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Urinary Incontinance
Urinary Incontinance
35
Nursing
Graduate
02/21/2013

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Term

Urinary Incontinence

Definition

Definition
Incontinence is an involuntary loss of urine severe enough to cause social or hygienic problems
Term

Urinary Incontinence

Types

Definition

1. Stress incontinence

2. Urge Incontinence

3. Overflow incontinence

4. Mixed incontinence

5. Functional incontinence

6. Transient causes

7. Permanent causes

Term

Stress Incontinence

Definition/Cause/Manifestations

Definition

Definition: Involuntary loss of urine during activities that increase abdominal and detrusor pressure

Cause: Weakening of bladder neck supports

Intrinsic sphincter deficiency caused by such congenital conditions

Anatomic damage of the urethral sphincter

Manifestations: Urine loss with physical exertion, cough, sneeze, or exercise

Small amounts of urine are lost

Normal voiding <8 time a day, < 2 times a night

Post void residual < 50ml

Hypermobility of the urethra or bladder neck with valsalva maneuvers

Term

Urge Incontinence

Definition/Cause/Manifestations

Definition

Definition: Involuntary loss of urine associated with a strong desire to urinate

Cause: Unknown

Manifestations: Abrupt and strong urge to void

May have loss of large amounts of urine with each occurrence

Term

Overflow Incontinence

Definition/Cause/Manifestations

Definition

Definition: Involuntary loss of urine associated with overdistension of the bladder when the bladder's capacity has reached its maximum

Causes: Diabetic neuropathy

Enlarged prostate, large genital prolapse

Abnormal contraction of the skeletal muscle

Manifestations: Bladder distention, often up to the level of the umbilicus

Constant dribbling of urine

Term

Mixed Incontinence

Definition/Cause/Manifestation

Definition

Definition: Combination of stress, urge, and overflow incontinence

Cause: As with each separate disorder

Manifestations: As with each separate disorder

Term
Cystourethroscopy
Definition
Diagnostic test used to examine the inside of the bladder and urethra directly
Term
Cystometrogram (CMG)
Definition
Diagnostic test used to measure the pressure inside the bladder as it fills
Term
Urethral pressure profilometry (UPP)
Definition
Diagnostic test to measure the pressure in the urethra in relation to the bladder pressure during various activities
Term
Uroflowmetry
Definition
Diagnostic test used to measure rate and degree of bladder emptying
Term
Electromyography (EMG)
Definition
A diagnostic test in which a tampon shaped instrument is inserted into the vagina to measure the strength of pelvic muscle contraction. the graph shows the amplitude of muscle contraction to the patient as a method of biofeedback
Term

Functional Incontinence

Definition/Manifestations

Definition

Definition: Leakage of urine caused by factors other than disease of the lower urinary tract

 

Manifestations: Quantity and timing of urine leakage vary

Term
Laboratory Tests
Definition

Urinalysis-rule out infection

If RBC's, WBC's, leukocyte  esterase, or nitrites are found further culturing is needed

 

-An infection is treated before further assessment of incontinence

Term
Imaging Tests
Definition

Urography-used to locate the kidneys and ureters.

Voiding cystourethrogram (VCUG)-assesses the size, shape, support, and function of the bladder

-Problems identified by this test include obstruction and post-void residual.

Ultrasonographic bladder scanner-assess post-void residual

Term
Risk factors for urinary incontinence
Definition
  • Age
  • If female, menopausal status
  • Neurologic disease
  • Parkinson disease 
  • Dementia
  • Multiple sclerosis
  • Stroke
  • Spinal injury 
  • Diabetes mellitus
  • Child birth
  • Urologic procedures
  • Prescribed and over-the-counter drugs
  • Bowel patterns
  • Stress/anxiety level
Term
Symptoms of urinary incontinence
Definition
  • Leakage
  • Frequency
  • Urgency
  • Nocturia
  • Sensation of full bladder before leakage
Term
Patient and family education
Definition
  • Maintain a normal body weight to reduce the pressure on the bladder
  • Do not try to control incontinence by limiting fluid intake
  • If a catheter is in the bladder, follow the instruction given about maintaining the sterile drainage system
  • If discharged with with a suprapubic catheter in the bladder, inspect the entry site for the tube daily, clean the skin around the opening gently with warm soap and water,and place a sterile gauze dressing on the skin around the tube. Report redness, swelling, drainage, or fever
  • Do not put anything in the vagina
  • Do not have sexual intercourse until after the 6-week post operative checkup
  • Do not lift of carry anything heavier than 5 pounds or participate in any strenuous exercise until physician gives clearance

 

Term
Anterior vaginal repair
Definition
Elevates the urethral position and repairs any cystocele
Term
Retropubic suspension
Definition
Elevated the urethral position and provides longer-lasting results
Term
Needle bladder neck
Definition
Elevates the urethral position and provides longer-lasting results without a long operative time
Term
Pubovaginal sling procedures
Definition
A sling made of synthetic or fascial material is placed under the urethrovesical junction to elevate the bladder neck
Term
Midurethral sling procedures
Definition
The sling is placed near the urethrovescial junction to increase the angle, which inhibits movement of urine into the urethra with lower intravesiclar pressures
Term
Artificial sphincters
Definition
A mechanical device to open and close the urethra is placed around the anatomic urethra
Term
Periurethral injection of collagen or siloxane
Definition
Implantation of small amounts of an inert substance through several small injection provides support around the bladder neck
Term

Interventions Urinary Incontinence

Urinary bladder training

Definition

Urinary bladder training

  • Determine ability to recognize urge to void
  • Keep a continence specification record for 3 days to establish voiding pattern
  • Establish interval of initial toileting schedule, based on voiding pattern
  • Establish beginning and ending time for toileting schedule, if not for 24 hours
  • Establish interval for toileting of not less than 1 hour and preferably not less than 2 hours
  • Toilet patient or remind patient to void at prescribed intervals
  • Provide privacy for toileting
  • Use power of suggestion to assist patient to void
  • Avoid leaving patient on toilet for more than 5 minutes
  • Reduce toileting interval by one-half hour if there are more than three incontinence episodes in 24 hours
  • Increase toileting interval by 1 hour if patient has no incontinence episodes for 3 days until optimal 4-hour interval is achieved
  • Teach the patient to consciously hold urine until the scheduled toileting time
  • Discuss daily record of continence with patient to provide reinforcement
Term

Urinary Incontinence Interventions

Urinary Habit training

Definition
  • Keep a continence specification record for 3 days to establish voiding pattern
  • Establish interval of initial toileting schedule, based on voiding pattern and usual routine
  • Establish beginning and ending time for the toileting schedule
  • Establish interval for toileting of preferably not less than 2 hours
  • Assist patient to toilet and prompt to void at prescribed intervals
  • Provide privacy for toileting
  • Use power of suggestion to assist patient to void
  • Avoid leaving patient on toilet for more than 5 min
  • Reduce toileting interval by on-half hour if there are more than two incontinence episodes in 24 hours
  • Increase the toileting interval by on-half hour if patient has no incontinence episodes in 48 hours until optimal 4-hour interval is achieved
  • discuss daily record of continence with staff to provide reinforcement and encourage compliance with toileting schedule
  • Maintain scheduled toileting to assist in establishing and maintaining voiding habit
  • Give positive feedback or positive reinforcement
Term
Outcomes Urinary Incontinence
Definition

patient will describe the type of urinary incontinence experienced

Demonstrate knowledge of proper use of medications and correct procedures for self-cauterization's, use of artificial sphincter, or care of an indwelling urinary catheter

Demonstrate effective use of the selected exercise or bladder-training program

Select and use incontinence devices and products

Have a reduction in the number of incontinence episodes

 

Term
Estrogen
Definition

Action: Reduces incontinence, by improving vaginal and urethral blood flow and tone

Nursing Interventions: Teach patients to notify provider if they experience any unusual vaginal bleeding 

teach to avoid smoking while on the drugs and to report calf pain or swelling

Term
Oxybutynin
Definition

Anticholinergic

Action: Reduce incontinence by causing bladder muscle relaxation and suppressing the urge to void

Nursing Interventions: Ask about glaucoma

 

 

Term
Imipramine
Definition

Tricyclic antipepressant

Action: Have anticholinergic actions and also black acetylcholine receptors. Relieve urinary incontinence

Nursing Interventions: Warm patient not to take medication with other tricyclic antidepressants or MAO inhibitors

Term

Stress Urinary Incontinence

Interventions

Definition
  • Pelvic floor exercise therapy for women-strengthens the muscles of the pelvic floor which increases the ability to start and stop the urine stream or passage of flatus
  • Nutrition therapy-weight reduction because incontinence is made worse by increased abdominal pressure from obesity
  • Drug therapy-used to improve urethral resistance
  • Vaginal cone therapy-helpful in strengthening the pelvic muscles
  • Electrical stimulation devices-strengthen urethral contractions
  • Surgical management-vaginal, abdominal or retropubic surgeries
  • Behavior modifications
  • Psychotherapy
Term

Urge Urinary Incontinence

Interventions

Definition
  • Behavioral intervention-bladder training, habit training, exercise therapy, and electrical stimulation
  • Drug therapy-relax smooth muscle and increase the bladder's capacity 
  • Nutrition therapy-help avoid fluid overload on the bladder and allow urine to collect at a steady pace, avoid foods that have bladder stimulating or diuretic effects
  • Bladder training-the patient learns to control the bladder
  • Habit training-increases awareness of need to void
  • Exercise Therapy-helps overcome abnormal detrusor contractions 
  • Electrical stimulation-treat urge and stress incontinence
Term

Reflex Urinary Incontinence

Interventions

Definition
  • Drug Therapy-increases bladder pressure
  • Bladder compression-promotes bladder emptying 
  • Intermittent self-catheterization-helps empty bladder
Term

Functional Urinary Incontinence

Interventions

Definition
  • Applied devices-helps maintain the correct position of the bladder
  • Containment-Collect urine and keep skin and clothing dry
  • Catheterization-controls incontinence
Term
Source
Definition
Ignatavicius, D., & Workman, L. (2010). Medical-surgical nursing patient-centered collaborative care. (6 ed., Vol. 2, pp. 1559-1570). St. Louis: Missouri.
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