Upgrade to remove ads
Only $2.99/month

Urinary tract disorders; Neurogenic bladder

Terms in this set (17)

Neurogenic bladder definition
Incontinence, overfilling or incomplete emptying of the bladder. Due to the disruption of the central or peripheral nervous system linked to bladder function. may interfere with; bladder filling, perception of voiding & fullness, & bladder emptying.
Neurogenic bladder pathophysiology
bladder filling/emptying controlled by CNS. Control can be disrupted in:
*Cerebral cortex= voluntary impulses.
*Midbrain=macturation center
*Spinal cord tracts= spastic bladder dysfunction
*Bladder=peripheral nerves
Spastic bladder dysfunction
((Flaccid, atonic then spastic))
*Spastic neurogenic bladder= frequent spontaneous detrusor muscle contraction & involuntary bladder emptying happens when disruption of CNS transmission ABOVE THE SACRAL SEGMENT cord. Both sensory & voluntary control interrupted. sacral reflux arc remains intact.
*may require bladder retraining: trigger points & crede's method
Normal reflex arc pathway
Normally reflex arc (pathway of neural reaction) exists between the bladder & spinal cord at S2-S4.
- >400mL of urine→bladder stimulated →contraction of
detrusor muscle→bladder emptying →or voluntary
suppression happens.
Flaccid bladder dysfunction
((stays flaccid,atonic))
*Flaccid neurogenic bladder= damage to SACRAL SPINAL CORD AND BELOW THE T12-L1, cauda equina (roots below spinal cord), or sacral nerve roots causes loss of detrusor muscle tone.Lost perception of fullness, overdistention, weak detrusor contractions.
*may require intermittent catheterization, 3-4hrs
Risk factors for flaccid neurogenic bladder
*Congenital/ acquired = may be due to myelomeningocele, spinal cord injury, peripheral neuropathies, DM is common cause, M.S.
*Behavioral= chronic ETOH,& prolonged over distention.
Risk factors for Spastic neurogenic bladder
may be due to; spinal cord injury, stroke, m.s., CNS lesions.
Diagnostic tests
*Urine culture=detect UTI
*Urinalysis & eGFR, serum createnine & BUN=evaluates
renal function
*Postvoid bladder scan=measures residual urine (amounts
>50mL= ineffective detrusor contractions)
*Cystometrography=eval bladder filling& detrusor
tone/function
Neurogenic bladder medications
Medications are used to:
* ↑ or↓ contractility of the detrusor muscle
-Cholinergic drugs: Bethanecol
-anticholinestrerase drugs: Neostigmine & Pyridostigmine
* ↑ or ↓ tone of internal sphincter
-Anticholinergic drugs: Oxybutynin, tolterodine,
darifenacin, solifenacin succinate, trospium,
propantheline, & flavoxate
* Relax external urethral sphincter
Cholinergic drugs
*Bethanechol= stimulates detrusor muscle contraction in flaccid neurogenic bladder. Used in short term urinary retention (surgery, childbirth)
*may be used in combo w/ bladder training technique to promote complete emptying of neurogenic bladder
Anticholinergic drugs
((parasympathetic blockers))
*relax detrusor muscle & contract internal sphincter, increasing bladder capacity in patients w/spastic bladder dysfunction.
*Oxybutynin, tolterodine, darifenacin, solifenacin succinate, trospium, propantheline, & flavoxate.
*Adverse effects=dry mouth, blurred vision, constipation
Anticholinesterase drugs
*increases detrusor muscle tone
*Neostigmine & Pyridostigmine
neurogenic bladder nutrition
*diet to reduce risk for UTI & urinary calculi
*moderate-high fluid intake
*fluid intake timing
*diet that acidifies the urine (cranberry juice, cheese, eggs, grapes, meat & poultry, plums & prunes, tomatoes, whole grain)
Bladder retraining
*using trigger points to stimulate urination= for spastic neurogenic bladder. stroking, pinching abdomen, inner thigh or glans penis, pulling pubic hairs, tapping the suprapubic region, or inserting finger in rectum and gently stretching anal sphincter
*use Credes method =for spastic or flaccid bladder. apply pressure to suprapubic region with fingers of one of both hands, manual pressure on abdomen, and valsalva maneuver (bearing down while holding breath).
-caution: ↑abdominal pressure can stimulate autonomic
dysreflexia= ↑BP due to SNS stimulation.
neurogenic bladder Surgery
*Rhizotomy=destruction of nerve to detrusor/ external \
sphincter. for hyperreflexia or spasticity.
*Urinary diversion=ileal conduit, bilateral cutaneous
urostomy, & continent urinary reservoir
*Implantation of Artificial sphincter
Nursing diagnosis
*Impaired urinary elimination
*Toileting self-care deficit
*Risk for impaired skin integrity
*Risk for Infection
Neurogenic bladder: community- based care
*Intermittent self catheterization (for flaccid)
*Avoidance of OTC meds w/anticholinergic effect
*Bladder training information
*Care of indwelling catheter
*Signs of UTI or urolithiasis & how to ↓risks
THIS SET IS OFTEN IN FOLDERS WITH...