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NURS 523: Bowel and Bladder Continence > Pharmacology of Defecation and Micturition > Flashcards

Pharmacology of Defecation and Micturition Flashcards

1
Q

Suprapubic Catheter

A

Site 2cm above pubic bone

  • bladder cancer vs indwelling cath
  • fecal incontamination
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2
Q

Suprapubic Catheter Indications

A 
Prostrate obstruction, infection, stricture
Urinary tract/pelvic trauma
Injuries to genitalia, bladder, urethra
Urethral closure
Chronic bladder drainage
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3
Q

Suprapubic Catheter Contraindications

A 
Nondistended bladder
Pregnancy
Bladder cancer/pelvic radiation
Chronic unstable bladder
Detrusor instability, hyperreflexia, intrinsic sphincter deficiency
Obesity
Bleeding disorder
Gross hematuria w/ clots
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4
Q

Suprapubic Catheter Complications

A 
Hematuria
Bowel perforation
Cellulitis
Abscess
Catheter obstruction
Infection
Peritonitis 
Bladder stones
Bladder cancer if used 10+ years
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5
Q

Suprapubic Catheter Care and Management

A

Placed by dr or urologist w/ local anesthesia
Change at home by clinician
Self-change after tract established in 2-10 weeks
Insert 4 cm after urine begins to flow
Daily cleansing w/ clean technique
Clamping = 0 preservation of detrusor compliance

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6
Q

Suprapubic Catheter Removal

A

Cover w/ gauze for closure w/i days
If difficult: milk tubing, insert sterile H2O into inflation valve
If accidental: replace ASAP by trained clinician

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7
Q

Suprapubic Catheter Types

A

16-18 Fr or smaller
Silicone elastomer or silicone product
If leakage: use smaller balloon
100% silicone = balloon cuffing and difficulty removing
Silicone may lose H2O in balloon and fall out

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8
Q

External Catheter Indications

A 
- or 0 post-void residual
Sphincter damage
Reflexive voiding
Urgency/frequency
Impaired skin integrity
Limited toilet access
Safety issues w/ toilet
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9
Q

External Catheter Contraindications

A

Phimosis (inability to pull foreskin over head of penis)

Catheter induced hypospadias

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10
Q

External Catheter Care

A

Diameter = circumference (in mm) x 7 / 22
Leave foreskin in natural position
Wer 12-72 hours
Vinegar/H2O (1:3) or bleach/H2O (1:10)
Complication: Candidal balanitis (inflammation of glans penis)

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11
Q

Complications of CAUTI

A 
* Urosepsis (fatal 40-60% cases) *
Cystitis
Periurethral abscess
Prostatitis
Epididymitis
Pyelonephritis 
Gram - bacteremia
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12
Q

Bacteriuria

A

Long-term cath = polymicrobial bacteria in urine
0 treatment if asymptomatic in long-term cath user
Treat if immunocompromised, pregnant, scheduled for urological surgery

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13
Q

CAUTI Diagnosis

A 
\+WBC in urine
Bladder, flank, urethra pain
Fever +100.4 (38c) chills
Malaise
Urine odor
Change in urine color
Hematuria
Bladder spasms/leakage
Cath obstruction
Weakness, spasticity
Change in mental status
Bacteremia
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14
Q

Catheter-Related CAUTI Risks

A 
In place 6+ days
Inserted anywhere other than OR
Used to measure urinary output
Drainage bag above level of bladder
Not maintained as closed system
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15
Q

Patient-Related CAUTI Risks

A 
Female
Pregnant
Malnourished/frail/chronic illness
DM
Azotemia (creatinine +2.0mg.dL)
Ureteral stent
Other sites of infection
Immunosuppressed
Hip fracture in nursing home pt
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16
Q

INAPPROPRIATE Strategies to Prevent UTI

A

Antibiotics in drainage bag
Antibiotics to meatus
Systemic prophylactic antibiotics
Cranberry juice

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17
Q

Incontinence-Associated Dermatitis Treatment

A

0 routine use of steroidal or antimicrobial topical treatment
Antifungal only if cutaneous fungal rash

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18
Q

IAD High-Risk

A

Pt unable to care for self

Incontinent 3x+/day

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19
Q

Early IAD

A

Skin exposed to stool/urine is pink but intact
0 blisters
Warm skin

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20
Q

Moderate IAD

A

Bright red skin
Shiny/moist skin w/ weeping and bleeding
Small areas of skin loss
tx: zinc oxide

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21
Q

Severe IAD

A

Red skin w/ denudement
Oozing/bleeding
Skin layers stripped off due to sticky oozing
tx: semiprone position BID for air exposure, low air loss mattress, Domeboro soaks

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22
Q

Fungal-Appearing Rash

A

In addition to IAD (any level)
Spots noted near edges of red areas
Intense itching
tx: antifungal, 0 cream use, zinc oxide, exposure to air

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23
Q

Alpha Adrenergic Agonists

A

Sudafed
+ bladder neck contraction
Treats stress UI
Causes overflow incontinence
Side effect: HTN, hallucinations, tachy, insomnia, dry mouth
Contraindication: elderly, cardiac disease, HTN, hyperthyroidism

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24
Q

Alpha Adrenergic Antagonists

A 
doxazosin (Cardura), tamulosin (Flomax)
- bladder neck contraction/obstruction
Treats overflow UI and BPH
Causes stress UI
Side effect: hypotension
Contraindication: Alpha adrenergic agonist
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25
Q

Anticholinergics

A

oxybutinin (Ditropan), tolterodine (Detrol)
Relaxes detrusor: + filling, storage, stability
Treats urge UI and OAB
Causes retention
Side effect: constipation, dry mouth, confusion, heartburn, blurred vision
Contraindication: glaucoma, retention

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26
Q

Antidepressants

A

imipramine (Tofranil)
Relaxes detrusor and + bladder neck contraction
Treats mixed stress and urge UI, enuresis
Causes retention
Side effect: drowsiness, hypotension, +BG
Contraindication: MAOIs, after acute MI

27
Q

Beta-3 Adrenergic Agonist

A 
mirabegron (Myrbetriq) 
Bladder relaxation by stimulating beta-3 receptors
Treats urge/OAB
Causes retention
Side effect: +BP, nasal drip
Contraindication: uncontrolled HTM
28
Q

Estrogen

A

ESTring q90 days
+urethral resistance in urogenital atrophy
Treats stress, urge, mixed UI
0 side effects listed
Contraindication: estrogen dependent CA, acute liver disease, thromboembolic disease

29
Q

Posterior Pituitary Agonist

A

Desmopressin (DDAVP)
- nocturnal urine production by + H2O reabsorption and urine concentration in distal tubules
Synthetic vasopressin replacement
Treats nocturnal polyuria and enuresis
Side effect: hyponatremia in 1st 1-3 weeks, seizures, H2O toxicity
Contraindication: -Na

30
Q

5-alpha Reductase Inhibitors

A 
finasteride (Proscar) 
-prostate by inhibiting male hormone DHT
Used for prostate +40g
Treats overflow UI
Side effect: - sexual desire, erectile dysfunction
31
Q

ACE Inhibitors

A

“pril” drugs
Causes stress UI
Side effect: chronic cough

32
Q

Alcohol

A

Sedative and diuretic effect

33
Q

Antihistamines

A

Sudefed
+bladder neck contraction
Causes overflow UI

34
Q

Antispasmodics

A

bentyl

Used for IBD, relaxes bladder and facilitates emptying

35
Q

Ca Channel Blocker

A

diltiazem (Cardizem), nifedipine (Procardia)
Relaxes detrusor, +nighttime urine production, constipation
Causes retention

36
Q

Skeletal muscle relaxants

A

baclofen (Lioresal), diazepam (Valium)
Relaxes detrusor
Causes retention

37
Q

Meds for IAD

A

Antifungal (Miconazole, nystatin)

Anti-inflammatory (Hydrocortizone)

38
Q

Meds that increase risk of IAD

A

Antibiotics

Alter function of GI or urinary tract

39
Q

Sympathetic Fibers

A

T10-L2
Bladder relaxation/bladder neck tighten
Promote urine storage
Relaxes colon and slows motility

40
Q

Parasympathetic Fibers

A

Tells bladder to contract

Promotes gut motility

41
Q

Stool Bulking Agents

A 
Metamucil (psyllium), Benefiber (guar gum)
1st line for constipation
Same effect as dietary fiber
For constipation: give w/ full glass of H2O
For diarrhea: give w/ 1/2 glass H2O
0 use w/ esophageal strictures
\+ peristalsis and H2O absorption
0 use for slow-transit constipation
Slowly increase dose due to gas
42
Q

Surfactants (emollients)

A

(Docosate sodium)
- surface tension = + H2O in stool
Stool softener
Takes several days to be effective

43
Q

Laxatives: Osmotic or saline

A 
Milk of mag
Lactulose causes gas 2nd to bacteria
Polyethlyene glycol
2nd line for constipation
Use as needed (ok daily)
Pulls fluid into bowel to soften stool/distend bowel
\+ dose = watery stool in 2-6 hours
- dose = soft stool in 6-12 hours
\+ fluid intake to avoid dehydration
44
Q

Laxatives: Stimulant or contact

A

Stimulates enteric system to + peristalsis
Frequently abused (ExLax, Dulcolax, Senokot)
Use for slow-transit constipation
Senna, Castor Oil, or bisacodyl

45
Q

Laxative Abuse

A 
- intrinsic nervous system response to stretch = + reliance on laxatives
\+ risk of electrolyte imbalance, dehydration, colitis
Melanosis Coli (dark discoloration of intestinal mucosa)
46
Q

Castor Oil

A

Only contact laxative to work on small bowel

47
Q

Mineral Oil

A

Mixture of indigestible hydrocarbons
Lubrication
Side effects: oil aspiration = lipid pneumonia, anal leakage, - absorption of fat soluble vitamins, oil deposit in liver

48
Q

Glycerin

A

Softens and lubricates stool (osmotic action)
Stimulates rectal contraction
Works in 30 minutes

49
Q

Iso-osmotic solution

A 
H2O and electrolytes not absorbed or secreted = can use in dehydrated pt or w/ electrolyte imbalances
Utilized as bowel prep
Polyethylene glycol (GoLYTELY, CoLyte)
50
Q

Antidiarrheals

A

Loperamide (imodium), bismuth (Pepto-bismol), Lomotil
Slow bowel transit time or thicken stool
Use for ileostomy dysfunction, IAR, ileorectal anastomosis, radiation enteritis
Contraindication: Crohn’s, CUC, infectious diarrhea, toxic megacolon

51
Q

Sympathetic Nerves Neurotransmitter

A 
Adrenaline (norepinephrine) 
Adrenergic (alpha or beta)
T10-L2
Bladder base and neck
Hypogastric Nerve
52
Q

Parasympathetic Nerves Neurotransmitter

A 
Acetylcholine
Cholinergic 
C = contraction and cholinergic
S2-S4 
Body of bladder
Pelvic Nerve
53
Q

Somatic Nerve Neurotransmitter

A 
Acetylcholine
Cholinergic 
S2-S4
Pelvic muscle
Pudendal nerve
54
Q

Beta Adrenergic Receptors

A

Located in bladder wall
Receive adrenaline (norepinephrine) from sympathetic
Causes detrusor to relax to store urine

55
Q

Alpha Adrenergic Receptors

A

Located in bladder neck
Receive adrenaline (norepinephrine) from sympathetic
Stimulates contraction of bladder neck to store urine

56
Q

Pelvic Muscle

A

Voluntary control
Pudendal nerve relaxes/tightens
Test integrity w/ anal wink or squeeze during digital exam

57
Q

Cholinergic Receptors

A

Stimulated by acetylcholine to contract bladder
Muscarinic (M2 and M3) receptors in bladder
Anticholinergic meds - bladder contraction

58
Q

Alpha Adrenergic Antagonists

A

“Sin” meds
Tamsulosin (Flomax), Doxazosin (Cardura)
Improve bladder emptying and reduce blockage
SE: Hypotension, dizziness, fatigue, ED

59
Q

Anticholinergic Meds

A

AKA anti-muscarinic
Oxybutynin (Ditropan)
SE: dry mouth, constipation, blurred vision, urinary retention, confusion

60
Q

Beta-3 Adrenergic Agonist Meds

A

Mirabegron (Myrbetriq)

SE: +BP, nasal drip, nasopharyngitis, urinary retention

61
Q

Atrophy of Urogenital Tract

A

Area sensitive to estrogen
+Estrogen = blood flow, moisture, supple tissue
- Estrogen = dry/pale vag mucosa
sx: urethritits, vaginitis, caruncle, urgency, frequency, UI

62
Q

Alpha Adrenergic Agonist Meds

A

Cold medicine (Sudafed)
SE: retention, +BP, +HR, anxiety, insomnia, drowsiness
0 use if pt has BPH

63
Q

Mixed UI

A

To contract bladder and decrease bladder irritability

Imipramine (antidepressant) alpha adrenergic agonist and anticholinergic

64
Q

5 Alpha Reductase Inhibitor

A

Treats enlarged prostate

Proscar or Avodart

NURS 523: Bowel and Bladder Continence (3 decks)

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