Voiding Disfunctions
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| What is the trigone of the bladder? | a rectangular area that is created from ligaments that suspend and anchor the bladder within the pelvic and pubic bones
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| What is the transitional epithelium? | a continuous layer of cell that line the renal pelvis and the ureters and is continuous with the urinary bladder
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| How long is the male urethra? | 18-20 cm
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| How long is the female urethra? | 2.5-3.0 cm
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| What is the potential bladder volume? | 750ml to 1000ml
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| At what volume in the bladder do you feel the urge to urinate? | 250ml
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| Where does the awareness of the need to void come from? | the stretch receptors in the walls of the bladder
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| Stimulation of stretch receptors can result in what? | involuntary contraction of the bladder
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| How much urine remains in bladder after urination? | 10ml
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| 95% of urine is what? What is the remainder? | About 95% is water, the rest is nitrogenous waste
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| Define Enuresis: | Involuntary urination at an age when continence should be present
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| At what age do most children acheive bladder control? | By age 5
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| As a maturational problem, when does enuresis cease in children? | between 6 and 8 years of age
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| Other than age, what can enuresis result from? | *Decreased renal concentrating ability *Heart failure *Diabetes mellitus *Poor bladder emptying
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| Define pneumaturia: | Passage of gas in urine during voiding
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| What does pneumaturia result from? | *Sigmoid diverticulitis (most common) *Fistula between bowel and bladder *Rectosigmoid cancer *Regional ileitis *Gas-forming urinary tract infections
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| What is the tympanic sound of a full bladder? | 'dull'
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| When will the bladder be palpable? | The bladder will only be palpable if there is at least moderate distention
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| How do you assess the kidneys for tenderness and pain? | by striking one fist lightly over the costovertebral angle.
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| What do you assess if an assessment of the kidneys is positive for pain/tenderness? | signs of electrolyte and water imbalance
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| What is cystocele? | Downward displacement of the bladder
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| What is urethrocele? | Downward displacement of the urethra
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| what can cystocele/urethroceles cause? | Stress incontinence
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| What is urge incontinence? | A strong desire to void caused by CNS disorders (such as a stroke or brain tumor), infection, or uninhibited bladder contractions
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| What is functional incontinence? | function of the lower urinary tract (bladder, urethra and pelvic floor muscles) is intact but other factors (immobility or severe cognitive impairment) may cause the problem
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| What effect does Ditropan have? | reduce bladder spasticity and involuntary contractions
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| What effect does Dibenzaline have? | improve sphincter control
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| What effect does Urecholine have? | increase muscle contraction of the detusor muscle
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| What effect does Detrol/Detrol LA have? | decreases urinary frequency, urgency, or urge incontinence
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| Why are fluids encouraged in a PT with incontinence? | Reduction in fluid intake may cause urine to become more concentrated, irritating the bladder mucosa and increasing the urge to urinate
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| Who are kegel exercises helpful for? | Female PTs
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| How often should kegels be done? | Ten repetitions five times a day (another slide in the same PPT says 3-4 sets a day)
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| How are kegel exercises done? | Clench the muscles used to stop the flow of urine. Hold the tension for 10 seconds, then relax for 10 seconds
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| What is urinary retention? | Inability to void even with an urge to void
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| What is Phimosis? | Inability to retract foreskin
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| What drugs can cause urinary retention? | *anticholinergics *antihistamines *General anesthesia
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| What is chronic urinary retention? | Able to void but unable to completely empty the bladder (retention with overflow), Residual urine >50 ml (May exceed several hundred ml)
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| What causes neurogenic bladder? | a lesion of the nervous system that interferes with normal nerve conduction to the urinary bladder
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| What amount of residual urine is not normally percussible? | 130mL and below
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| What drug that diminishes urinary tract discomfort causes orange-red urine? | Pyridium
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| What does Prosed DS do? | kills bacteria in urine, decreasing pain and inflammation, and reducing muscle spasms in the urinary tract
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| What does Uroxatrol do? | relaxes smooth muscle in the bladder neck and the prostate
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| What is a spastic bladder? | a lesion above the voiding reflex arc (UPPER motor neuron) that results in a loss of sensation to void and a loss of motor control. The bladder wall atrophies, decreasing bladder capacity.
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| What is a flaccid bladder? | Caused by a lesion of a LOWER motor neuron The bladder continues to fill and distend, with urine stasis and incomplete emptying Patient loses sensation to void.
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| What urinary catheter is used in PTs with an enlarged prostate? | Coude. Designed with a curved and tapered tip
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| What urinary catheter is used to drain urine from the renal pelvis of the kidney? | Malecot and de Pezzer (Also called a mushroom catheter)
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| Which I&O urinary catheter has multiple openings in the tip to facilitate intermittant drainage? | Red Robinson
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| Which urinary catheter has a slanted, larger orifice at its tip to be used with patients with hematuria (to prevent occlusion if clots are present) | Whistle-tip
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| Which urinary catheter is long and slender to pass into the ureters? | Ureteral
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| Which urinary catheter is designed with a balloon near its tip which is inflated after insertion, holding the catheter in the urinary bladder for continuous drainage? | Foley
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| Which urinary catheter is inserted surgically through the abdominal wall above the symphysis? | Suprapubic
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| When is a suprapubic catheter removed? | When the PT is able to void and measured residual urine is consistently less than 50 ml
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| What is an external (Texas or Condom) Catheter? | A non-invasive drainage system attached to external genitalia in an incontinent male to minimize skin irritation from urine.
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| How often are condom catheters removed for cleaning and inspection? | Daily.
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| If a PT with a urine drainage system attached voids less than 50mL over 4 hours, what must first be done? | check the drainage system for proper placement and function prior to contacting the physician
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| What can a PT with a urinary catheter drink to help prevent UTIs? | drinking fluids that acidify urine, such as cranberry juice
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| How often is catheter care performed? | twice daily
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| How is cleansing around urinary catheter performed | Cleanse perineum with mild soap and warm water, rinse well, and pat dry
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| What do you rinse the urine collection bag with? | Solution of vinegar and water
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| At what decrease in urine output should the PT contact the physician? | <30cc/hr for 2hrs
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| Up to how many groups of repetitions of kegel exercises should the PT build up to? | Groups of 20 repetitions at least 4 times a day (another slide says 5 times a day, and another says 3-4 times a day)
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| What is the suggested voiding pattern for PTs with voiding difficulties? | Void upon arising, before each meal, and at bedtime
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