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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 Clitoris Perineum Anus Uterus Ovaries Urethra Vagina Labia majora & minora Urinary meatus Bartholin’s glands Cervix Fallopian tubes Kidneys Bladder Skene’s gland Anatomy and Physiology Review 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 Relationship to Other Systems What is the relationship of the female genitourinary system to other systems? Integumentary Gastrointestinal Lymphatic Musculoskeletal Cardiovascular Respiratory Endocrine Neurological Developmental Variations Children—next quarter Pregnant clients—next quarter Older Women Reproductive ability peaks in late 20’s Estrogen levels begin to decline, and between 46 & 55 menstrual periods become shorter, less frequent, & cease Increased risk of infection (decreased vaginal secretions) Cultural Variations page 618 African Americans Asians Jews Native Americans Whites Case Study Mrs. James, 29-yearold, married, mother of 4-year-old daughter, housewife C/O scant midcycle vaginal bleeding for past 2 months Annual PAP test and gynecologic exam Symptoms What 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 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?
