23.7: Nursing Assessment of the Genitourinary System II: Inspection and Palpation

The nursing assessment of the genitourinary (GU) system involves a systematic inspection and palpation to identify abnormalities in the kidneys, bladder, and surrounding structures.

Inspection

1. Mouth: Inspect for signs of kidney dysfunction, such as stomatitis (inflammation of the mouth) and ammonia breath, which may occur in advanced kidney disease due to the buildup of urea, breaking down into ammonia.
2. Skin: Check for pallor, which could indicate anemia caused by kidney disease. Look for yellow-gray discoloration, excoriations (scratches from itching), and changes in skin turgor (elasticity), which may be signs of kidney dysfunction. Bruising and rough or dry skin may also indicate renal failure or systemic conditions affecting the kidneys. Inspect for generalized edema (swelling), especially in the face and extremities. It is often associated with fluid retention caused by renal dysfunction.
3. Abdomen
   Abdominal Contour: Inspect the abdomen for changes in shape and size. A midline mass in the lower abdomen may suggest bladder distention due to urinary retention. A unilateral mass in the flank area could indicate kidney enlargement caused by tumors, polycystic kidney disease, or other conditions.
4. Edema: Inspect the extremities and face for signs of generalized edema, which can signal fluid retention due to kidney dysfunction or other systemic issues.

Palpation

1. Kidneys

• Location: The kidneys are behind the abdominal organs and muscles, protected by the ribs and back muscles, making them difficult to palpate directly.

1. Right Kidney: The inferior pole of the right kidney may be palpable occasionally, especially during deep inhalation. It may feel like a smooth, rounded mass that moves downward as the person breathes in.
2. Left Kidney: The left kidney is usually not palpable because of its position beneath the spleen.

• Assessment: Palpate to assess the kidneys for size, contour, and tenderness. Any enlargement may suggest severe conditions such as kidney tumors or polycystic kidney disease.

2. Bladder

• The bladder is typically not palpable unless it is distended with urine.
• A distended bladder will feel like a firm, rounded mass in the lower abdomen, which may be tender to pressure and indicate urinary retention.

Assessment for Masses or Tenderness

1. CVA Tenderness: Palpate for tenderness over the costovertebral angle(the junction of the lower ribs and vertebral column), which can be a sign of renal infection or inflammation.
2. Abdominal Masses: Palpate the lower abdomen for masses, which may indicate bladder distention or more severe issues like tumors or cysts. Palpate for ascites (fluid accumulation in the abdomen) may result from kidney or liver dysfunction.