PrepU Patho Ch 27

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?

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?

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 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?

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.

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 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.

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." 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 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." 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.

During male ejaculation, which statement addresses why sperm is not normally seen inside the bladder?

The musculature of the trigone area, bladder neck, and prostatic urethra contract at the same time. During male ejaculation, which is mediated by the sympathetic nervous system, the musculature of the trigone area and that of the bladder neck and prostatic urethra contract and prevent the backflow of seminal fluid into the bladder.

A client tells the nurse that he is experiencing involuntary loss of urine associated with a strong desire to void (urgency). The nurse would recognize this as:

Urge incontinence Urge incontinence is the involuntary loss of urine associated with a strong desire to void (urgency). 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. 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. Incontinence may occur as a transient and correctable phenomenon, or it may not be totally correctable and may occur with various degrees of frequency.

A client is admitted with lower urinary tract obstruction and stasis. Which action is the primary intervention?

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.

A warehouse worker is experiencing trouble with incontinence, especially when lifting heavy objects. What intervention is most appropriate for this client's needs?

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?

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 caring for a client with a spinal cord injury at C4 and assesses a blood pressure of 180/120 mm Hg; heart rate of 42 beats/min; and profuse diaphoresis. Which priority intervention should the nurse implement?

Assess the patient for a kinked indwelling catheter. Spastic bladder due to spinal cord injuries at the cervical level is often accompanied by a condition known as autonomic hyperreflexia. Because the injury interrupts central control of sympathetic reflexes in the spinal cord, severe hypertension, bradycardia, and sweating can be triggered by insertion of a catheter or mild overdistention of the bladder.

Which physiologic change in the elderly population contributes to urinary incontinence?

Decline in detrusor muscle function In the older adult population, overall bladder capacity is reduced as is urethral closing pressure. Changes associated with aging include decline in detrusor muscle function, decrease in bladder contraction, and impairment in bladder emptying. Medications may contribute to incontinence; however, it is not a physiologic change but rather a chemical influence.

When explaining about the passage of urine to a group of nursing students, the clinic nurse asks them which muscle is primarily responsible for micturition. Which student response is correct?

Detrusor The detrusor muscle is the muscle of micturition. When it contracts, urine is expelled from the bladder. External sphincter is a circular muscle that surrounds the urethra distal to the base of the bladder and can stop micturition when it is occurring. Trigone is a smooth triangular area that is bounded by ureters and the urethra. Urinary vesicle is another name for the bladder.

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?

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.

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 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.

When teaching a community education class about the seven warning signs of cancer, the nurse will note which is the most common sign of bladder cancer?

Painless, bloody urine The most common sign of bladder cancer is painless hematuria. Gross hematuria is a presenting sign in the majority of people with the disease, and microscopic hematuria is present in most others. A flaccid bladder, kidney stones, and clots are usually seen after surgery such as transurethral resection of the prostate, where bladder irrigation is called for to prevent the clots from blocking urine output.

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 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 nursing student learns in her anatomy and physiology class that the bladder has how many main components?

Two The bladder consists of 2 main components: the body in which the urine collects and the neck which connects with the urethra.