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Continence 2.2 > Lesson 4+5: Assessment + Management Of Urinary Incontinence > Flashcards

Lesson 4+5: Assessment + Management Of Urinary Incontinence Flashcards

1
Q

Patient Interview - Chief Complaint

A
  • Type of problem
    — Difficulty emptying?
    — Leakage?
  • Onset, duration, severity
  • Past + present management
  • Impact on lifestyle
  • Goals for treatment
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2
Q

Patient Interview - Lower Urinary Tract Symptoms

A

Storage symptoms
- Frequency
- Urgency
- Nocturia

Incontinence
- Voiding symptoms
- Hesitancy
- Straining
- Weak stream
- Incomplete emptying
- Post-void dribbling

Post-void symptoms
- Post-void dribbling

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3
Q

Patient Interview - Key Questions

A
  • Do you know when you need to urinate?
  • Do you have any problems urinating/emptying your bladder?
  • Do you ever leak urine?
    — If yes, is there any associated strong urge to void?
  • What are your goals for treatment?
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4
Q

History - General

A
  • height and weight
  • recent weight changes
  • alcohol + tobacco use
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5
Q

History - Urology

A
  • recent, recurrent, or severe UTIs
  • prostatic issues
  • bladder or pelvic surgery
  • recent onset sexual dysfunction
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6
Q

History - Gynaecology

A
  • GTPAL
  • Menopausal status
  • Gynecological procedures
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7
Q

History - Neurology

A

CNS processes
- CVA
-MS
- TBI
- Parkinson’s

Spinal Cord Processes
- Spinal cord injury
- Spina bifida
- MS
- Lower back injury

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8
Q

History - Endocrine

A

Diabetic
- Type
- Duration
- Management
- Recent HbA1C

Hypercalcemia

Thyroid disorders

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9
Q

History - GI

A
  • Stool frequency + consistency
  • Problems with bowel control
  • Any fecal incontinence
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10
Q

History - CVS

A
  • Heart failure
  • Use of diuretics
  • Peripheral enema
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11
Q

History - Respiratory

A

Any conditions causing chronic cough

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12
Q

History - Pharmacologic

A
  • all current meds (both Rx and OTC)
  • any herbal supplements
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13
Q

History - Cognitive

A
  • Mini-cog test
  • MMSE
  • Clock drawing test
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14
Q

History - Quality of Life

A

Use of quantified screening tool

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15
Q

History - Environmental/Functional

A
  • Access to toilet facilities
  • Time required to get to toilet
  • Time required to prepare to void
  • Dexterity + clothing
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16
Q

Focused Physical Exam - Abdominal Exam

A
  • Identify bladder distension or colonic distension
  • Inspect for obvious distension
    — Localized vs general
  • Percuss from xiphoid to symphysis
    — Evidence of bladder detention?
  • Percuss along length of colon
    — Should be resonant/tympanic
    — If dull - suggests full colon
  • Palpate abdomen
    — Note masses, suprapubic tenderness, or palpable stool
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17
Q

Focused Physical Exam - Pelvic Exam

A
  • Inspect perineal structures
    — Urethra midline?
  • Inspect vaginal + urethral mucous
    — Atrophic changes?
  • Inspect for obvious pelvic organ prolapse
    — Both at rest and when bearing down
  • Leakage with cough
    — Immediate = stress UI
    — Delayed = urge UI
  • Pelvic muscle strength + function
    — Assess muscle strength + function with correct contraction
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18
Q

Scale of Pelvic Muscle Strength

A

0: no discernible contraction
+1: very weak contraction held <1 second
+2: weak but clearly discernible contraction held for 1-3 seconds
+3: moderately strong contraction held for 4-6 seconds, repeated x3
+4: firm contraction held for 7-9 seconds, repeated 4-5 times
+5: strong contraction held for 10 seconds repeated 4-5 times

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19
Q

Focused Physical Exam - Anorectal Exam

A
  • Routine for men, PRN for women
  • Insert gloved finger and insert into anal canal
  • Instruct patient to tighten and lift
    — Male: assess sphincter muscle strength, duration of contraction, and scrotal lift
    — Female: assess for circumferential contraction of sphincter
  • Assess for retained stool
  • If neuro lesion suspected = assess for bulbocavernosus reflex/anal wink
20
Q

Focused Physical Exam - Sensorimotor

A

When neurological lesion is a concern

Sensory
- Stroke perineum + inner thighs with cotton applicator and ask pt to identify structures
- Ask patient to identify site of greatest urge to void
— Male: glans or penile shaft
— Female: vaginal opening

Motor
- Gait, sphincter function, ability to fan toes laterally
- Ability to recognize bladder filling + voluntarily contract sphincter

21
Q

Focused Physical Exam - Perineal Skin Status

A
  • maceration
  • dermatitis
  • yeast rash
22
Q

Focused Physical Exam - Urinary Stream

A
  • Screening test for voiding dysfunction
  • Have pt void on uroflow machine, listen to stream, or have pt select diagram
  • Normal = no difficulty starting + continuous stream until empty
  • Intermittent = difficulty starting + intermittent stream
  • Poor = prolong + weak urinary stream
23
Q

Diagnostics - Urinalysis

A

Rule out infection, hematuria, and glucosuria
- Best if clean catch

24
Q

Diagnostics - PVR

A

If any suspected retention
- Feelings of incomplete emptying
- Poor or intermittent stream

Bedside ultrasound or straight catheter post-void
- No absolute cut-off for abnormal findings
- >250 mls = significant
- >350 mls = risk of damage to upper tract

25
Q

Diagnostics - Bladder Diary

A
  • Maintain for 2-3 days
  • Time + volume of voided urine
  • Time + estimated volumes of leakage episodes with associated factors

Insights
- Usual diurnal + nocturnal frequency
- Functional bladder capacity
- Frequency, severity, pattern of incontinence
- Type, volume, pattern of fluid instance

26
Q

Bladder Diary - Stress UI

A
  • Leakage with activity
  • No leakage at HS
  • No urgency
27
Q

Bladder Diary - Urge UI

A
  • Frequency
  • Urgency
  • Small voided volumes
  • Nocturia
  • Leakage
28
Q

Bladder Diary - Voiding Dysfunction

A
  • frequency
  • urgency
  • feelings of incomplete emptying
  • urgency
29
Q

Bladder Diary - Functional UI

A
  • loss of continence
  • pt unaware of need to void
30
Q

Diagnostics - Cystoscopy

A
  • Provides anatomic information
  • Indicated for patients with hematuria or s/s of infection
31
Q

Diagnostics - Urodynamics

A

Indications
- Neurogenic bladder
- Voiding dysfunction to determine cause
- High pressure chronic retention (HPCR) vs low pressure chronic retention (LPCR)
- Stress incontinence
- Severe pelvic organ prolapse
- To assess bladder compliance

32
Q

Diagnostics - Uroflowmetry

A

Pt voids into special commode that graphs urinary system
- Provides peak and mean flow rates

4 patterns
- Normal
- Explosive
- Poor
- Intermittent

33
Q

Diagnostics - Voiding Cystometrogram

A

Measures bladder’s ability to stretch/store and contract/empty
- Cystometrogram = storage study
- Pressure flow study = emptying study

Measured via catheter with pressure transducer inserted into bladder and rectum
- Measure bladder and abdo pressures

Insights
- Bladder capacity
- Bladder compliance
- Conscious sensation
- Involuntary bladder contractions

34
Q

Diagnostics - Pressure Flow Study

A
  • Emptying study
  • Calculated bladder contractility and presence/absence of outlet obstruction
  • Pt voids on uroflow device with pressure-sensitive catheter in place
35
Q

Diagnostics - Sphincter Studies

A
  • Measures function of voluntary sphincter
  • Via patch or needle electrodes
  • Can measure bulbocavernosus reflex
  • Measure point at which sphincter function fails
  • Determines severity of stress incontinence
36
Q

Diagnostics - Urethral Pressure Profile

A

Measures urethral resistance

37
Q

Hierarchy of Patient Management

A

1 - correct reversible factors

#2 - if chronic, determine type and develop management plan
#3 - consider need for absorptive products

38
Q

Absorptive pads with adhesive strip

A
  • For ambulatory patients with low volume leakage
  • Varying lengths, designs, and absorbances

For men
- “Drip collectors” that fit over penis

39
Q

Pant + pad absorptive systems

A

For ambulatory patients with light to moderate volumes of leakage
- Ie Urge UI
Do not interfere with toileting program

Varying absorbances with waterproof outer layer

Critical to change with wet to protect skin

40
Q

Adult Brief

A
  • High volume leakage or leakage of urine+stool
  • Side tab openings for bedbound
  • Pull-up for ambulatory
41
Q

Petrolatum-Based

A
  • Easy to apply + remove
  • Less effective against liquid stool
  • May transfer to pads/linens
42
Q

Zinc-Based

A
  • Good protection against liquid stool
  • Difficult to remove
43
Q

Dimethicone-based

A
  • Easy to apply + remove
  • Nonocclusive
  • Non-greasy
  • Does not protect against liquid stool
44
Q

Hydrophilic Paste

A
  • Hydrocolloid based
  • Use on damaged skin
  • Adheres to moist skin
45
Q

Ostomy Powder

A

Crust on denuded areas with barrier spray

46
Q

Cyanoacrylate liquid

A

Dressing for denuded areas

Avoid use of cleansers/ointments with emollients

Continence 2.2 (14 decks)

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