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Genitourinary Assessment

Genitourinary Assessment. NURS 347 Towson University. Ladies First. Anatomy & Physiology. External Genitalia Vulva Mons pubis Labia majora & minora Frenulum Clitoris Vestibule Urethral meatus Vaginal orifice Hymen Bartholin’s & Skene’s glands. Anatomy & Physiology.

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Genitourinary Assessment

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  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’sglands

  4. Anatomy & Physiology • Internal Genitalia • Vagina • Cervix • Squamocolumnarjunction • Rectouterine pouch • Uterus • Anterior & Posterior fornix • Fallopian tubes

  5. Subjective Assessment • Subjective: • 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 • 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 • 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: • 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:feelsdiscrete, 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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