Voiding Dysfunctions renal 2 a

Question 1

VOIDING

DYSFUNCTIONS

Answer 1

Urinary Incontinence
Urinary Retention
Urinary Catheterisation

Question 2

Bladder Emptying

Answer 2

• Otherwise known as voiding,
micturition, or urination.
• Controlled by muscles and nerves.
• Learned behaviour - not present at
birth.
• Muscle and nerve control

Question 3

Adult Dysfunctional Voiding Patterns:

Answer 3

• Urinary incontinence

* Urine retention I

Question 4

Urinary Incontinence (UI)

Answer 4

“Involuntary uncontrolled leakage of urine”

Question 5

UI is normal in infants

Answer 5

• Reflex voiding occurs when bladder stretch receptors are activated.
• Internal sphincter prevents dribbling of urine between voids as it does in adults

Question 6

Urinary Incontinence (UI) occurs

Answer 6

“UI occurs when bladder pressure
exceeds urethral closure pressure.
Anything that interferes with bladder or
urethral sphincter control can result in
UI.”

Question 7

Causes of Urinary Incontinence (UI)

Answer 7

• Emotional problems
• Physical pressure during and after
pregnancy
• Surgery
• Nervous system problems
• Medical conditions
• Not a natural consequence of ageing

Question 8

Causes can include

DRIP

Answer 8

D delirium, dehydration, depression
R restricted mobility, rectal impaction
I infection, inflammation,
P polyuria, polypharmacy
(

Question 9

Types of Urinary Incontinence (UI)

Answer 9

Stress incontinence
• Urge incontinence
• Overflow incontinence
• Reflex incontinence
• Functional incontinence

Question 10

Interventions for Urinary Incontinence (UI)

Answer 10

Lifestyle modifications - including fluid management, good bowel
regimen, weight reduction, quit smoking
• Scheduled voiding regimens
• Pelvic floor muscle rehabilitation – exercises, vaginal muscle training,
biofeedback, electrical stimulation
• Anti-incontinence devices
• Containment devices
• Pharmacological therapy
• Surgical therapy

Question 11

Pelvic floor muscle (Kegel) exercises

Answer 11

• Pelvic floor muscles provide support for bladder and rectum
• Pelvic floor exercises:
• Otherwise known as Kegel exercises
• Series of exercises designed to build up muscles of pelvic floor
• Can be done anytime, anywhere

Question 12

• Exercises consist of:

Answer 12

“Squeeze and lift” of pelvic floor muscles (hold for 8 seconds) then “let go”
ØRest for about 8 seconds between exercises
ØRepeat up to 8 – 12 times
ØPlan to do training 3 times a day

Question 13

UI Pharmacological Therapy

Answer 13

Muscarinic receptor antagonist and
anticholinergic
a-adrenergic antagonists
a-adrenergic agonists

Question 14

Muscarinic receptor antagonist and

anticholinergic

Answer 14

Oxybutynin
• Tolterodine
Reduce overactive bladder contractions in urge urinary
incontinence and overactive bladde

Question 15

a-adrenergic antagonists

Answer 15

• Alfuzosin
• Terazosin
Reduce urethral sphincter resistance to urinary outflow

Question 16

a-adrenergic agonists

Answer 16

• Pseudoephedrine

Increase urethral resistance

Question 17

UI Surgical Therapy

Answer 17

Periurethral bulking
• Collagen injection
• Retropubic colposuspension or
pubovaginal slings

Question 18

Urinary retention

Answer 18

Inability of the bladder to empty completely

Question 19

Acute urinary retention

Answer 19

total inability to pass urine (medical emergency)

• e.g. post operative patients

Question 20

Chronic urinary retention

Answer 20

incomplete bladder emptying despite urination

Question 21

Post-void residual (PVR):

Answer 21

amount of urine left in the bladder after voiding (50 – 100mls)

Question 22

Causes include: Urinary retention

Answer 22

§ Bladder outlet obstruction – prostate enlargement
§ Deficient detrusor (bladder muscle) contraction strength – neurological diseases,
diabetes mellitus, over-distention, chronic alcoholism, medications (e.g. anticholinergic
drugs)

Question 23

Urinary retention

The problem – urinary retention can

Answer 23

chronic infection

Question 24

Nursing measures to promote normal urinary elimination

Answer 24

§ Catheterisation

§ Drug therapy (Parasympathomimetic - Bethanecol)

Question 25

Catheterisation can be performed to achieve the following:

§

Answer 25

Assist with postoperative drainage in urological and other surgeries
§ Used to monitor accurate urine output in critically ill patients
§ Promote urinary drainage in patients with neurogenic bladder dysfunction or urine
retention
§ Prevent urinary leakage in patients with stage III to IV pressure ulcers

Question 26

Types of urinary catheters and catheterisation:

Answer 26

Indwelling catheters
§ Suprapubic catheters
§ Intermittent self-catheterisation

Question 27

Nursing care considerations:urinary catheters and catheterisation:

Answer 27

§ Preventing infections
§ Minimising trauma
§ Retraining the bladder after removal of indwelling catheter

Question 28

Types of Urinary

Catheters

Answer 28

A, Simple urethral catheter
B, Mushroom-tip de Pezzer catheter (can be for
suprapubic catheterisation)
C, Wing-tip Malecot catheter. (Malecot wings are
employed to provide enhanced drainage and
promote catheter retention)
D, Indwelling urethral catheter with inflated
balloon
E, Indwelling Tiemann catheter with coudé tipinflated balloon (Tiemann catheter, is angled
upward at the tip to assist in negotiating the
upward bend in the male urethra)
F, Three-way indwelling catheter (third lumen can
be used for irrigation)