympanic sound.
16. Palpation
- Because the kidneys lie behind other organs and are
protected by muscle, they normally aren’t palpable unless
they’re enlarged. If the kidneys feel enlarged, the patient
may have hydronephrosis, cysts, or tumors.
- In very thin patients, you may be able to feel the lower end
of the right kidney as smooth round mass that drops on
inspiration.
- In elderly, you may be able to palpate both kidneys because
of decreased muscle tone and elasticity.
- You won’t be able to palpate the bladder unless its
distended.
17. Palpation of Bladder
✓With the patient in a
supine position, use the
fingers of one hand to
palpate the lower
abdomen in a light
dipping motion.
- A distended bladder will
feel firm and relatively
smooth
18. Palpation of the kidneys
✓ To palpate the left kidney, reach
across the client, have the patient
lie in a supine position.
✓ Place your left hand under the
client’s left flank with your palm
upward.
✓ Elevate the left flank with your
fingers, displacing the kidney
upward.
✓ Ask the client to take a deep
breath
✓ Use the palmer surface of your
20. • Obtain the family health history, history of present
illness, lifestyle and health practices and review
records if available.
• Check if there is an order to collect specimen like
urine sample, etc.
• Check for special precautions if there is any.
• Measure and record the height, weight and vital
signs.
ASSESSMENT:
21. • Gather all the necessary equipment and materials
for the procedure.
• which includes:
stool; light; water-soluble lubricant; cotton-tipped
applicators; sterile disposable gloves; mirror
PLANNING:
22. • Explain the procedure to the client.
• Instruct the patient to void if possible.
• Do hand washing.
• Provide privacy by drawing the curtains, closing
the door, etc.
• Help patient undress and provide a gown.
• Assist the client into the examination table,
stretcher or bed, position and drape the patient
according to the body area to be assessed.
IMPLEMENTATION:
23. • Observe the client’s general and physical
development, nutritional state, mental alertness,
evidence of pain, restlessness, body position,
hygiene and grooming.
GENERAL APPEARANCE:
24. • Place client in a dorsal recumbent position
making sure that the knees are flexed and are
perpendicular to the bed. Instruct client to
relax the thighs to allow each leg to abduct to
side. The client’s head may be elevated for
comfort. Client may also be placed on
Lithotomy position.
• Drape over the client’s torso and thighs to
expose external genitalia.
• Don gloves and observe appropriate infection
control procedures.
FEMALE EXTERNAL GENITALIA AND ANUS:
INSPECT AND PALPATE
25.
26.
27. IMPLEMENTATION:
• Inspect the mons pubis, labia majora and
minora for the distribution, amount and
characteristics of pubic hair. Check for
parasitic infestation, inflammation, swelling
and lesions and any discharges.
• Inspect the clitoris, urethral orifice, and
vaginal orifice by separating the labia
majora and labia minora.
28. • Pubic hair distribution: kinky in menstruating adult,
straighter and thinner after menopause; distributed
in inverse triangle.
• Pubic skin intact, no lesions.
• Vulval skin slightly darker than the rest of body.
• Labia round, full and relatively symmetrical.
• Clitoris does not exceed 1cm in width and 2cm in
width.
• Urethral orifice appears as small slit and same color
with surrounding tissue.
• No inflammation, swelling or discharge.
Normal Findings:
29.
30. Deviations from normal:
• Scant pubic hair - may be hormonal in nature
• hair growth extending over the abdomen
• lice, lesions, fissures, swelling, erythema, scars (from
episiotomy), varicosities
• presence of inflammation, swelling or discharges
31.
32. • Syphilitic chancre
- red, painless,
eroding lesion with
a raised, indurated
boarder; usually
appears in vagina
but may also
appear in the
external genitalia
GENITAL LESIONS
33. • Genital warts -
an STD caused by
human
papillomavirus;
painless, stemlike
structures on the
vulva, vagina,
cervix or anus
which usually
starts as tiny red
or pink swellings
34. • Genital Herpes -
multiple shallow
vesicles, lesions, or
crusts inside the
vagina, external
genitalia, buttocks
or even in thighs;
may cause dysuria,
regional lymph node
inflammation, pain,
edema and fever.
35. • Vaginitis -
results from
overgrowth of
infectious
organisms;
causes redness,
dypareunia,
dysuria and
maladorous
discharge
37. • Urinary disorders are usually not dignosed
early on - have only mild symptoms
• If not diagnosed and treated early, it may
affect other body sytems:
✓ ovarian dysfunction can cause hormonal
imbalance
✓ kidney dysfunction alters blood pressure,
disrupts serum electrolytes and affect the
oroduction of red blood cells
ABNORMAL URINARY FINDINGS:
38. • Polyuria - production and excretion of more
than 2.5L of urine daily; results from DM,
diabetes insipidus, diuretic use; increases risk of
hypovolemia
• Hematuria - presence of blood in urine; might
be brown or bright red urine; can also be
caused by GI, vaginal, or certain coagulation
disorders
39. • Urinary frequency - abnormally frequent
urination; usually results from decreased bladder
capacity; CLASSIC SIGN of UTI
• Urinary Urgency - sudden urge to urinate;
commonly accompanied by bladder pain; another
sign of UTI
• Nocturia - Excessive urination at night; common
sign of kidney or lower urinary tract disorders;
resulting from disruption of urine pattern;
overstimulation of nerves or muscles that control
urination; use of diuretics
40. • Urinary Incontinence - release of small or large
amounts of urine; COMMON complaint; may be
transient or permanent; caused by: stress, tumor,
bladder cancer, calculi;
• Dysuria - pain during urination; signals lower UTI
• Dysmenorrhea - steady, aching pain which may
radiate to perineum or rectum
• Amenorrhea - absence of urine flow; caused by
anovulation; any obstruction to menstrual flow,
cervical stenosis, intrauterine adhesions; drug or
hormonal treatments
41. • Palpate the Bartholin’s glands noting swelling,
tenderness, and discharge.
• Palpate the urethra if the client has urethral
complaints or symptoms.
• Palpate the inguinal lymph nodes using the
pads of the fingers in a rotary motion, noting for
enlargement and tenderness.
IMPLEMENTATION:
42. Normal Findings:
• No swelling,
inflammation or
tenderness of
Bartholin’s glands and
urethra
• No enlargement or
tenderness of inguinal
lymph nodes
44. Inspecting the Internal genitalia
✓To start, select an
appropriate speculum for
your patient.
✓Hold the speculum under
warm, running water to
lubricate and warm the
blades.
✓Don’t use other lubricants
because many of them can
alter Papanicolau (Pap)
test results.
48. After insertion
✓Observe the following:
- Vaginal lining: color, texture, integrity
- Vaginal walls: thin, white, odorless discharge
- Cervix: color, position, size, shape, mucosal integrity, and
discharge.
- Central cervical opening or cervical os: clear, watery
cervical discharge during ovulation, and slightly bloody
discharge just before menstruation
✓Obtain specimen for Pap test
49.
50. Palpating internal genitalia
✓Lubricate the index and middle fingers of your
gloved dominant hand.
✓Use thumb and index finger of your other hand to
spread the labia majora.
✓Insert your two lubricated fingers into the vagina,
exerting pressure posteriorly to avoid irritating the
anterior wall and urethra.
51. Performing a bimanual examination
palpation of uterus and ovaries from the inside and the outside
simultaneously
52.
53. Rectovaginal Palpation
- Is the last step in a genital assessment, is used to
examine the posterior part of the uterus and the pelvic
cavity.
54.
55.
56. • Inspect the perineum and anus noting for the
color, shape, integrity and skin lesions.
• Palpate the rectum for anal sphincter tonicity,
nodules, masses, and tenderness.
• Remove gloves and discard it to the proper
receptacle. Do hand hygiene.
IMPLEMENTATION:
57. • Intact perianal skin; might be slightly
pigmented than the skin in buttocks
• Good anal sphincter has good tone
• Rectal wall is smooth and not tender
Normal Findings:
58. • Presence of fissures, ulcers, inflammation,
abscess, protruding hemorrhoids, tumors,
prolapse
• Hypertonicity/ hypotonicity of anal sphincter
• Rectal wall is tender and nodular
Deviations from normal:
61. • Place client supine, with legs spread slightly, or in
standing position and have client hold his penis.
• Don gloves and observe appropriate infection
control procedures.
MALE EXTERNAL GENITALIA AND ANUS:
INSPECT AND PALPATE
62. • Inspect the distribution, amount and
characteristics of pubic hair. Check for any parasitic
infestation.
• Inspect the penis, urethral meatus and scrotum
for symmetry, size, discharges, swelling, lesions,
inflammation, and lumps.
• Inspect the glans for an uncircumcised penis by
retracting the prepuce. Check the glans for smegma,
a chessy secretion commonly found beneath the
prepuce.
IMPLEMENTATION:
63. • Triangular distribution, often spreading in the
abdomen
• Penile skin intact, may appear slightly wrinkled
and color varies with other body skin
• Scrotum may appear asymmetric
• Pink and slitlike appearance of urethral meatus;
positioned at the tip of penis
Normal Findings:
64.
65. • Scant pubic hair - may be hormonal in nature
• Presence of lice
• Presence of lesions, nodules, inflammation,
swelling or discharges
• Variation in meatal location: Hypospadias
(underside of penile shaft); Epispadias (upperside
of penile shaft).
Deviations from normal:
66. • To inspect urethral meatus, compress the tip of
the glans
• Check for proper positioning of the urethral
opening and any drainage
- Drainage should be sent for urethral culture
- Skin should be pink and smooth
67.
68. • Transilluminate the scrotal contents if an
abnormal mass or swelling is noted.
• Palpate the shaft of the penis and scrotum
using thumb and first two fingers to assess the
entire length. Note for tenderness, masses and
nodules.
• Inspect the Scrotom and testes. Ask the
patient to stand and to hold his penis away
from his scrotom. Observe the scrotom’s size
and appearance.
IMPLEMENTATION:
69. - Left scrotom: normally appears lower because
the left spermatic cord is longer than the right
cord.
- Skin on the scrotom: commonly darker then
the skin on the rest of the body.
•Spread the surface of the scrotom and inspect for
swelling, redness, ulcerations, and distended
veins.
70.
71. Epididymides
✓Palpate the epididymides, which are usually located
in the posterolateral area of the testes.
- They should be smooth, discrete, non-tender, and free
from swelling and induration.
Spermatic cords
✓Palpate both spermatic cords, one of which located
above each testis.
✓Palpate from the base of the epididymis to the
inguinal canal.
✓Note for any swelling, irregularity, or nodules.
Transilluminate the problem area.
72. ✓Gently palpate both testes
between your thumb and
first two fingers of your
gloved hand. Assess their
size, shape, and response
to pressure.
- A normal response is a deep
visceral pain.
PALPATION OF TESTES
73. • Inspect for inguinal and femoral hernia,
watching for bulges while the client bears down.
• Palpate the client’s inguinal area for inguinal
and femoral hernias.
IMPLEMENTATION:
74.
75. • No tenderness, masses and nodules.
• No swelling or bulges.
• No palpable bulges.
Normal Findings:
77. Inguinal area
Direct inguinal hernia
✓ To assess patients for a direct inguinal hernia,
place two fingers over each external inguinal ring
and ask the patient to bear down. If he has hernia,
you’ll feel a bulge.
Indirect hernia
✓ To assess patient for an indirect inguinal hernia,
examine him while he’s standing and then while
he’s in a supine position with his knee flexed on
the side you’re examining.
78. • Inspect the perineum and anus noting for the
color, shape, integrity and skin lesions.
• Palpate the rectum for anal sphincter tonicity,
nodules, masses, and tenderness.
IMPLEMENTATION:
79.
80. • Intact perianal skin; might be slightly
pigmented than the skin in buttocks
• Good anal sphincter has good tone
• Rectal wall is smooth and not tender
Normal Findings:
81. • Presence of fissures, ulcers, inflammation,
abscess, protruding hemorrhoids, tumors,
prolapse
• Hypertonicity/ hypotonicity of anal
sphincter
• Rectal wall is tender and nodular
Deviations from normal:
82.
83. • Instruct the client to lean on the examination table
or have him lie on his left side with either knee and
hip flexed or both his knees drawn to the chest
• Lubricate the gloved index finger of your dominant
hand and insert your finger into the rectum. Tell
the patient relax or if unable, ask him to bear
down.
• Palpate the prostate gland on the anterior wall just
past the anorectal ring with your finger pad. Check
for tenderness, size, shape, texture, or
irregularities.
• Remove gloves and discard it to proper receptacle.
Do hand hygiene.
IMPLEMENTATION:
84.
85. • Prostate is smooth and rubbery and is
about the size of a walnut.
• No tenderness.
• No nodules.
86. • Prostate is not smooth, has lumps and
nodules.
• Enlarged and is protruding on rectal lumen.
• With tenderness.
87. • Document significant normal and abnormal
findings in an organized manner according
to the related system.
• Do aftercare.
• Refer findings to the attending physician.
88.
89. ABNORMALITIES
Benign prostatic hyperplasia
- also called prostate gland enlargement, is a common condition as
men get older. It can cause uncomfortable urinary symptoms,
such as blocking the flow of urine out of the bladder. It can also
cause bladder, urinary tract or kidney problems.
90. Interstitial Cystitis
- a chronic condition causing bladder pressure, bladder pain
and sometimes pelvic pain. The pain ranges from mild
discomfort to severe pain. The condition is a part of a
spectrum of diseases known as painful bladder syndrome.
91. Urinary tract stones
- Begin to form in a kidney
and may enlarge in a ureter
or the bladder. Depending
on where a stone is located,
it may be called a kidney
stone, ureteral stone, or
bladder stone. The process
of stone formation is called
urolithiasis, renal lithiasis, or
nephrolithiasis.
92. Post-vasectomy pain syndrome
- is diagnosis of exclusion, and may
be caused by direct damage to
spermatic cord structures,
compression of nerves in the
spermatic cord via inflammation,
back pressure from epididymal
congestion, and perineural fibrosis.
93. Female Reproductive System
Endometriosis
- is an often painful disorder in
which tissue similar to the
tissue that normally lines the
inside of your uterus, the
endometrium grows outside
your uterus. Endometriosis
most commonly involves your
ovaries, fallopian tubes and the
tissue lining your pelvis.
94. Uterine fibroids
- are non-cancerous
growths of the uterus that
often appear during
childbearing years. Also
called leiomyomas or
myomas, uterine fibroids
aren't associated with an
increased risk of uterine
cancer and almost never
develop into cancer
95. Polycystic ovary
syndrome (PCOS)
- a condition that affects a
woman's hormone levels.
Women with PCOS produce
higher-than-normal amounts
of male hormones. This
hormone imbalance causes
them to skip menstrual
periods and makes it harder
for them to get pregnant.
96. Gynecologic Cancer
- any cancer that starts in a
woman's reproductive
organs. Cancer is always
named for the part of the
body where it starts.
Gynecologic cancers begin in
different places within a
woman's pelvis, which is the
area below the stomach and
in between the hip bones.
97. Male Reproductive System
Prostate Cancer
- is marked by an uncontrolled (malignant) growth of cells in the
prostate gland. The prostate is the walnut-sized gland in men,
located just below the bladder and in front of the rectum,
surrounding the urethra – the tube that carries urine out of the
98. Testicular Cancer
- forms in tissues of one or both testicles. Testicular
cancer is most common in young or middle-aged men.
Most testicular cancers begin in germ cells (cells that
make sperm) and are called testicular germ cell tumors.
99. Prostatitis
- is swelling and
inflammation of the
prostate gland, a walnut-
sized gland situated
directly below the bladder
in men. The prostate
gland produces fluid
(semen) that nourishes
and transports sperm.
