Nursing Assessment of the Genitourinary System II: Inspection and Palpation

Inspect the mouth for uremic fetor and stomatitis, which suggest advanced kidney disease from urea buildup. Check skin for pallor indicating anemia, yellow-gray discoloration, excoriations from itching, and changes in skin turgor. Bruising and rough or dry skin may signal renal failure. These findings help nurses identify kidney dysfunction early during physical examination.

Generalized edema in the face and extremities signals fluid retention from kidney dysfunction. When kidneys fail to regulate fluid balance properly, fluid accumulates in tissues. This swelling is a key indicator of conditions like nephrotic syndrome or other renal disorders. Nurses should assess edema distribution and severity to evaluate kidney function.

A midline mass in the lower abdomen may indicate bladder distention from urinary retention. A unilateral flank mass could suggest kidney enlargement caused by tumors, polycystic kidney disease, or other conditions. Palpating for abdominal masses helps nurses detect serious pathology affecting the genitourinary system and identify urinary obstruction or retention.

Place your left hand behind the patient's right side between the rib cage and iliac crest, then palpate deeply with your right hand. Feel for the kidney's smooth, rounded lower pole that descends on inspiration. Enlargement may suggest kidney tumors or polycystic kidney disease. Tenderness or inability to palpate may indicate inflammation or other renal pathology.

A distended bladder feels like a firm, rounded mass in the lower abdomen that may be tender to pressure. It indicates urinary retention and requires further investigation. The bladder is typically not palpable unless filled with urine. Tenderness suggests irritation or infection requiring clinical follow-up and possible intervention.

Costovertebral angle tenderness, located between the 12th rib and spine, suggests kidney infection or inflammation. Palpate this area gently to assess for pain or discomfort. This finding is significant because it may indicate pyelonephritis or other acute renal conditions. Positive CVA tenderness warrants further diagnostic evaluation and clinical assessment.

The left kidney is usually not palpable because of its position beneath the spleen, which protects it. The kidneys are located behind abdominal organs and muscles, protected by ribs and back muscles, making direct palpation difficult. Only the inferior pole of the right kidney may be felt occasionally during deep inhalation. Understanding kidney anatomy helps nurses recognize normal findings versus abnormalities.