Porth's Patho: Bladder & Lower Urinary Tract, Chapter 35

The nurse understands that medications, although very beneficial to clients, can have harmful effects. When working with older adult clients the nurse should recognize that which outcome is a common result of potent, fast-acting diuretics? -No untoward effects -Decreased urine output -Increased potassium levels -Urge incontinence

Urge incontinence Medications prescribed for other health problems may prevent a healthy bladder from functioning properly. Potent, fast-acting diuretics are known for their ability to cause urge incontinence. They can decrease potassium levels and increase urine output. They do have untoward effects.

A client is admitted with lower urinary tract obstruction and stasis. Which action is the primary intervention? -Urinary catheterization -Laxative administration -Increased oral fluids -Administration of intravenous fluids

Urinary catheterization The relief of lower urinary tract obstruction is directed toward relief of bladder distension through urinary catheterization. This is the primary intervention. The other interventions are not the priority.

Urinary incontinence can be a problem with older adults. One method of treatment is habit training, or bladder training. When using this treatment with an older adult, how frequently should he or she be voiding? -Every 3 to 5 hours -Every 1 to 3 hours -Every 4 to 6 hours -Every 2 to 4 hours

Every 2 to 4 hours "Contract and relax the pelvic floor muscles at least 10 times every hour while awake."

A client reports urinary incontinence, specifically not feeling the urge to urinate until the bladder voids uncontrollably. Client history shows type 1 diabetes of 40+ years and compliance with medication and diet. What is the most likely diagnosis? -Incontinence related to neuropathy causing overactive bladder -Incontinence caused by stress on the bladder -Incontinence caused by a physical block in the urethra -Incontinence related to having large volumes stored in the bladder

Incontinence related to neuropathy causing overactive bladder Neural damage is brought about by chronic diabetes and can result in the loss of control of the detrusor muscle. Stress, urge, and functional incontinence are all caused by pressure or blockage

A client has just been diagnosed with a neurogenic disorder of the bladder. The nurse caring for him understands that this means that this client could demonstrate which of the following? Select all that apply. -Failure to empty urine -All of the above -Failure to make urine -Failure to store urine

-Failure to empty urine -Failure to store urine Neurogenic disorders of bladder function commonly are manifested in one of two ways: failure to store urine or failure to empty urine. Failure to make urine is not a problem for a client with this diagnosis.

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 with diabetes mellitus -A client whose arthritis makes walking difficult -A client embarrassed to use a bedpan -A client who gave birth to two large-for-gestational age infants

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

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.

While studying the GU system the nursing students learn that which sex achieves continence first? -Girls -Both sexes at the same time -No definite proof that one sex or the other achieves it sooner -Boys

Girls Girls typically achieve continence before boys and bowel control is typically achieved before bladder control.

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? -Pus in urine -Gross hematuria -Frequent urination -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.

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: -Chronic stress response -Pelvic inflammatory disease -Prostate enlargement -Psychosocial disorders

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.

The nursing instructor who is teaching about incontinence in older adults recognizes a need for further instruction when a student makes which statement? -"Frequency is not a major problem for the elderly." -"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." 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.

One of the many tests done during urodynamic studies is the sphincter electromyelogram. What does this test study? -Ability of the bladder to store urine -Flow rate during urination -Pressure of the bladder during filling and emptying -Activity of the voluntary muscles of the perineal area

Activity of the voluntary muscles of the perineal area Sphincter electromyelogram allows the activity of the striated (voluntary) muscles of the perineal area to be studied. Cystometry measures the ability of the bladder to store urine as well as the pressure of the bladder during filling and emptying. Uroflowmetry measures the flow rate during urination.

The nursing students are studying about kidney function and correctly identify which test that is used to measure bladder pressure during filling and voiding? -Cystometry -KUB -Bladder scan -Uroflowmetry

Cystometry Cystometry is used to measure bladder pressure during filling and voiding. Uroflowmetry measures the flow rate during urination. A bladder scan estimates bladder volume. A KUB is a urodynamic study that assesses 3 aspects of bladder function: the bladder, ureteral, and intra-abdominal pressure changes, characteristics of urine flow, and the activity of the striated muscles of the external sphincter and pelvic floor.

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? -CBC -SBAR -FACES -DIAPPERS

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.

Disruption of which muscle's contraction can lead to the inability to expel urine from the bladder? -Sphincter -Trabeculae -Trigone -Detrusor

Detrusor The detrusor muscle, also called the muscle of micturition, contracts to allow urine flow from the bladder. The detrusor muscle coordinates the functions of the internal and external sphincters, allowing controlled urination. The trigone is a nonmuscle triangle area bounded by the ureters and urethra. Trabeculae are hypertrophied inner bladder surface smooth muscle fibers that develop as a result of chronic outlet obstruction.

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

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

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. -You may experience feelings of euphoria. -Increased tearing and drowsiness may occur. -Stop the medication if you develop spasms.

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.

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

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.

A 40-year-old mother of three reports incontinence. Her physician suggests Kegel exercises because they strengthen the pelvic floor muscles. Kegel exercises are most likely to help which type of incontinence? -Urge incontinence -Overflow incontinence -Mixed incontinence -Stress incontinence

Stress incontinence Stress incontinence is commonly caused by weak pelvic floor muscles, which allow the angle between the bladder and the posterior proximal urethra to change so that the bladder and urethra are positioned for voiding when some activity increases intra-abdominal pressure. Overflow incontinence results when the bladder becomes distended and detrusor activity is absent. Urge incontinence is probably related to CNS control of bladder sensation and emptying or to the smooth muscle of the bladder. Mixed incontinence, a combination of stress and urge incontinence, probably has more than one cause.

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? -Overflow -Urge incontinence -Functional incontinence -Stress 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.

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's father was diagnosed with bladder cancer when he was in his 60s. -The client states that the majority of his fluid intake during the day is tea or coffee. -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.

Urinary obstruction in the lower urinary tract triggers changes to the urinary system to compensate for the obstruction. What is an early change the system makes in its effort to cope with an obstruction? -The bladder begins to shrink. -The stretch receptors in the bladder wall become hypersensitive. -Bladder contraction weakens. -Ability to suppress urination is increased.

The stretch receptors in the bladder wall become hypersensitive. During the early stage 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 virtually produces bladder spasm. There is urgency, sometimes to the point of incontinence, and frequency during the day and at night.

The older adult client tells the health care provider about experiencing incontinence ever since starting diuretic therapy 2 weeks ago. What term should the provider document in the medical record related to the type of incontinence? -Neurogenic -Stress -Transient -Chronic

Transient The causes of incontinence can be divided into two categories: transient and chronic. Of particular importance is the role of pharmaceuticals as a cause of transient urinary incontinence. Numerous medications, such as long-acting sedatives and hypnotics, psychotropics, and diuretics, can induce incontinence. Chronic urinary incontinence occurs as a failure of the bladder to store urine (stress incontinence) or a failure to empty urine (neurogenic incontinence).

The older adult client tells the health care provider about experiencing incontinence ever since starting diuretic therapy 2 weeks ago. What term should the provider document in the medical record related to the type of incontinence? -Transient -Neurogenic -Stress -Chronic

Transient The causes of incontinence can be divided into two categories: transient and chronic. Of particular importance is the role of pharmaceuticals as a cause of transient urinary incontinence. Numerous medications, such as long-acting sedatives and hypnotics, psychotropics, and diuretics, can induce incontinence. Chronic urinary incontinence occurs as a failure of the bladder to store urine (stress incontinence) or a failure to empty urine (neurogenic incontinence).

The nursing instructor who is teaching about disorders of the lower urinary tract realizes a need for further instruction when one of the students makes which statement? -"Alterations in bladder function can include urinary obstruction with retention or stasis of urine." -"Alterations in bladder function can include urinary incontinence with involuntary loss of urine." -"Alterations in bladder function occurs frequently in the elderly." -"Alterations in bladder function can only occur when there is incontinence."

"Alterations in bladder function can only occur when there is incontinence." Alterations in bladder function include urinary obstruction with retention or stasis of urine and urinary incontinence with involuntary loss of urine. Alterations in bladder function does occur more frequently with aging.

A young mother asks, "Why can my 3-year-old daughter have a bowel movement on the toilet but she wets her pants?" What is the nurse's best response? -"Boys obtain control of continence earlier than girls do." -"Bowel control occurs earlier than bladder control." -"We will have to evaluate if your daughter has problems with her sphincter muscles." -"Your daughter could have a urinary tract infection."

"Bowel control occurs earlier than bladder control." Bowel control occurs earlier than bladder control in young children, and girls gain control earlier than boys. This would not be a symptom of urinary tract infection or difficulty with bladder sphincter control.

The nurse is scheduled to teach a client experiencing urinary incontinence about Kegel exercises. Which descriptor should the nurse include in this education? -"Contract and relax the pelvic floor muscles at least 10 times every hour while awake." -"Try to start and stop urination while sitting in a bathtub full of warm soapy water." -"Drink at least two glasses of water and then try to hold it for at least 3 hours before going to the bathroom." -"After you have emptied your bladder, continue sitting on the commode and try to forcefully expel more urine."

"Contract and relax the pelvic floor muscles at least 10 times every hour while awake." Exercises for the pelvic muscles (or Kegel exercises) involve repetitive contraction and relaxation of the pelvic floor muscles and are an essential component of client-dependent behavioral interventions. None of the other distractors are examples of Kegel exercises.

Following a health promotion class, which statement by a participant demonstrates an accurate understanding of the risk factors for bladder cancer? -"I can see that preventing bladder cancer is one more benefit of a healthy diet." -"I suppose I should listen to my health care provider and drink more cranberry juice." -"I think I should be okay because there's no history of bladder cancer in my family that I'm aware of." -"More than ever, I guess it would be worthwhile for me to quit smoking."

"More than ever, I guess it would be worthwhile for me to quit smoking." Cigarette smoking is highly correlated with all bladder cancers. Cranberry juice may be of benefit in the prevention of urinary tract infections, not cancer, and neither poor diet nor family history is as significant as cigarette smoking in the etiology of bladder 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 due to something outside the body." -"You should not worry about its cause." -"The cause is unknown." -"It is usually inherited."

"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 has a postvoid residual (PVR) volume of 40 mL. Which information would the nurse teach the client? -"This value indicates you are emptying your bladder too completely." -"This value indicates you are having difficulty emptying your bladder." -"This is a normal value." -"This test indicates you do not have adequate bladder control."

"This is a normal value." The nurse should teach the client that PVR values under 50 mL indicate that the client is adequately emptying the bladder and further evaluation is not necessary.

A client has a postvoid residual (PVR) volume of 250 mL. Which information would the nurse tell the client? -"This value indicates you are having difficulty emptying your bladder." -"This value indicates you are emptying your bladder too completely." -"This is a normal value." -"This test indicates you do not have adequate bladder control."

"This value indicates you are having difficulty emptying your bladder." The nurse should inform the client that values over 200 mL indicate an inability to adequately empty the bladder and that further evaluation is necessary. It is not a normal value, nor does it indicate that the client does or does not have adequate bladder control.

A mother asks, "Why can't my 1-year-old go to the bathroom by himself?" What is the nurse's best response? -"Does he wear diapers during the day?" -"Your child is too young to begin toilet training." -"Young children are very manipulative." -"How long have you been trying to train him?"

"Your child is too young to begin toilet training." Conscious control of the bladder begins at about 2 to 3 years of age. A 1-year-old child is too young to be able to consciously control toileting.

The client has had prolonged urethral outlet obstruction. The nurse knows that physiologically the client may likely develop small pockets of mucosal tissue, called cellulae, which can ultimately cause which complication? Select all that apply. -Infections due to stasis -Backpressure on the ureters -Development of hydroureters -Sphincter dystonia

-Infections due to stasis -Backpressure on the ureters -Development of hydroureters With continued outflow obstruction, this smooth surface is replaced with coarsely woven structures (i.e., hypertrophied smooth muscle fibers) called trabeculae. Small pockets of mucosal tissue, called cellulae, commonly develop between the trabecular ridges. These pockets form diverticula when they extend between the actual fibers of the bladder muscle. Because the diverticula have no muscle, they are unable to contract and expel their urine into the bladder, and secondary infections caused by stasis are common. Along with hypertrophy of the bladder wall, there is hypertrophy of the trigone area and the interureteric ridge, which is located between the two ureters. This causes backpressure on the ureters, the development of hydroureters and, eventually, kidney damage. Detrusor-sphincter dyssynergia is uncoordinated activity that causes overdistention. Sphincter dystonia is a cause of incontinence. Interstitial cystitis is a condition of increased sensitivity to bladder pressure, loss of bladder elasticity, and severe urgency unrelated to outlet obstruction.

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

-Radiation therapy -Surgical removal -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.

One of the many tests done during urodynamic studies is the sphincter electromyelogram. What does this test study? -Activity of the voluntary muscles of the perineal area -Pressure of the bladder during filling and emptying -Ability of the bladder to store urine -Flow rate during urination

Activity of the voluntary muscles of the perineal area Sphincter electromyelogram allows the activity of the striated (voluntary) muscles of the perineal area to be studied. Cystometry measures the ability of the bladder to store urine as well as the pressure of the bladder during filling and emptying. Uroflowmetry measures the flow rate during urination.

A warehouse worker is experiencing trouble with incontinence, especially when lifting heavy objects. What intervention is most appropriate for this client's needs? -Bladder ultrasonography two to three times daily -Administration of diuretics as ordered to promote frequent bladder emptying -Administration of alpha-adrenergic agonist drugs as ordered -Intermittent catheterization

Administration of alpha-adrenergic agonist drugs as ordered The client likely has stress incontinence, for which alpha-adrenergic agonist drugs may be ordered. Diuretics are not used to treat incontinence. Bladder ultrasound neither assesses nor treats stress incontinence. Catheterization does not address the underlying problem.

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? -Calcium channel blockers -Biofeedback -Antibiotics -Anticholinergic medications

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 nursing instructor, while teaching about renal function and disorders, informs the students that the most frequent form of urinary tract cancer is: -Bladder -Kidney -Testicular -Uterine

Bladder Bladder cancer is the most frequent form of urinary cancer in the United States. Uterine cancer and testicular cancer are not considered to be cancers of the urinary tract.

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

A client reports urinary incontinence, specifically not feeling the urge to urinate until the bladder voids uncontrollably. Client history shows type 1 diabetes of 40+ years and compliance with medication and diet. What is the most likely diagnosis? -Incontinence related to neuropathy causing overactive bladder -Incontinence caused by stress on the bladder -Incontinence caused by a physical block in the urethra -Incontinence related to having large volumes stored in the bladder

Incontinence related to neuropathy causing overactive bladder Neural damage is brought about by chronic diabetes and can result in the loss of control of the detrusor muscle. Stress, urge, and functional incontinence are all caused by pressure or blockage.

A nurse is caring for a client admitted for chemotherapy due to bladder cancer. Which route would the nurse anticipate that the chemotherapy will be administered when the goal is to minimize systemic side effects? -Topical -Intravesical -Intravenous -Oral

Intravesical In many cases, chemotherapeutic or immunotherapeutic agents can be administered intravesically (instilled directly into the bladder), thereby avoiding the side effects of systemic therapy. All other routes provided as options would result in systemic side effects.

A nurse suspects a client may be experiencing flaccid bladder dysfunction based on 24-hour intake and output. Which diagnostic method is most likely to confirm or rule out whether the client is retaining urine? -Measurement of postvoid residual (PVR) by ultrasound -Routine urinalysis -Blood test for creatinine, blood urea nitrogen, and glomerular filtration rate -Urine test for culture and sensitivity

Measurement of postvoid residual (PVR) by ultrasound Measurement of postvoid residual (PVR) can be achieved quickly, accurately, and painlessly by the use of ultrasonography. A PVR value of less than 50 mL is considered adequate bladder emptying, and more than 200 mL indicates inadequate bladder emptying. Urine tests and blood tests will not directly indicate whether a client is experiencing bladder fill with insufficiency in emptying.

An older adult who experiences chronic pain takes prescribed opioid analgesics, which has resulted in frequent fecal impaction. Which renal outcome may directly result from this gastrointestinal complication? -Urinary tract infections -Bladder cancer -Overflow urinary incontinence -Neurogenic bladder

Overflow urinary incontinence Fecal impaction occurs when a large bolus of stool forms in the rectum, which can push against the urethra causing obstruction that results in overflow incontinence. This does not constitute a risk factor for bladder cancer or neurogenic bladder, and although a urinary tract infection (UTI) may result, this is an indirect consequence of the bowel obstruction.

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

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.

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? -Transient -Stress -Neurogenic -Overflow

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.

A female client asks, "Why do I leak urine every time I cough or sneeze?" The health care worker's response is based on which physiologic principle? -A pressure difference between the urethra and bladder -When intravesical pressure exceeds maximal urethral closure pressure -A decrease in bladder distensibility -Involuntary bladder continence during filling

When intravesical pressure exceeds maximal urethral closure pressure Stress incontinence represents the involuntary loss of urine that occurs when, in the absence of detrusor muscle action, the intravesical pressure exceeds the maximum urethral closure pressure. Stress incontinence, which is a common problem in women of all ages, occurs as the result of weakness or disruption of pelvic floor muscles, leading to poor support of the vesicourethral sphincters. Except during the act of micturition, intraurethral pressure is normally greater than intravesical pressure. Urge incontinence and overactive bladder are associated with urgency caused by bladder infection or CNS or myogenic mechanisms. Overflow incontinence is an involuntary loss of urine that occurs when intravesical pressure exceeds the maximal urethral pressure because of bladder distention in the absence of detrusor activity.

Which clinical manifestations would tell a nurse that a client is having progressive decompensation related to obstruction of urinary outflow? -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 waking up several times in the night to void. -Client complains of urinary urgency

When tested for residual urine volume, 1400 mL of urine is obtained when client is catheterized. When compensatory mechanisms are no longer effective, signs of decompensation begin to appear. The period of detrusor muscle contraction becomes too short to expel the urine completely, and residual urine remains in the bladder. At this point, symptoms of obstruction become pronounced. These symptoms include frequency of urination, hesitancy, need to strain to initiate urination, a weak and small stream, and termination of the stream before the bladder is completely emptied. With progressive decompensation, the bladder may become severely overstretched with a residual urine volume of 1000 to 3000 mL. Urinary urgency is a compensatory mechanism. Incontinence may be caused by many different factors and does not indicate decompensation.