NWT Clinical Practice Guidelines for Primary Community Care Nursing - Genitourinary System
Assessment Of The Genitourinary System
General
The genitourinary (GU) system may be affected abnormalities and diseases of the kidneys. Some of
by infection, external problems, congenital the more common problems are discussed below.
History Of Present Illness And Review Of System
The following symptoms are those most The following symptoms are associated with
commonly associated with urinary tract infection nephrotic syndrome and glomerulonephritis:
(UTI) in children: • Swelling (e.g. ankles, around eyes)
• Fever • Headaches
• Unexplained crying • Nosebleeds (an occasional symptom of
• Holding of genitals hypertension, but nosebleeds also occur
• Enuresis (bed-wetting) frequently in normal children)
• Constipation (chronic) • Hematuria
• Toilet-training problems • Decreased urinary output
• Dysuria
• Frequency A complete history of the GU system should
• Urgency include questions related to the following topics:
• Change in colour of urine • Sexual activity (for adolescents)
• Abdominal pain and back pain • Problems related to inappropriate touching by
• Scrotal or groin pain, vaginal discharge others (i.e. sexual abuse)
• Genital sores, swelling, disation
Children must be asked such questions with
• Jaundice in young infants sensitivity and without the use of leading
questions. The parents or caregiver can be asked
about these topics directly.
Physical Examination
Vital Signs Percussion
• Temperature • Liver span (may be increased in
• Heart rate glomerulonephritis)
• Blood pressure • Ascites (dull to percussion in flanks when child
is supine; location of dullness shifts when child
Urinary System (Abdominal changes position)
Examination) • Tenderness over costovertebral angle
For full details, see "Examination of the
Abdomen," in chapter 12, "Gastrointestinal Palpation
System." • Size of liver and any tenderness because of
congestion
Inspection • Kidneys are often palpable in infants, the right
• Check specifically for any abdominal distension kidney being most easily "captured"; perform
(a sign of ascites) deep palpation to determine kidney size and
• Masses tenderness (place one hand under the back and
the other hand on the abdomen to try to
• Asymmetry
"capture" the kidney between the hands)
September 2004 General Assessment - Genitourinary System - Pediatrics 1
NWT Clinical Practice Guidelines for Primary Community Care Nursing - Genitourinary System
Male Genitalia For information about examining the adolescent
Perform examination with the child supine and, if male, see "Physical Examination of the System," in
possible, in the standing position. chapter 6, "Urinary and Male Genital Systems," in
the NWT Clinical Practice Guidelines for Primary
Penis Community Care Nursing (Adult) 2003.
Inspection
• Position of urethra (e.g. epispadias, Female Genitalia
hypospadias) • Child should be in supine frog-leg position for
• Discharge at urethra (sign of urethritis) examination
• Inflammation of foreskin or head of penis (sign • Do not perform an internal vaginal examination
of balanitis) in a prepubescent child or an adolescent who is
not sexually active
Palpation • Spread labia by applying gentle traction toward
• Foreskin adherent at birth examiner and slightly laterally to visualize
• In 90% of uncircumcised male children, the introitus
foreskin becomes partially or fully retractable by
3 years of age Inspection
• Inability to retract foreskin (phimosis) • Vulvar irritation
• Inability of retracted foreskin to return to normal • Erythema (in prepubescent girls, the labia
position (paraphimosis) normally appears redder than in adult women,
because the tissue is thinner)
Scrotum and Testicles • Urethral irritation (sign of UTI)
Inspection • Vaginal discharge (may indicate vaginitis or
• Scrotum may appear enlarged sexual abuse)
• Check for edema (a sign of glomerulonephritis), • Bleeding (may indicate vaginitis or sexual abuse
hydrocele (transillumination should be possible), in a prepubescent girl)
hernia or varicocele • Enlargement of vaginal orifice (may indicate
sexual abuse)
Palpation
• Cremasteric reflex (absent in testicular torsion) For information about examining the adolescent
• Testicular size, consistency, shape and descent female, see "Examination of the Female
into scrotum Reproductive System," in chapter 13, "Women's
Health and Gynecology," in the NWT Clinical
• Testicular tenderness: consider torsion or
Practice Guidelines for Primary Community Care
epididymitis (pain is actually in the epididymis,
Nursing (Adult) 2003.
not the testicle)
• Swelling in inguinal canal: consider hernia or
hydrocele of spermatic cord
September 2004 General Assessment - Genitourinary System - Pediatrics 2
