Flashcards in Urinary Incontinence & Pressure Ulcers Deck (54):
What nervous system is in charge of the detrusor muscle contraction?
What nervous system is in charge of the internal urethral sphincter?
What muscles is the external urethral sphincter made of?
Where is urination controlled in the brain? What is is called?
Pons; Micturition Center
What nervous system is in charge of the stopping detrusor muscle contraction?
Common aging changes in the bladder
- Decreased Bladder Capacity
- Decreased Ability to Inhibit Reflex Contractions
- Decreased Closing Pressure
- Increased Residual Urine
What can cause incontinence that is "readily" treatable? In other words, these are "short term incontinence issues."
Pharmaceutical (diuretics, sedatives)
Endocrine (Inc. Glucose/Calcium)
What are the 4 types of Incontinence?
- Detrusor Instability (Urge)
- Stress Incontinence
This type of incontinence is most common in men. It is caused by defects in CNS regulation, hyperexcitability, or sometimes deconditioning. Essentially, the detrusor contractions are not inhibited as they should be.
Urge/Detrusor Instability Incontinence
This type of incontinence is caused by an outlet obstruction or destrusor inadequacy. Commonly, diabetic neuropathy can cause this. The Intravesicular pressure cannot exceed intraurethral pressure.
This type of incontinence is caused by a weakness of pelvic muscles, estrogen deficiency, or urologic surgery. Physiologically caused by sphincter insufficiency.
In real life, can different types of incontinences overlap? Or are they exclusive?
They can overlap. There are cases of obstruction or stress incontinence that often have assc. destrusor instability
In what patients should you inquire about urinary incontinence?
All middle-aged and older women
When inquiring about urinary continence, what should you ask in regard to pattern?
- Incontinence Chart
- Stress Related Behavioral or Functional Problem
When inquiring about urinary continence, what should you ask in regard to local factors?
- Outlet Obstruction
- Hx Pelvic Surgery
- Local Neurologic Symptoms
When inquiring about urinary continence, what should you ask in regard to systemic factors?
- Hx Neoplasia
- Hx DM
- CNS Dysfunction
Upon physical exam, what things are you looking for that can cause or indicate urinary incontinence
- Estrogen Deficiency
- Fecal Impaction
- Prostatic Hypertrophy
- Sacral Neurologic Function
- Enlarged Bladder After Voiding
- Incontinence with Coughing (Supine vs. Upright)
What labs would you order in someone with potential urinary incontinence?
- Serum Glucose/Calcium
- Post-void residual volume measurement (normal < 100 mL)
T/F: Due to the small urethra, females tend to have an obstruction as a cause of incontinence at a greater degree than men.
False, men have a higher likelihood for incontinence.
What tests do you order to check Urodynamics
- Post-void residual
- Urine Flow
When do you refer for a Urodynamic Study
- Hx of Pelvic Sx or Irridiation
- Marked Pelvic Prolapse
- Evidence of Prostatic Obstruction
- Post-void Residual > 100 mL
- Uncertain Dx
- Unresponsive to Tx
What effect do diuretics have that can affect continence?
What effect does caffeine have that can affect continence?
What effect do beta agonists have that can affect continence?
What effect do anticholinergics have that can affect continence?
What effect do hypnotics have that can affect continence?
What effect do alpha agonists have that can affect continence?
What effect do alpha blockers have that can affect continence?
What effect do narcotics have that can affect continence?
What is the treatment goal for functional urinary incontinence?
Re-establish normal pattern
What is the treatment goal for stress incontinence?
Inc. Intraurethral Pressure
What is the treatment goal for overflow incontinence?
What is the treatment goal for detrusor instability?
Dec. Detrusor Contractions
What is a class of drug you would use for detrusor instability?
Anticholinergic Agents/Bladder Relaxants because they block detrusor contractions
i.e. Oxybutynin, Tolterodine, Solifenacin
What are some problems with anticholinergics?
What is another class of drug you would use for detrusor instability?
Imipramine. Used because it has anticholinergic and alpha sympathetic agonist activity.
What non-pharmacologic treatments could you use in conjunction with medication for detrusor instability?
- Bladder training/scheduled voiding
- Eliminate Caffeine
- Formal training using biofeedback in pelvic floor (Kegel) contraction prn urge sensation
How do you treat an obstructive cause of overflow incontinence?
- Sx: May have detrusor instability for period post-op
- Drug: alpha blockers, anti-androgens (finasteride)
How do you treat a detrusor weakness cause of overflow incontinence?
- Intermittent Catherization
- Inswelling (Foley) catheter
How do you treat stress incontinence?
- Kegel Exercises
- Bladder Training
How do you treat functional incontinence?
- Incontinence Chart
- Tx Psych issues
- Use prompted voiding
This is defined as an area of soft-tissue breakdown, usually occurring over a bony prominence.
This type of pressure ulcer has erythema present for at least 24 hours, it is indurated and the epidermis is intact.
This type of pressure ulcer extends into the dermis with surrounding erythema and is indurated.
This type of pressure ulcer involves deep fascia and/or muscle with surrounding erythema and is indurated
This type of pressure ulcer involves a break in the epidermis or a blistering with surrounding erythema and induration.
Rule of Thumb with people at risk for ulcers
Small opening at the surface may underlie a large undermining defect.
What is the most common location for a pressure ulcer?
What percent of patients develop a pressure ulcer during hospitalization?
If interstitial pressure is elevated, what can happen that can cause pressure ulcers to occur (>12 mm)
- Filtration of Capillary Fluid
- Occlusion of Lymphatics
- Accumulation of Metabolic Wastes
Contributing Factors ot Pressure Ulcers
- Shearing Force
How do you treat a pressure ulcer?
1. Relieve Pressure (turn Q2hours)
2. Debride Necrotic areas
3. Wound Dressing (kept wet)
-- Superficial: Paraffin Gauze
-- Deep Ulcer: wet-to-wet
4. Improve General Health (Nutrition)
5. Inspect Skin (measure)!
Objectives of Sx
- Excision Ulcerate Areas
- Resection Bony Prominences
- Formation of large Flaps
- Obtainment of Additional Padding (Muscle)