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Year 2: Neuromuscular II > Test 1: Bowel, Bladder, and Sexual Function > Flashcards

Test 1: Bowel, Bladder, and Sexual Function Flashcards

1
Q

types of bladder management strategies

A

depends if LMN or UMN

indwelling cath
intermittent cath
condom drainage
suprapubic cystostomy
reflex voiding
bladder augmentation

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2
Q

bladder management: LMN vs UMN

A

UMN (above T12) = reflex operated;
- micturition reflex: bladder fills because of stretch, when stretched the detrusor mm contracts which opens the internal sphincter and inhibits the external sphincter

LMN = areflexive; will leak and requires a leg bag

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3
Q

bladder complications

A

urinary retention
bladder overdistension
urinary reflux into ureter
UTI
kidney and bladder stones

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4
Q

when to use an indwelling foley and how to manage/ what are the risk

A

indicated if pt is unable to self cath (no hand function) and with LMN injuries

risk = high rate of UTIs

management = need to change monthly and needs to be kept clean

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5
Q

why is it important to consider post spinal shock when working with bladder management

A

recommend urodynamic testing with urologist around 3 months to see what works

sacral sparing (UMN) = presence of bulbocavernous reflex/anal wink

flaccidity/gravity = LMN

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6
Q

when is intermittent catheterization recommended and what are the risks/management requirements

A

indications = aesthetics and lower infection rates

risks = infection; in clean IC there is reuse of catheters; need to make sure everything is clean

managemetn = need hand function or tenodesis at least with adaptive equipment; must do it every 4-6 hours; positioning is important

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7
Q

positioning for intermittent cath in females

A

must assume reclined position to access urethra

good justification for letters of medical necessity for power seating functions

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8
Q

indications, risks, and management of condom cath

A

indications = males only; LMN or UMN; may be used as “just in case” with SCI pts and still intermittent cath

risks = infection (less than indwelling, urinary retention), can get pulled with transfers/clothing management

management = would need to use valsalva or suprapubic management to void

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9
Q

indications, risks, and management of suprapubic cath

A

indications = easier access/management for higher level injuries who have difficulty with self cath

risk = infection

management = change every 4-6 weeks, must keep clean, and can do free drainage or have catheter valve (on/off system)

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10
Q

sympathetic bladder reflex

A

filling/storage

fight/fligh = less likely to have an accident

detrusor mm relaxes, internal AND external urethral sphincter contract

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11
Q

parasympathetic bladder reflex

A

micturition

rest/digest = can use bathroom/be intimate

detrusor mm contracts

internal AND external urethral sphincter relax `

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12
Q

what is the guarding reflex

A

IUS and EUS activation

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13
Q

what is bladder augmentation and why might it be done; risks, management?

A

surgical expansion of bladder mm in setting of mm atrophy

used with atrophy or UMN injuries (to stimulate reflex)

risks = infection due to sx procedure

management = check volumes in addition to other bladder management strategies

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14
Q

stats of UTI in pts who need bladder management

A

frequently occur in hospitals

one of the leading causes of bloodstream infections in SCI

least likely to occur with IC

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15
Q

incidence of pts who need bowel care/its impact

A

98% SCI pts have bowel program

34% require assistance

one of largest impacts on QOL

sphincters controlled by pudendal nn

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16
Q

risks of improper bowel management

A

constipation
abdominal pain
small bowel obstruction
bowel incontinence
bowel rupture/infection/sepsis
AD in pts T6 and up

17
Q

UMN bowel program vs LMN

A

UMN
- mediated via pudendal n

  • pts may discover bulbocavernosus reflex to help determine how to address bowel plan
  • defecation reflex

LMN
-based on timing and diet

18
Q

how does an UMN bowel program work

A

indicated if injury above cauda equine BCR reflex present

  1. use suppositoty to get stool moving
  2. digital stimilation to stimulate BCR reflex
    - genital/anal stim sends reflex loop to SC to open sphincter
    - circular motion to elicit a void

usually done 1x/day in AM or PM

takes up to an hour

best to keep timing consistent so body adjusts

19
Q

how does LMN bowel program work

A

indicated with cauda equina injuries and LMN presentations

no reflex activity so cannot use BCR

sphincter is flaccid so stool will flow with gravity or increased abdominal pressure

30-40 min after major meals

diet = need fiber and fluid balance to create optimal stool firmness

evacuation = valsalva or manual evacuation

20
Q

when is a colostomy indicated and how does management of this work

A

indicated to save time, QOL, or if pt has difficulty with hand function for bowel program

risks = infection/aesthetics

management
- last resort
- studies suggest increased QOL due to decreased time for bowel program and decreased hospitalizations for bowel problems

2016- 2.4% SCI pts had colostomies

21
Q

equipment needed for bowel programs

A

suppositories (LMN)
lubricant
gloves
orthotic stimulation device/U cuff (UMN)
ways to increase abdominal pressure
pads

usually done in bed/padded commode with cut out

22
Q

bowel program impact on daily life

A

takes up to an hour

LMN - high risk for accidents throughout day, especially if eating upright

LMN programs often BID

UMN may be morning or night

LMN is after eating so may impact desire to eat in public

23
Q

how does erectile capacity differ between UMN vs LMN and complete vs incomplete injury in males

A

greater capacity in UMN and incomplete

24
Q

how does ejaculation capacity differ between LMN vs UMN and complete vs incomplete injury in males

A

LMN = 15%, UMN = 5%

incomplete more likely than complete

25
Q

how does a reflex control erection in males

A

external stimulation of genital or perineum results in reflex loop mediated through S2-S4 resulting in an erection

26
Q

how does a psychogenic erection occur

A

in LMN pts

due to areflexia

cognitively controlled through activity such as fantasy

message goes from cortex to sympathetics in thoracolumbar region

27
Q

medical options for increasing erectile capacity following SCI

A

viagra, levitra, and cialis

injectable meds

topical agents

mechanical devices

28
Q

how does reflexogenic sexual function work in females with UMN injuries

A

stimulation of perineum region will result in reflex loop that causes:
- caginal lubrication
- engorgement of labia
- clitoral erection

UMN women will lose ability for psychogenic responses

29
Q

how does a psychogenic response work with females with LMN injuries

A

using cortical center and thoracolumbar sympathetics for a response

reflexogenic response will be lost with LMN

30
Q

stats in regard to reproductive health in males with SCI

A

decreased rates of
- fertility
- semen production
- viability of sperm

lower odds of reproducing

testicular atrophy

increased difficulty with ejaculation

31
Q

reproductive health stats for women following SCI

A

menstrual cycle interrupted 5-12 months initially post injury

difficulty in this time frame to conceive but past this relatively minimal change compared to baseline

32
Q

pregnancy with SCI patients have higher risk of

A

AD
DVT
UTIs
PE
anemia
respiratory compromise
increased spasticity (in UMN)

33
Q

how does labor and delivery work with SCI pts

A

can carry full term/have vaginal birth (OB can use forceps or vaccum if they cannot push)

C section still an option but not automatic

higher risk for AD T6 and above

need to closely monitor BP

some may not be able to feel labor so they need to understand the S&S besides pain to recognize

positioning and prevention of secondary complications will matter

have to have a safe way to transfer to be positioned

34
Q

postpartum management of SCI pts

A

can breastfeed but most do not

may require PT

may have postpartum depression

may need assistance holding baby if UEs are affected

Year 2: Neuromuscular II (18 decks)

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