Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS 523: Bowel and Bladder Continence > Urinary Incontinence > Flashcards

Urinary Incontinence Flashcards

1
Q

UI and OAB: Age

A

+ w/ age
Relaxation of pelvic floor = prolapse female pelvic organs
Stress incontinence age 45 - 54
UI age 35 - 64

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

UI and OAB: Race

A

White = shorter urethra, weak pelvic floor muscle, lower bladder neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

UI and OAB: Pregnancy/childbirth

A

Perineal trauma = partially reversible pudendal/pelvic nerve damage
Vag delivery = relaxation/lengthening of pelvic floor muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

UI and OAB: Menopause/estrogen depletion

A
  • estrogen = - urethral mucosa vascularity/thickness
    Estrogen receptors in urethra, bladder, pelvic floor muscle
  • ability to maintain seal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

UI and OAB: Pelvic/prostate surgery

A

40% UI increase w/ uterus removal

Loss of structural support, urethral scarring, pelvic nerve disruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

UI and OAB: Smoking

A

Nicotine contracts bladder

Coughing = pressure + on bladder/urethra, damage to urethral/vag support, perineal nerve damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

UI and OAB: Obesity

A

+ pressure on bladder
+ urethral mobility
Impairs blood flow and innervation to bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

UI and OAB: High-impact activities

A

Inadequate ABD pressure, pelvic floor muscle fatigue, connective tissue/collagen changes to pelvic floor muscles
Jumping, landings, dismounts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

UI and OAB: Medications

A

Diuretics impacts bladder filling/emptying
Anticholinergics: retention, impaction
Antidepressants: retention, impaction, sedation
CNS depressants: muscle relaxation, immobility, delerium
Narcotics: retention, fecal impaction, sedation, delerium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Voiding diary

A 
Keep for 3-day period
# voids, time interval, fluid intake, urine volume, incontinence episodes, associated activities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

UI: Neurological exam

A

Lower extremities and perineum
Normal/equal strength
Deep tendon reflexes assess lumbosacral spinal cord
Sharp/dull sensation around thighs = lower micturition center intact
Anal wink

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

UI: gynecologic exam

A
  • estrogen = cherry red urethra/pale, smooth dry vag mucosa
    Infection = afferent sensation of urethra = freq, urgency, dysuria
    Cystocele, rectocele, enterocele, prolapse
    Assess muscle for strength/endurance
    Use of accessory muscles
    Spasm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Postvoid Residual (PVR)

A

-50mL = normal

+ due to infection, mechanical obstruction, neuro factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pelvic floor muscle rehab

A

Kegel
Ideal for pt w/ stress incontinence
Weighted vag cones for proprioreceptive biofeedback

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Urge/Overactive Bladder

A

Involuntary bladder contractions = bladder pressure exceeds urethral pressure
Unstable bladder or detrusor instability 2nd to CNS disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Overflow Incontinence

A

Hypotonic or acontractile detrusor, urethral obstruction
2nd to diabetic bladder, neuropathy, SCI
sx: palpable bladder, + PVR, interrupted urinary flow, continual leakage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Dietary modifications for Urinary Continence

A 
Alcohol
Citrus
Spices
Carbonation
Sugar
Honey
Milk
Corn syrup
Tea
Coffee (even decaf)
Artificial sweetener
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Goals for controlled voiding

A
    • bladder spasm and exposure to irritants
    • sphincter function and coaptation
    • pelvic floor muscle support/function
    • bladder outlet obstruction
    • bladder tone/contractility
  6. Modify environment
  7. Facilitate complete voiding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q
    • bladder spasm and irritants: UTI
A

Dip-stick check of clean catch urine
Bacteria or WBC = double check for accuracy
Epithelial cells = specimen contamination
+ result = urine culture and antibiotics
Consult for bladder cancer rule out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q
    • bladder spasm and irritants: Fluid
A

Concentrated urine = urgency, freq, urge incontinence
- fluid = + UTI risk
Maintain bladder capacity to prevent deconditioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q
    • bladder spasm and irritants: Urge
A

Urge Suppression

  1. Stop and stand
  2. Squeeze/relax pelvic muscles 5x
  3. Concentrate on urge suppression
  4. Distraction
  5. Allow urge to dissipate
  6. Urinate when bladder calm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q
    • bladder spasm and irritants: Bladder retraining
A

Treats urgency and frequency
Best for mild/moderate urge, stress/mixed incontinence
Strengthens brain’s control over urinary tract
Void on schedule
Clean/compliant rectum needed
Keep treatment log to record each void

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q
    • sphincter function/coaptation: Bowel Management
A

Constipation = pressure on urethra = urine obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q
    • bladder spasm and irritants: Meds
A

Not 1st line
Anticholinergics/Antimuscarinics/Beta-3 Adrenergic Agonits
I. Tolterodine (Detrol)
II. Oxybutynin (Ditropan)
III. (Sanctura, Vesicare, Enablex, Toviaz)
IV. Mirabegron (Myrbetriq)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q
    • sphincter function/coaptation: Bulking Injections
A

Nonimmunogenic, hypoallergenic agent injected into periurethral space
+ urethral resistance by creating cushions to - lumen size
Product degrades w/i 2 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q
    • sphincter function/coaptation: Meds
A
  • meds that relax bladder neck (alpha adrenergic antagonists)
    + meds that tighten bladder neck (alpha adrenergic agonists): estrogen, tricyclics, Duloxetine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q
    • sphincter function/coaptation: Occlusion
A

Female: tampon-like w/ balloon, inserted in urethra
Male: Compress soft penile tissue (clamp/cuff), caution for ischemia, remove Q3hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q
    • pelvic floor muscle support/function: PME
A

Pelvic Muscle Exercise for stress, urge, mixed UI
Assess sensation (vag, perineal, rectal), anal wink
Assess vag mucosa
Assess resting tone of bag and rectum
Strength of contraction
Educate pt on IDing pelvic floor muscles
Goal: 10 second contract/relax phase (6-12 wks to accomplish)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q
    • pelvic floor muscle support/function: Electrical Stimulation
A

Pts w/ stress/urge/mixed UI or freq, painful bladder
Electrodes stimulate afferent pudendal nerve fibers = reflex
Contraction of smooth and striated muscles in urethra and pelvic floor, reflex inhibition of detrusor
Must have intact sacral autonomic/somatic nerve pathways
High freq (50-100Hz) for stress incontinence, stimulate fast-twitch/slow-twitch fibers
Low freq (10-20Hz) for urge incontinence/OAB = reflex inhibition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q
    • pelvic floor muscle support/function: PTNS
A

Posterior Tibial Nerve Stimulation
For urge incontinence or OAB if failed 2 trial meds
Stainless steel needle inserted 5cm above medial malleolus
Electrical impulse for 30 min/week to 12 weeks
Calms detrusor instability
May be done for 2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q
    • pelvic floor muscle support/function: Vag cones
A

Assist to strengthen pelvic muscle

Attempt to retain weight for 15 min while walking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q
    • pelvic floor muscle support/function: KNACK
A

Purposeful voluntary contraction of pelvic muscles PRIOR to + abd presure (cough, sneeze, lifting)
Teach sustained contraction during routine activities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q
    • pelvic floor muscle support/function: Magnetic
A

Extracorporeal Magnetic Innervation Therapy
Pelvic floor strengthening
Magnet activated = induces electrical depolarization of nerves/muscles in magnetic field
Strong contraction of pelvic muscles
Non-invasive
Pt sits on chair, fully clothed
2x/week for 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q
    • pelvic floor muscle support/function: Surgery
A

Repair of prolapse
Prerequisite: urodynamic testing to confirm urethral hypermobility present and UI not due to Type III SUI
Type II/III SUI: surgery only once less invasive interventions used
All procedures to - SUI must + urethral resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Surgery: Retropubic suspension

A

Marshall Marchetti Krantz

Elevate lower urinary tract (especially urethrovesical junction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Surgery: Needle Bladder Neck Suspension

A

Stamey or Raz procedure

Tissue adjacent to urethral and bladder neck supported w/ sutures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Surgery: Anterior Vag Repair

A

Not used for SUI alone
Dissect anterior vag wall from bladder base and urethra , secure to pubocervical fascia
+ complication rate
Also used to repair cyctocele

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Surgery: Sling Procedure

A

1st line w/ intrinsic sphincter deficiency AND hyper mobility
Strips of autologous fascia or synthetic material placed under urethra and anchored to retropubic or and structures to elevate urethra
Abdominal or bag approach or combination
TVT (tension-free vagina) preferred method 2nd - complications (transient retention, bladder perforation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q
    • bladder outlet obstruction: Pessaries
A

Non-surgical management of prolapse or SUI

Self-clean or clinic removal monthly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q
    • bladder outlet obstruction: Meds
A
  • urethral resistance (alpha adrenergic antagonist) used for BPH, incomplete emptying, detrusor sphincter dyssynergia, or prevent autonomic dysreflexia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q
    • bladder tone/contractility: Meds
A

Alpha adrenergic agonist (sudafed) + smooth muscle tone
Use in SUI
Side effects limit use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q
  1. Facilitate complete voiding: Toileting Programs
A

Pts physically/cognitively impaired = dependent continence

Voiding set at fixed times or voiding patterns and ability to participate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Habit Training/Individualized Scheduled Toileting (IST)

A 
Pt w/ moderate cognitive impairment but cooperative
Modified voiding diary kept for 3 days
Pt checked Q1-2 hrs, record wet or dry
Track incontinent episodes
Fluid management
Maintain stable voiding pattern
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Routine Scheduled Training (RST)

A 
Timed/habit voiding
Toileting on fixed schedule
Pt cognitively impaired, unable to ID need to void, lacks motivation
Common at long-term care facilities
Useful when staffing limited
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Prompted Voiding

A

Pt w/ mild/moderate cognitive impairment, able to follow directions, recognizes urge to void
Must be safe to transfer w/ 1 person
Goals: 1. + ability to respond to urge
2. + self-initiating toileting
Pt will relearn appropriate response to full bladder
ID pts normal voiding pattern and prompt voiding
Desired behavior praised
Undesired behavior not reinforced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Double Voiding

A

Mild cases of retention and overflow
Pt voids and rests while on toilet, 2nd void after 1-2 min
Pt has diabetes or MS w/ large post-void residual

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Clean Intermittent Cath (CIC)

A

Maintain cath volumes at 400cc
If pt voids incompletely, cath at bedtime
If 0 voiding, cath 4-6x/day
Reuse cath for 7-10 days
Wash cath w/ soap while wash hands for 10 sec
Airdry cath on paper towel
Store in plastic bag

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Indwelling Cath

A

Broad spectrum antibiotics given prior to insertion
Instill male w/ 10mL anesthetic 3-5 min prior
Large 18 Fr cath in males
Monitor for vasovagal response (sweat, pallor)
All indwelling caths 100% colonized by 30 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Urinary Diversion or Bladder Augmentation

A

Pts w/ reflex incontinence and neurogenic bladder
Preserve upper tract (kidneys)
Neuro bladder = risk for upper urinary tract distress and kidney damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Bladder Augmentation

A

Dome of bladder split and detubularized bowel segment anastomosed like patch over opening
Interrupts spastic detrusor contractions
- risk of reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Urinary Diversion

A

Continent or incontinent
Continent if bladder removed and new bladder created
Incontinent = ileal or sigmoid conduit

52
Q

Artificial Urinary Sphincter

A

Small balloon reservoir for fluid, small pump, inflatable cuff
Cuff fits around bladder neck to act as sphincter
Pump used to deflate cuff to void
Pump placed in scrotum or labia
Postop problems: infection, erosion, mechanical malfunction
Common in males post prostatectomy

53
Q

Attaining Bladder Continence

A

Infancy - 1y: 20 voids/day

2-3 yrs: aware on need to void and briefly delay

54
Q

Bladder Control Development

A

Capacity (up to 12 yrs: capacity in ounces = age + 2)
Muscle control: By age 3
Micturition reflex control: initiate or inhibit bladder contraction

55
Q

Posterior Urethral Valves

A

Abnormal membrane w/i male posterior urethra = obstruction

56
Q

Main Causes of UI in children

A

Congenital abnormalities
Abnormal neurologic pathways
Developmental issues (functional incontinence)

57
Q

Prune Belly System

A

0 abd musculature
Expanded bladder
Upper tract issues
Incomplete emptying = bladder, kidney, ureter impairment

58
Q

Bladder Exstrophy

A

Failure of bladder wall to close
Bladder externalized
Seen w. pelvic diastasis (widening/separation)
Penis shortened w/ 0 urethral meatus

59
Q

Non-neurogenic Functional Incontinence in Peds

A 
Daytime incontinence, poor stream, encopresis, UTI
0 neurologic impairment
Urodynamics to determine pattern:
Small capacity hypertonic bladder
Detrusor hyperreflexia
Lazy Bladder Syndrome
Hinman Syndrome
60
Q

Abnormal Neuro Pathways is Peds

A

Spinal cord trauma

Neural tube defects (myelomeningocele, Sacral agenesis)

61
Q

Nocturnal Enuresis

A 
Primary - Nocturnal bedwetting in kid never dry at night
Secondary - Wet after dry for 6mo
More common in boys
Daytime more common in girls
More common if parents suffered
More common in poor, large families
2nd to maturational lag
62
Q

Small Capacity Hypertonic Bladder

A

Bladder wall inflamed w/ sensory threshold altered = sense full bladder at - volume
Delay void 2nd to pain or inappropriate setting
Unstable contractions at low volume
Prolonged contraction of sphincter = outlet obstruction and incomplete emptying

63
Q

Detrusor Hyperreflexia

A

Freq, urgency, sudden incontinence, nocturnal enuresis
Unstable detrusor contractions = pelvic floor/sphincter contractions
Leakage, incomplete emptying 2nd to bladder contracting against closed sphincter
Risk for dilation of ureters and recurrent UTIs

64
Q

Lazy Bladder Syndrome

A

Infreq voiding (2x/day) 2nd to aversion to public WC or episode of dysuria
Incomplete voiding
Strain and + and pressure to void
Detrusor contractions min or 0
Large compliant bladder w/ large PVR and freq UTI
Chronic constipation or encopresis

65
Q

Himan Syndrome

A

AKA non-neurogenic bladder
All features of neurogenic bladder but 0 lesion
Most severe of dysfunctional voiding disorders
Dyssynergic bladder-sphincter activity
Elevated PVRs, UTIs, vesicoureteral reflux and upper tract damage

66
Q

Neurogenic Bladder

A

Lesion at any level of nervous system
Lack of coordination btwn detrusor contraction and sphincter relaxation (dyssynergia)
UTI (2nd bladder spasms)
Upper tract deterioration (2nd to reflux and functional outlet obstruction)
Preserve upper tract (Intermittent cath, oxybutin, bladder augmentation, artificial urinary sphincter)

67
Q

Dysfunctional Voiding in Peds

A

Lacks awareness of bladder filling/need to void
Urgency, incontinence
- sensation of fullness
Dysfunctional voiding postures (squeeze penis, fingers against urethra w/ heel against perineum, kneeling)
Constipation
- or + voiding, UTIs

68
Q

Dysfunctional Voiding Assessment in Peds

A

UA and urine culture
BUN and creatinine tests
0 urodynamic studies unless SCI, neural tube defects, congenital abnormalities, freq UTI

69
Q

UTIs in Peds

A

Fever w/o cause or recurrent abd pain
+ treatment 2nd to risk for renal scarring/hydronephrosis
Urine specimen and culture w/ suspected UTI
Reculture 3 days post-antibiotic start, after antibiotics finished, 1 month after antibiotics finished

70
Q

Red Flags in Peds History and Exam

A

Masses (retained stool/bladder distention)
+ daytime incontinence
Spinal anomalies
Abnormal neuro findings (- reflexes/sensation, altered gait)
- urinary stream
UTI

71
Q

UTI Risk Factors in Peds

A 
Vesicoureteral reflux (VUR)
Urinary tract obstruction (stones, strictures, PUV)
Renal malformation (polycystic kidney disease, dysplasia)
Non-circumcised
Defer urination/defecation 
Poor hygiene
Catheterization
Pinworms
72
Q

Voiding Cystourethrogram (VCUG)

A 
Kids - 16 yrs w:
UTI
Male
Girls +5yrs w/ pyelonephritis
Recurrent UTI
Unresponsive to antibiotics
73
Q

Management of Enuresis: Environ/Behavior Modifications

A 
Self-awakening at night
Enuresis alarms (for 3-4 mo in kids 8+ yrs)
Counseling responsibility
Reward system
Urge inhibition and bladder retraining
74
Q

Enuresis Meds: Imipramine

A

+ bladder capacity/control if behavioral interventions insufficient
Anticholinergic to relax bladder
Adrenergic to strengthen sphincters
Monitor serum levels - lethal at low doses

75
Q

Enuresis Meds: Desmopressin accetate (DDAVP)

A
  • nocturnal urine production by + H2O reabsorption and urine concentration in distal tubules
    Nasal spray or PO
    Rare adverse effects: epistaxis, nostril pain, nasal congestion, headache, water intoxication, seizures
    Check electrolytes after 1st week of treatment
76
Q

Stress, Urge, Mixed UI

A

80-90% all UI cases
Typically respond to 1st line treatment
0 threat to upper tract damage (hydronephrosis)

77
Q

Q-Tip Test

A

ID urethral hypermobility (causative factor in SUI)
Sterile q-tip placed 2cm into urethra
Pt bears down/valsalva
Upward movement +30 = + test = bladder neck movement

78
Q

Cough Test (Provocative Maneuvers)

A

Reproduce symptoms or leakage w/ exertion
Have pt cough and observe for leakage
If 0, repeat after pelvic exam
If loss delayed or large = overactive or urge UI

79
Q

Pad Testing/Paper Towel Test

A

Pad: Weigh pt pad after exertion
Paper Towel: Hold towel against perineum while coughing, repeat test w/ contraction of pelvic muscles before coughing, compare wet spot size, smaller = need for pelvic muscle re-education

80
Q

Phimosis

A

Difficulty retracting or restoring foreskin

81
Q

Urine Analysis

A 
Blood
Glucose
WBC
Protein
RBC
Nitrates for bacteria
Urine culture if WBCs or bacteria present
82
Q

Post-Void Residual

A

Deliniate btwn overflow UI and OAB/urge UI
Pt w/ difficulty voiding, neuro problems
Obtain w/i 5 min of voiding
Normal = -50cc
Repeat = 100 - 200cc
Investigate = +250
PVRs +25% of total capacity = need for evaluation

83
Q

Stress Urinary Incontinence (SUI)

A

Leakage w/ activity not associated w/ urgency
Immediate leakage w/ coughing
Positive pad test
Variable contractility and endurance of pelvic muscles
Vaginal deliveries
Hysterectomy
Pelvic surgery

84
Q

OAB/Urge UI

A

Urgency, frequency, nocturia
Small void volumes
Urgency/leakage 2nd to stimuli (running H2O)

85
Q

Blood Tests

A

BUN and Creatinine for renal function
Pt w/ +150cc PVR or w/ cystocele
Pt w/ upper urinary tract involvement

86
Q

Ultrasonography

A

Evaluates hydronephrosis, renal masses, filling defects

Displays image for eval of GU tract

87
Q

Plain Film of Kidneys, Ureters, Bladder (KUB)

A

Evaluates soft tissue, skeletal structures, calculi, calcification

88
Q

Intravenous Pyelography (IVP)

A

IV administration of contrast dye
Reveals kidneys, ureters, bladder abnormalities
Localizes renal masses, hydronephrosis

89
Q

Cystoscopy

A

Evaluation of bladder via scope
Use for pain w/ filling, hypermobility w/ straining, urinary obstruction, total incontinence 2nd to open proximal urethra
Required for pt w/ hematuria or RBC on UA
Rule out bladder or urethral pathology

90
Q

Radiography (VCUG) Voiding Cystourethrography

A

Info re anatomy of bladder, antegrade voiding, integrity of ureterovesical valve mechanism
Bladder filled w/ radiographic contrast while pt stands, strains, coughs, voids
Info re reflux into ureters, urethra diverticula
Will demonstrate PVR and anatomical changes
Bladder neck opens w/ contraction, may look like contraction = need cath placed during study
VCUG + measurement of bladder pressure = video urodynamic

91
Q

Urodynamics

A

Tests evaluating bladder filling/storage and elimination
Must be done prior to surgery for SUI (IDs cause)
If conservative treatment fails
Voiding issues: blockage, +PVR
For pt w/ any neuro disease

92
Q

Simple Urodynamics

A

Observation of voiding: hesitancy, straining, - stream

Listen as pt voids

93
Q

Bedside Cystometrogram (CMG)

A

Crude type of CMG
Detects bladder capacity/involuntary detrusor contractions
1. Indwelling cath placed
2. Toomey syringe placed on end of cath and held above symphysis pubis
3. Bladder slowly filled w/ sterile H2O
4. Monitor for fluid level - should remain consistent w/ filling
Rise in fluid level of syringe = low bladder wall compliance
Pt reports urge to void
Dramatic rise in syringe = bladder or detrusor contraction

94
Q

Overflow Urodynamics

A

Invasive test
Measures flow rate while pt voids into uroflow device
Assess bladder capacity, quality of stream, intermittency

95
Q

Cystogram (CMG)

A

Assess bladder/urethral anatomy
Localizes where leakage occurs
Records pressure w/i bladder while filling at set rate (40-60mL/min)
Document volumes triggering detrusor contractions/urge to void

96
Q

Sympathetic NS and Urination

A 
T10-L2 via hypogastric nerve plexus
Bladder relaxation/proximal sphincter contraction
Beta: bladder relaxation
Alpha: Sphincter contraction
Neurotransmitter: Norepinephrine
97
Q

Parasympathetic NS and Urination

A

S2-S4 via pelvic nerve plexus
Bladder contraction/sphincter relaxation
Cholinergic receptor sites: muscarinic receptors
Neurotransmitter: Acetylcholine

98
Q

Pudendal Nerve

A

Voluntary contraction of distal 2/3 urethral sphincter and pelvic floor nerves S2-S4
Sends/receives messages to diaphragm

99
Q

Somatic Nerve System Neurotransmitters

A

Glutamine
Activates “on/off” switch promoting sphincter closure or inhibiting (ON) contraction to produce opening of urethra (OFF)
Activates 2 additional neurotransmitters at Onuf’s nucleus to promote contraction of pelvic muscle and rhabdosphincter (norepinephrine, serotonin)

100
Q

Good Urinary Control

A

Coordinated bladder contraction/sphincter relaxation
Bladder able to hold 10-12 oz urine
Sphincter able to close tightly even if + abd pressure

101
Q

Genuine Stress Incontinence

A

Type 1 or Type 2 SUI (determined by pelvic support)
Weak pelvic floor muscles (levator ani)
Lack of support for bladder/urethra = Urethral Hypermobility (bladder neck displaced)

102
Q

Intrinsic Sphincter Dysfunction (ISD)

A

Type 3 SUI

Failure of sphincter to close to H2O tight seal (coaptation)

103
Q

Risk Factors for SUI

A 
Childbirth
Obesity
Pelvic relaxation/prolapse
Hysterectomy
- Estrogen (menopause)
Age
Chronic straining
Smoking
Sacral lesions (below S2)
Trauma
Radical prostatectomy
Autonomic neuropathy
Pelvic surgery
104
Q

Genuine SUI (Type 3): Behavioral Treatment

A

PME/KNACK are 1st line
Biofeedback assisted PME (weighted cones)
Electrical Stimulation
Extracorporeal electromagnetic therapy

105
Q

Genuine SUI (Type 3): Devices

A

Pessary
Urethral occlusion insert
Penile clamp

106
Q

Genuine SUI (Type 3): Surgery

A

Tension-free Vaginal Taping (TVT)
Retropubic Suspension
Needle bladder neck suspension
Anterior vaginal repair (poor results)

107
Q

Intrinsic Sphincter Dysfunction (type 3): Treatment

A

Periurethral bulking injection of collagen
Sling procedure
Artificial urinary sphincter

108
Q

Stress Incontinence Medications

A

Alpha-adrenergic agonists (pseudofedrine, ephedrine)
Tricyclics (imipramine, useful for mixed UI)
Estrogen cream/ring (0 effectiveness in SUI alone)
Drug therapy - use 2nd to side effects/limited efficacy = adjunct to behavioral therapy

109
Q

Urge Incontinence Causes: Sensory

A

Abnormal sensitivity to bladder filling
Freq/small amounts voided
Normal detrusor muscle function
Defective CNS

110
Q

Urge Incontinence Causes: Motor

A

Overactivity of detrusor
Stimulated by cold, running H2O
Low/moderate volume of urine AKA detrusor instability

111
Q

Detrusor Hyperactivity w/ Impaired Contractility (DHIC)

A

Elderly

Overactive bladder w/ incomplete emptying

112
Q

Urge Incontinence DHIC: Extrinsic Factors

A 
Reversible
Dietary irritants
Infection
Stones
Constipation/Impaction
BPH
Meds (methotrexate, diuretics)
Atrophic vaginitis 
Cystocele
Tumors
DM
CVA
MS
Parkinson's
113
Q

Urge Incontinence DHIC: Intrinsic Factors

A

Idiopathic
Detrusor becomes less stable
Changes in normal cell junctions

114
Q

Urge Incontinence: Treatment

A 
1st correct reversible causes
DIAPPERS
Treat UTI
Eliminate dietary irritants/H2O +
Review contributing meds
Modify clothing/environment
115
Q

Urge Incontinence: Behavioral Management

A

1st: urge suppression/bladder training w/ dietary changes
Biofeedback to + pelvic floor muscles
Electrical stimulation/PtnS for refractory OAB
Routine scheduled toileting

116
Q

Urge Incontinence: Meds

A

Anticholinergic/antimuscarinic
Beta-3 adrenergic agonist
Estrogen cream or ring topically if atrophic/menopause

117
Q

Mixed Incontinence (Urge/Stress): Meds

A

Imipramine (tofranil)

118
Q

Overflow (Retention) Incontinence: Causes

A
  1. Contractile dysfunction (underactive/hypotonic/atonic bladder)
    r/t: neuro bladder: transient from anesthesia/narcotics; diabetic neuropathy; low SCI; MS
  2. Obstructed urinary outflow (BPH)
    r/t: obstruction 2nd to enlarged prostate, pelvic neoplasm/prolapse; impaction; urethral stricture; post surgery
119
Q

Overflow (Retention) Incontinence: Treatment

A

1st clean intermittent cath to + drainage
Assistive voiding (abd straining)
Intermittent self-cath (14-6hrs) to keep residual -400mL
Surgical: TURP, pessary (prolapse), bowel program (impaction), indwelling cath or urostomy (last resort)

120
Q

Overflow (Retention) Incontinence: Meds

A

Alpha-adrenergic antagonist to relax bladder neck (Tamulosin/Flomax, Doxazosin/Cardura)
Finasteride to - prostate size (if +40 g)
Cholinergic agonist if contractile dysfunction (- efficiency)

121
Q

Reflex Incontinence

A

Subset of UI
Uncontrolled urine loss 2nd to neurogenic disorders/detrusor hyperreflexia (bladder spasm)
Leakage w/o desire to urinate
Unconscious UI: - or 0 sensory awareness

122
Q

Reflex Incontinence: Complications

A
  1. Detrusor sphincter dyssynergia (DSD): complication of detrusor hyperreflexia
    Bladder/sphincter contract at same time = + bladder pressure/reflux = upper tract deterioration
    - coordination btwn striated sphincter and detrusor
  2. Autonomic Dysreflexia (AD): extreme stimulation of autonomic system (overextended bladder, kinked foley)
    Dangerous +B/P, sweating, headache
    SCI at T6 or higher
    tx: stop stimuli, semi-fowler, meds
123
Q

Reflex Incontinence: Causes

A 
Spinal cord lesion C2-S1
r/t: invertebral disc disease
spinal stenosis
cervical spondylosis
MS
spina bifida
SCI
CP
Lupus
Guillain Barre
124
Q

Reflex Incontinence: Treatment

A

External urine containment
For DSD: clean intermittent cath 1st + meds, sphincterectomy
Surgery for + pressure bladder to preserve upper tract (continent urinary diversion, ileal conduit, bladder augmentation)
Follow-up w/ urology annually

125
Q

Reflex Incontinence: Meds

A

Alpha adrenergic antagonists

Add anticholinergic to - bladder spasms when intermittent cath is the treatment

126
Q

Urge Incontinence: Description

A

Strong urge to void
8+x/day
2+x/night

NURS 523: Bowel and Bladder Continence (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions