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Ch.22- Urinary Incontinence
Terms in this set (29)
An abnormal flow rate is specific for the following types of incontinence:
The best way to initially assess incontinence is by a combination of:
-Culture and Sensitivity
-Residual Volume Determination
How common is urinary incontinence amongst the elderly population?
What effect does aging have on post-void residual urine?
What effect does aging have on first urge to void?
Occurs at a lower capacity
What effect does aging have on total bladder capacity?
What autonomic activity causes urination?
-Inhibition of sympathetic
-Stimulation of parasympathetic
What are the four principle components necessary for continence?
-Effective functioning of the urinary tract
What causes overflow incontinence?
the inability to empty because of an obstruction or loss of function (drugs/neuropathy).
What causes urge incontinence?
-irritability of the trigone of the bladder
-causes involuntary bladder contractions
What conditions cause urge incontinence?
-local/surrounding infection (UTI, etc)
-Motor urge incontinence
What is detrusor hyperreflexia
-motor urge incontinence
-An uninhibited bladder caused by stoke, dementia, or parkinson's
What changes related to aging cause stress incontinence?
-weakness of the pelvic floor musculature
-Thinning and atrophy of the perineal and vaginal tissues
What can cause stress incontinence in men?
Sphincter damage that occurs after prostate surgery
What can cause overflow incontinence?
-atonic or flaccid bladder that has lost its neuronal innervation
What are the cardinal symptoms of overflow incontinence?
-straining to urinate
-decreased flow rate
-size of stream
What can the presence of stool during an incontinent episode indicate?
Neurogenic combined urinary and fecal incontinence
What is the Bonney (Marshall) Test?
-Place two fingers in lateral vagina and ask patient to cough
-If urine leakage occurs on coughing,
-but is prevented by finger pressure,
-then significant pelvic laxity
What labs should be run for primary care workup of urinary incontinence?
What is an elevated postvoid residual urine of 200ml indicative of?
What is the initial therapy for urge incontinence?
What is drug therapy for urge incontinence directed at?
Relaxing smooth muscle of the base of the bladder or blocking the involuntary bladder contractions
What is one drug that can be used in urge incontinence?
Tricyclic agents that possess moderate anticholinergic properties
What are the mainstays of treatment for stress incontinence?
-Pelvic Floor exercises
When can insertion of a pessary be useful?
-Severe stress incontinence in a non-surgical candidate
What drugs can cause overflow incontinence?
-Drugs with anticholinergic or antimuscarinic activity
What is the most type of chronic urinary catheter?
When should indwelling catheters be changed?
When significant sludge or debris has accumulated and is causing reduced urinary catheter drainage by partially obstructing the catheter lumen
When should diapers be used?
-Cognitively and functionally impaired patients
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