genitourinary and sexual health assessment Flashcards
what is Micturition
the action of urinating
factors influencing micturition
- disease or disability
- fluid balance
- medication
- pelvic floor muscle tone
- psychological factors
what is the expected healthy urine output
0.5mL/kg/hr
how does the factor disease and disability affect micturition
- change in volume or quality of urine produced
- renal obstruction
- continence(ability to control movements of the bowels and bladder)/ retention concerns
- dementia, immobility/mobility restrictions and/or neurological changes can all affect urination
how do psychological factors affect micturition
- embarrassment anxiety, environmental factors
- could inc. urgency and/frequency and/or retention
influences of growth and development to GU
- infants and children - continence
- pregnancy - hormonal and intra-abdominal pressure
- aging
- dec. ability to concentrate urine (reabsorb Na and H2O)
- inc. incidence of nocturia
- inc. frequency results to decrease muscle tone and dec. bladder capacity
- inc residual urine results to decreased effectiveness of muscle control voiding
- inc. risk for UTI that does not present in the classic way
what is focused history
- reviewing clients normal urinary pattern and assess for changes to that norm
- pattern includes aspects such as frequency, time of day, volume, colour, odor
- review the associated symptoms (pain history, describing all parameters in detail)
- identifying contributing factors
- functional impact
physical examination: inspection of GU
- inspect skin, mucous membranes
- perineum: skin breakdown, atrophy
- inspect bladder area – convex curve of lower abdomen when distended
- check to see if bladder is empty (if empty, behind pubic symphysis)
inspection of urine
check for:
- clarity
- odor
- volume
- sediment, mucous or blood
- lab test results
urinary system normally a sterile environment
cloudy urine could mean UTI
urinary tract infections
- common in females
- males can get them but not as often
- it is frequent in young girls
- appearance of urine can be dark colour, presence of blood, cloudy, mucous threads
- bacteria is usually the reason for UTI
- could also be fungi (yeast)
- e-coli is a common bacteria responsible for UTI
risk factors of UTIs
incontinence
catheterization
hygiene
stasis of urine
intercourse
tampon use
residual urine
signs and symptoms of UTI
burning on urination
frequency
urgency
hematuria
foul odor
pelvic pain
fever
flank pain
delirium in elderly
what is fluid balance
describe the balance of the input and output of fluids in the body to allow metabolic processes to function correctly
signs of fluid imbalance: fluid volume overload
dyspnea
crackle in the lungs
pitting edema in lower legs/ankles
edema in arms/legs
fatigue
in the bloodwork and labs it would show diluted/lower conc. of electrolytes
signs of fluid imbalance: fluid volume deficit
impaired cognitive function
headaches, fatigue, sunken eyes
dry skin (poor skin turgor), dry mucous membranes
paeds: sunken fontanelles, lack of tears
hypotension, postural drop, tachycardia, weak thready pulse, cold hands/feet, cap refill delayed
labs show higher concentrations of electrolytes, abnormal kidney markers (BUN, creatinine)
oliguria - low urine output
lead to hypovolemic shock and organ failure
nursing actions for fluid imbalance
- maintain meticulous ins and outs (when indicated)
- encourage adequate fluid intake ~2L/day
- dialysis patients are on fluid restriction, measurement take in a different meaning
- monitor for signs of fluid imbalance
- collaborate with family members
- collaborate with interprofessional team
factors influencing sexuality and reproductive health
individual
family
culture
community
determinants of health
policy
5 Ps in sexual assessment
partners
practices
past history of STDs
protection from STDs
pregnancy plans
health promotion in sexual health
safer sex guidelines
immunizations
Ontario breast screening program
breast/ testicular self examination
pap smear guidelines
define dysuria
sensation of pain, burning, stinging, itching when urinating
define hematuria
blood in urine -could be micro- or macro- scopic
