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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
Anticholinergics
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
26
Antidepressants
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
Beta-3 Adrenergic Agonist
``` mirabegron (Myrbetriq) Bladder relaxation by stimulating beta-3 receptors Treats urge/OAB Causes retention Side effect: +BP, nasal drip Contraindication: uncontrolled HTM ```
28
Estrogen
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
Posterior Pituitary Agonist
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
5-alpha Reductase Inhibitors
``` finasteride (Proscar) -prostate by inhibiting male hormone DHT Used for prostate +40g Treats overflow UI Side effect: - sexual desire, erectile dysfunction ```
31
ACE Inhibitors
"pril" drugs Causes stress UI Side effect: chronic cough
32
Alcohol
Sedative and diuretic effect
33
Antihistamines
Sudefed +bladder neck contraction Causes overflow UI
34
Antispasmodics
bentyl | Used for IBD, relaxes bladder and facilitates emptying
35
Ca Channel Blocker
diltiazem (Cardizem), nifedipine (Procardia) Relaxes detrusor, +nighttime urine production, constipation Causes retention
36
Skeletal muscle relaxants
baclofen (Lioresal), diazepam (Valium) Relaxes detrusor Causes retention
37
Meds for IAD
Antifungal (Miconazole, nystatin) | Anti-inflammatory (Hydrocortizone)
38
Meds that increase risk of IAD
Antibiotics | Alter function of GI or urinary tract
39
Sympathetic Fibers
T10-L2 Bladder relaxation/bladder neck tighten Promote urine storage Relaxes colon and slows motility
40
Parasympathetic Fibers
Tells bladder to contract | Promotes gut motility
41
Stool Bulking Agents
``` 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
Surfactants (emollients)
(Docosate sodium) - surface tension = + H2O in stool Stool softener Takes several days to be effective
43
Laxatives: Osmotic or saline
``` 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
Laxatives: Stimulant or contact
Stimulates enteric system to + peristalsis Frequently abused (ExLax, Dulcolax, Senokot) Use for slow-transit constipation Senna, Castor Oil, or bisacodyl
45
Laxative Abuse
``` - intrinsic nervous system response to stretch = + reliance on laxatives + risk of electrolyte imbalance, dehydration, colitis Melanosis Coli (dark discoloration of intestinal mucosa) ```
46
Castor Oil
Only contact laxative to work on small bowel
47
Mineral Oil
Mixture of indigestible hydrocarbons Lubrication Side effects: oil aspiration = lipid pneumonia, anal leakage, - absorption of fat soluble vitamins, oil deposit in liver
48
Glycerin
Softens and lubricates stool (osmotic action) Stimulates rectal contraction Works in 30 minutes
49
Iso-osmotic solution
``` 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
Antidiarrheals
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
Sympathetic Nerves Neurotransmitter
``` Adrenaline (norepinephrine) Adrenergic (alpha or beta) T10-L2 Bladder base and neck Hypogastric Nerve ```
52
Parasympathetic Nerves Neurotransmitter
``` Acetylcholine Cholinergic C = contraction and cholinergic S2-S4 Body of bladder Pelvic Nerve ```
53
Somatic Nerve Neurotransmitter
``` Acetylcholine Cholinergic S2-S4 Pelvic muscle Pudendal nerve ```
54
Beta Adrenergic Receptors
Located in bladder wall Receive adrenaline (norepinephrine) from sympathetic Causes detrusor to relax to store urine
55
Alpha Adrenergic Receptors
Located in bladder neck Receive adrenaline (norepinephrine) from sympathetic Stimulates contraction of bladder neck to store urine
56
Pelvic Muscle
Voluntary control Pudendal nerve relaxes/tightens Test integrity w/ anal wink or squeeze during digital exam
57
Cholinergic Receptors
Stimulated by acetylcholine to contract bladder Muscarinic (M2 and M3) receptors in bladder Anticholinergic meds - bladder contraction
58
Alpha Adrenergic Antagonists
"Sin" meds Tamsulosin (Flomax), Doxazosin (Cardura) Improve bladder emptying and reduce blockage SE: Hypotension, dizziness, fatigue, ED
59
Anticholinergic Meds
AKA anti-muscarinic Oxybutynin (Ditropan) SE: dry mouth, constipation, blurred vision, urinary retention, confusion
60
Beta-3 Adrenergic Agonist Meds
Mirabegron (Myrbetriq) | SE: +BP, nasal drip, nasopharyngitis, urinary retention
61
Atrophy of Urogenital Tract
Area sensitive to estrogen +Estrogen = blood flow, moisture, supple tissue - Estrogen = dry/pale vag mucosa sx: urethritits, vaginitis, caruncle, urgency, frequency, UI
62
Alpha Adrenergic Agonist Meds
Cold medicine (Sudafed) SE: retention, +BP, +HR, anxiety, insomnia, drowsiness 0 use if pt has BPH
63
Mixed UI
To contract bladder and decrease bladder irritability | Imipramine (antidepressant) alpha adrenergic agonist and anticholinergic
64
5 Alpha Reductase Inhibitor
Treats enlarged prostate | Proscar or Avodart

NURS 523: Bowel and Bladder Continence (3 decks)

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