ASSESSING THE FEMALE GENITOURINARY SYSTEM

OutcomesIdentify pertinent genitourinary history questions.

Obtain a female genitourinary history.

Perform a female genitourinary physical assessment.

(Continued)

OutcomesDocument 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

Anatomy and Physiology Review

FunctionsWhat 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)

FunctionsWhat are the functions of…

Clitoris:Erectile tissue for sexual stimulation

Urinary meatus: Opening to urethra

Skene’s glands: Lubricate and protect

(Continued)

FunctionsWhat 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)

FunctionsWhat are the functions of…

Cervix: End of the uterus into vagina

Uterus: Hollow, muscular organ; site for fertilized egg implantation; protects fetus

(Continued)

FunctionsWhat 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)

FunctionsWhat are the functions of…

Ureter: Connects kidneys to bladder

Bladder: Hollow muscular structure; holds urine

Urethra: Connects bladder to urinary meatus opening

Relationship to Other SystemsWhat is the

relationship of the female genitourinary system to other systems?

Integumentary Gastrointestinal

Lymphatic Musculoskeletal Cardiovascular Respiratory Endocrine Neurological

DevelopmentalVariations

Children—next quarter Pregnant clients—next quarter Older Women

Reproductive ability peaks in late 20’sEstrogen levels begin to decline, and between

46 & 55 menstrual periods become shorter, less frequent, & cease

Increased risk of infection (decreased vaginal secretions)

Cultural Variationspage 618

African Americans Asians Jews Native Americans Whites

Case Study Mrs. James, 29-year-

old, married, mother of 4-year-old daughter, housewife

C/O scant midcycle vaginal bleeding for past 2 months

Annual PAP test and gynecologic exam

SymptomsWhat symptoms would signal a problem with the female genitourinary system?

Vaginal discharge Lesions Vaginal bleeding, pain Amenorrhea Urinary symptoms

Pertinent History Findings Midcycle vaginal bleeding Taking BCP, occasional ASA + History of rheumatic fever Gravida 1/para 1; menarche 12; LMP 21

days ago, cycle every 21-23 days, menses 5 days, moderate-to-light flow.

Sexually active in monogamous, heterosexual relationship, satisfied with sexual performance

Physical AssessmentAnatomical 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

InspectionExternal genitalia: color, hair

distribution, condition of skin, lesions, discharge, odor, pubic pediculosis, prolapse

Rectal area: condition of skin, lesions, discharge, bleeding, hemorrhoids, fissures

(Continued)

InspectionPelvic 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

PalpationOvaries: size, shape, symmetry,

tendernessAnus 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?