Patho Chapter 35

A client with a neurogenic bladder has a lesion at the level of sacral reflexes/peripheral nerves that innervate the bladder. The nurse anticipates the client will experience which type of bladder dysfunction? flaccid bladder dysfunction spastic bladder dysfunction uninhibited neurogenic bladder detrusor-sphincter dyssynergia

flaccid bladder dysfunction Flaccid bladder dysfunction results in the ability to fill, but failure to empty urine. It is caused by lesions at the level of the sacral reflexes or the peripheral nerves that innervate the bladder. Spastic bladder dysfunction usually results from neurologic lesions located above the level of the sacral micturition reflexes.

The nurse is providing emotional support to a client who has just been diagnosed with low-grade urothelial bladder cancer. When the client inquires about prognosis rates for this type of cancer, the nurse responds that: it is usually noninvasive and has an excellent prognosis. it is highly metastatic and has a poor prognosis. it is typically invasive but has a good prognosis. although it is a rare form of bladder cancer it has an excellent prognosis.

it is usually noninvasive and has an excellent prognosis. The most common bladder cancer is derived from urothelium cells that line the bladder so it also known as urothelial cancer. These types of tumors include low-grade noninvasive tumors that have an excellent prognosis.

The nursing instructor who is teaching about incontinence in older adults recognizes a need for further instruction when a student makes which statement? "Many factors can contribute to incontinence." "A number of factors that contribute to incontinence can be altered." "Incontinence can increase social isolation in the elderly." "Frequency is not a major problem for the elderly."

"Frequency is not a major problem for the elderly." Incontinence can increase social isolation in the older adult population and frequency can lead to institutionalization of older adults. Many factors can contribute to incontinence but many of these can be altered.

A neighbor is complaining to a friend (who happens to be a nurse) about several changes in her body. Which of the following complaints raises a "red flag" because it could be a sign of epithelial cell bladder cancer? "Seems like I'm holding onto more water these days." "Every now and then, I have urine leak when I cough." "Sometimes I get a sharp pain in my side while exercising." "I noticed my urine is pinkish red, but I'm not having any pain when I pee."

"I noticed my urine is pinkish red, but I'm not having any pain when I pee." The most common sign of bladder cancer is intermittent, painless hematuria. Fluid retention, stress incontinence, and pain with exercise are not usual signs of cancer.

The client has just been diagnosed with bladder cancer and asks the nurse what causes it. What would be the nurse's best response to the client? "It is usually inherited." "The cause is unknown." "It is due to something outside the body." "You should not worry about its cause."

"The cause is unknown." The nurse should tell the client that the cause of bladder cancer is unknown; however, evidence suggests that its origin is due to local influences such as carcinogens that are excreted in the urine and stored in the bladder. It is not inherited and it would not be therapeutic to tell the client not to be concerned about its cause.

A client with bladder cancer asks the nurse, "What did the doctor mean by intravesicular chemotherapy? Am I going to lose all my hair and have to go for treatments over months and months?" The best response would be: "This is when they put the chemotherapy directly into the bladder to kill any cancer cells." "They will take you to radiology and inject some chemotherapy through your abdomen into your bladder." "The doctor will place a scope up your urethra, into the bladder, and burn the lining of the bladder with a laser and then inject some tuberculosis bacillus into the lining." "This is when they use a CyberKnife to cut off any lesions and then inject chemotherapy into the remaining portion of the bladder."

"This is when they put the chemotherapy directly into the bladder to kill any cancer cells." Surgical treatment of superficial bladder cancer is often followed by intravesicular chemotherapy or immunotherapy, a procedure in which the therapeutic agent is directly instilled into the bladder. None of the other responses describe this procedure. The chemotherapy drug is not injected through the abdomen into the bladder. Bacillus Calmette-Guerin (BCG) vaccine is instilled into the bladder to elicit an inflammatory response that can kill the tumor. A CyberKnife is used with the brain, not the bladder.

The nurse is evaluating client risk for the development of overactive bladder/urge incontinence and determines that which client is at highest risk for this condition? A client who gave birth to two large-for-gestational age infants A client with diabetes mellitus A client embarrassed to use a bedpan A client whose arthritis makes walking difficult

A client with diabetes mellitus Overactive bladder/urge incontinence can be caused by disorders of the detrusor muscle structure, which can occur as the result of the aging process or disease conditions such as diabetes mellitus. A stroke client develops this condition as a result of neurogenic causes rather than having a disorder of detrusor muscle problem.

Which statement accurately describes the etiology of stress incontinence? An increase in intra-abdominal pressure that results in involuntary urination The decrease in smooth muscle of the bladder causing increased urination The involuntary release of urine related to a strong sense of urgency Overactivity of the voiding reflexes related to the nervous system damage

An increase in intra-abdominal pressure that results in involuntary urination Stress incontinence results in involuntary passage of urine related to increased intra-abdominal pressure with coughing, sneezing, or laughing. The other options refer to the etiology of overactive/urge incontinence.

Which type of pharmacologic therapy does the nurse anticipate administering to a client for treatment of a spastic bladder in order to decrease bladder hyperactivity? Anticholinergic medications Antibiotics Biofeedback Calcium channel blockers

Anticholinergic medications Among the methods used to treat spastic bladder and detrusor-sphincter dyssynergia are the administration of anticholinergic medications to decrease bladder hyperactivity and urinary catheterization to produce bladder emptying. Antibiotics are used to treat urinary tract infections. Biofeedback is a behavioral method of treatment. Calcium channel blockers would not be effective in treating this disorder.

The nurse is preparing to assist a client for a procedure to measure bladder pressure during filling and voiding to determine total bladder capacity. For which procedure should the nurse assemble equipment? Cystometry Urethral pressure profile Uroflowmetry Sphincter electromyography

Cystometry Cystometry is used to measure bladder pressure during filling and voiding. It provides valuable information about total bladder capacity. The urethral pressure profile is used to evaluate the intraluminal pressure changes along the length of the urethra with the bladder at rest.

A nursing instructor who is teaching students about urinary incontinence in older adults suggests that an easy and effective way to remember the transient and treatable causes of urinary incontinence is to use which acronym? FACES SBAR DIAPPERS CBC

DIAPPERS DIAPPERS is the preferred acronym. D stands for dementia, I for infection, A for atrophic vaginitis, P for pharmaceutical agents, P for psychological causes, E for endocrine conditions, and R for restricted mobility. FACES is the acronym for the pain scale used with children. SBAR refers to method used in the hand-off report. CBC stands for a complete blood count.

While studying about the process of urination, the nursing student learns that which muscle is known as the "muscle of micturition"? External sphincter muscle Internal sphincter muscle Detrusor muscle Trigone muscle

Detrusor muscle The detrusor muscle is the muscle of micturition. In the bladder neck is the continuation of the detrusor muscle known as the internal urethral sphincter, which acts as a sphincter when closed. The external sphincter muscle surrounds the urethra distal to the base of the bladder. There is not a trigone muscle; the trigone is the smooth triangular area that is bounded by the openings for the both ureters and the urethra.

An older adult with urge incontinence and overactive bladder begins medication treatment with oxybutynin. Which side effects would the nurse include in the education? Dry mouth and constipation are common. Stop the medication if you develop spasms. You may experience feelings of euphoria. Increased tearing and drowsiness may occur.

Dry mouth and constipation are common. Anticholinergic effects of the muscarinic blocking agent oxybutynin include dry mouth and constipation. People taking anticholinergic drugs may also experience gastroesophageal reflux, blurred vision, urinary retention, and cognitive effects. Spasms are not common.

An older male comes to the clinic with the chief report of having difficulty voiding. The physician diagnoses him with a lower urinary tract obstruction and stasis. What should the nurse suspect to be the most frequent cause of this client's problem? Kidney infection Enlargement of prostate gland Bladder tumor Gonorrhea

Enlargement of prostate gland In men, the most important acquired cause of urinary stasis and urinary obstruction is external compression of the urethra caused by the enlargement of the prostate gland. Bladder tumors, gonorrhea, and kidney infections can cause the same symptoms—but the most important and frequent cause is benign prostatic hyperplasia (BPH).

A client informs the nurse that she is afraid of developing bladder cancer because her mother had it. She asks the nurse what signs and symptoms are present with this cancer. What does the nurse tell the client is the most common sign of bladder cancer? Frequent urination Gross hematuria Pus in urine Amber-colored urine

Gross hematuria The most common sign of bladder cancer is painless hematuria. Gross hematuria is a presenting sign in the majority of cases. Frequency, urgency, and dysuria occasionally accompany the hematuria.

Which assessment indicates to the nurse that a client may have a spastic bladder dysfunction? Distended abdominal area Failure to void for 8 or more hours Incontinence Severe cramping

Incontinence A spastic bladder condition causes inability to store urine. Incontinence would be a symptom of inability to store urine.

A middle-aged man reports new-onset urinary changes. Which reported change(s) would lead the health care provider to suspect an early stage of obstruction is occurring? Select all that apply. Diminished ability to suppress urination Reports of bladder spasm Increase in number of times client urinates throughout the day and night Constant pain in the back on the right side Bright red blood in the urine, especially in the early morning

Increase in number of times client urinates throughout the day and night Reports of bladder spasm Diminished ability to suppress urination During the early stages of obstruction, the bladder begins to hypertrophy and becomes hypersensitive to afferent stimuli arising from stretch receptors in the bladder wall. The ability to suppress urination is diminished, and bladder contraction can become so strong that it produces bladder spasm. There is urgency, sometimes to the point of incontinence, and frequency during the day and at night. Constant pain is not associated with early obstruction, but colicky pain due to spasm may be present. Blood in the urine usually is not caused by obstruction but can be a sign of cancer or infection.

The adult child of an older adult has noticed that the parent has become incontinent of urine for the first time. The client is diagnosed with transient urinary incontinence. To what is this condition most attributable in this population? Decrease in bladder and sphincter tone Bladder outlet obstruction Detrusor instability Medications

Medications Many medications commonly taken by older individuals, including long-acting sedatives, hypnotics, and diuretics, can induce incontinence. Chronic urinary incontinence should not be diagnosed or treated without first undertaking a thorough review of the client's drug regimen. Transient incontinence is less often rooted in physiologic changes in the bladder. Detrusor instability causes overflow incontinence. Bladder outlet obstruction is a cause of overactive bladder/urge incontinence.

What is the most common sign of bladder cancer? Severe oliguria Hyperproteinuria Hyperphosphaturia Painless hematuria

Painless hematuria The most common sign of bladder cancer is intermittent painless hematuria. Oliguria and proteinuria and hyperphosphaturia are associated with renal failure.

A nurse is caring for a client in spinal shock. Which intervention is appropriate in relation to the client's urinary status? Perform intermittent catheterization Assess bowel sounds Perform a urine culture Palpate the lower abdomen

Perform intermittent catheterization After a spinal cord injury, the early effects on bladder function are quite different from those that follow recovery from the initial injury. During the period immediately after spinal cord injury, a state of spinal shock develops, during which all the reflexes, including the micturition reflex, are depressed. The bladder is atonic and cannot contract. Intermittent catheterization is necessary to prevent injury to urinary structures associated with overdistension of the bladder.

The nurse is conducting a community health education program on urinary retention and urinary incontinence. The nurse determines that the participants are understanding the education when they state that the most common cause of urinary retention is: Psychosocial disorders Prostate enlargement Chronic stress response Pelvic inflammatory disease

Prostate enlargement In men, the enlarged prostate (due to hypertrophy or hyperplasia) frequently causes nonrelaxing external sphincter with urine retention. The stress response can cause retention of urine as part of the "fight-or-flight" response, unrelated to sphincter dysfunction. Developmental delays are associated with female or male children (not men). Psychosocial disorders sometimes have a transient effect on bladder function, and are rarely a cause of sphincter dysfunction in female or male clients.

A 56-year-old client reports urinary incontinence when laughing. The nurse documents this as which type of incontinence? Urge Stress Overflow Overactive

Stress In women, pelvic floor weakness may cause involuntary loss of urine (stress incontinence) during any activity that increases intra-abdominal pressure, such as laughing or coughing. Urge incontinence and overactive bladder are associated with urgency caused by bladder infection, central nervous system, or myogenic mechanisms. Overflow incontinence is the result of bladder distention in the absence of detrusor muscle activity.

A client is describing difficulty with urinating and informs the nurse that every time she coughs or laughs, she urinates and has begun to wear a thin pad. Which type of urinary incontinence is the client describing? Stress incontinence Urge incontinence Overflow Functional incontinence

Stress incontinence Stress incontinence is the loss of urine associated with activities, such as coughing, that increase intra-abdominal pressure. Overactive bladder/urge incontinence is urgency and frequency associated with hyperactivity of the detrusor muscle that may or may not involve involuntary loss of urine. Overflow is the involuntary loss of urine when intravesicular pressure exceeds maximal urethral pressure in the absence of detrusor activity. Functional incontinence is a lack of cognitive function to go to the bathroom, commode, or urinal/bedpan, resulting in spontaneous urination.

The nurse caring for clients who have bladder cancer identifies which treatments to be acceptable for this cancer? Select all that apply. Surgical removal Radiation therapy Hypnosis Chemotherapy Herbal therapy

Surgical removal Radiation therapy Chemotherapy The methods used in treatment depend upon the grade of the tumor and degree of invasiveness. They include surgical removal, radiation therapy, and chemotherapy. Hypnosis and herbal therapy are not recommended treatments for this disease.

An older adult client who recently started taking furosemide tells the nurse about now experiencing problems with urine incontinence. Which type of incontinence is this client likely experiencing? Stress Transient Overflow Neurogenic

Transient Transient incontinence is caused by medications such as long-acting sedatives and hypnotics, psychotropic medications, and diuretics such as furosemide. It can also be caused by rectal distension, fecal impaction, and acute cystitis or polyuria. Overflow incontinence is an involuntary loss of urine that occurs when intravesical pressure exceeds the maximal urethral pressure. Stress incontinence is the involuntary loss of urine during coughing, laughing, sneezing, or lifting that increases intra-abdominal pressure because of pelvic floor muscle dysfunction.

Which clinical manifestations would tell a nurse that a client is having progressive decompensation related to obstruction of urinary outflow? Client complains of waking up several times in the night to void. When tested for residual urine volume, 1400 mL of urine is obtained when client is catheterized. Client states that he or she is incontinent. Client complains of urinary urgency.

When tested for residual urine volume, 1400 mL of urine is obtained when client is catheterized.

A client asks the nurse what the most common sign/symptom of bladder cancer is. Which is the best response by the nurse? Painless hematuria Urinary frequency Intermittent urgency Continual dysuria

Painless hematuria The most common sign of bladder cancer is painless hematuria. Gross hematuria is a presenting sign in 75% of persons with the disease, and microscopic hematuria is present in most others. Frequency, urgency, and dysuria occasionally accompany the hematuria.

An older adult states that he awakens at least three times each night to void. When assessing the client, what potential causative factor should the nurse prioritize? The client takes his prescribed beta-blocker and diuretic each evening at bedtime. The client states that the majority of his fluid intake during the day is tea or coffee. The client's father was diagnosed with bladder cancer when he was in his 60s. The client takes over-the-counter glucosamine supplements for the treatment of arthritis.

The client takes his prescribed beta-blocker and diuretic each evening at bedtime. Taking diuretics in the evening can cause nocturia. The fact that the client mostly drinks tea and coffee is unlikely to cause nocturia. Frequency is not suggestive of bladder cancer. Glucosamine supplements are not linked to changes in voiding behavior.

A 65-year-old female who smokes presents with increased urinary frequency, dysuria, and sporadic, painless hematuria. The client's follow-up will likely include: long-term intermittent catheterization. cystoscopy. lithotripsy. bladder retraining.

cystoscopy. The most common sign of bladder cancer is painless hematuria. Frequency, urgency, and dysuria occasionally accompany the hematuria. Cystoscopy is among the most common diagnostic tests related to bladder cancer. Lithotripsy addresses renal calculi. Bladder retraining and catheterization are not directly related to the diagnosis and treatment of bladder cancer.