Nursing Assessment of the Genitourinary System

00:01 Now let's move on down our head to toe assessment to our GU system.

00:06 So here we're talking about the kidneys and the bladder, of course.

00:10 So, here's something to think about about palpating the kidneys.

00:14 Now, you may not do this so much as a nurse, but it is a common practice in assessment.

00:19 Specially for someone who's got a kidney infection, they may be really sensitive to having their flanks palpated.

00:26 Sometimes that UTI or a kidney infection can radiate to the flanks, or the back of the patient.

00:33 Now, if the kidneys are inflamed, or if there's an infection suspected, you can gently palpate these areas to see if there's any pain in those particular areas of your patient.

00:46 And next, it's really important to document in the GU assessment the patient's urine color.

00:51 So this is really important to note this throughout the shift.

00:55 Now this is going to tell us a whole lot of different things about your patient.

01:00 So let's start here at the beginning of a slide where you see clear, light yellow to yellow, this is actually normal.

01:07 And this is ideal assessment for a patient.

01:09 This is usually indicating that the kidneys are functioning properly, the patient's well hydrated.

01:16 Now, sometimes the patient can be dehydrated, and you may see the urinalysis, Amber, or like dark golden yellow color.

01:24 Again, this could be a sign of dehydration, and you want to make sure you enforce fluids on your patient and encourage intake.

01:32 Now next, you may see brown urine, so that is not normal.

01:38 That can mean that there's bilirubin in the patients urine.

01:42 Now, that's something bilirubin that this is extruded through the kidneys.

01:46 And it can mean that there's inflammation of the liver cells or some sort of blockage in the bile ducts.

01:52 And this needs to be reported to the healthcare provider.

01:55 And next is red urine. Red means blood.

01:59 As you can imagine, this is not normal.

02:02 This can be from trauma to the pelvis, maybe the patient got into an MVA or a Motor Vehicle Accident.

02:09 Sometimes your patient can be on a blood thinner for certain disease processes, and the patient's blood is far too thin, and we can see the patient's urine turn red.

02:20 Now in nursing, a lot of the times we take a lot of care on insertion of a foley catheter, but we can cause trauma, and this can lead to a red and blood filled urine.

02:32 Now with UTI, this actually can come up.

02:36 I've had a female patient where I went to cath and gained a urine sample.

02:40 She had such a severe urinary tract infection.

02:43 When I cath her, her urine return was actually had blood in it.

02:47 And I had to report this promptly to the provider.

02:50 So just note that anytime there's trauma here and we've got blood in the patient's urine.

02:56 Sometimes you may see in order for what they call continuous bladder irrigation, to flush out that bladder, try to keep any blood clots from forming and help resolve blood in the patient's urine if we can reverse it.

03:11 So when we provide visual inspection of the patient's GU assessment, there's some other things to consider when we're assessing our patient.

03:19 We also want to ask some particular questions.

03:22 Now, we also want to ask the patient, "Hey, is there any pain or burning when you void?" So this could mean the patient has a urinary tract infection, for example.

03:31 Now do you have trouble initiating urination? This could be anything from prostate issues in your patient.

03:38 It could mean anything, such as a UTI, for example, as well.

03:42 And do you avoid a lot throughout the night? And we call that nocturia.

03:47 Now when we're talking about our urinary system, sometimes it's important for an indwelling catheters to be in place.

03:55 So one thing to note before we go through this image, you want to assess frequently and try to remove as much as possible or as soon as possible.

04:04 As you can imagine any indwelling catheter into the patient's bladder is a source of possible infection.

04:11 So first thing when we look at is we want to look at the top of this image.

04:14 We want to make sure we're checking that insertion site and giving good Peri-care.

04:20 Because that insertion site needs to maintain and needs to be cleaned.

04:24 Also, make sure you secure the device and use the securement device for that Foley catheter and that's in place.

04:30 This is gonna prevent excess trauma or tugging on your patients Foley catheter.

04:35 Now going down the tubing, make sure you're looking and make sure every time you walk into the patient's room.

04:42 There's no loops in the tubing or kinks.

04:45 And don't forget about the patient's collection bag.

04:48 This may not seem like it makes a lot of sense for you.

04:52 But if you think about, if we fill up that collection bag and there's too much urine in there, and we don't dump it very regularly that urine can actually back up into the tubing into the patient's bladder.

05:05 And that is a big deal and it can cause urinary tract infections.

05:09 So like you see in this image, make sure when you assess the collection bag, it's no more than half full.

05:15 When it reaches that point, make sure you empty it appropriately and document.

05:20 And next because that collection bag has a place where we can dump out the urine, it traces up to the bladder, make sure that collection bag is not touching the floor and secured on a non-moving part of the bed.

05:34 And lastly, when that indwelling catheter is inserted, that balloon should be inflated to keep it in place at all times.