presented by Christine Cave
After completing a comprehensive assessment of a patient’s bladder function and capturing episodes of voiding patterns for at least 48 hours, the rehabilitation nurse can initiate interventions to address the predominant symptom of either incontinence or retention. This course will describe the various presentations of urinary incontinence as it relates to underlying structural or neurological deficits. Evidence-based nursing care recommendations that are the least invasive and least expensive will be discussed. Pharmacologic treatment will briefly be described. This course will present the symptom of urinary retention in association to various underlying pathologies, along with options for management. Neurogenic bladder will then be presented with recommended management strategies for nurses. The long-term care planning needed for affected patients will be presented, with emphasis on patient education and establishing a follow-up plan for ongoing support once a patient is discharged to the community.
Christine Cave is an advocate for the profession of nursing and the science of caring for rehabilitation patients across post-acute settings. Now in pursuit of an advanced degree as a doctorate prepared, family nurse practitioner at the University of San Francisco. Her specialty areas include bowel and bladder management and continence, functional and cognitive recovery for independent living, nutrition and fitness for aging populations.
This chapter will begin by expanding on symptom identification as noted at the end of the assessment module. Evidence-based definitions will be used for the various forms of urinary incontinence, retention and other mixed-incontinence causes (i.e. neurogenic bladder vs. pelvic floor dysfunction). A more detailed description of damage to sacral and thoracic nerves, which underlie neurogenic bladder dysfunction will be carefully described as it relates to common disease states (stroke/brain injury, multiple sclerosis, SCI, Parkinson’s disease).
This chapter explores the various etiologies of urinary incontinence and describes specific nursing interventions to promote continence for each. Conservative “standard” treatment will first be discussed (dietary modifications, fluid support and timing, perineal hygiene and treatment of underlying UTI). Emphasis is placed on utilizing a tracking tool (the frequency/volume-elimination chart).
This chapter introduces symptoms of overactive bladder (OAB) and techniques to manage (bladder training, urge suppression and anticholinergic medications). Then urinary urgency symptoms will be introduced with recommendations for management. Pharmacologic and additional treatments will be briefly discussed.
Stress incontinence is described (related to pelvic organ prolapse or pelvic floor dyssynergia) with basic nursing techniques to manage symptoms. Techniques will include pelvic floor muscle exercises, leakage management, and recommendations for outpatient follow-up.
Functional incontinence is often multifactorial in cause and requires a comprehensive assessment of cognitive function, mobility, psychological motivation and proper use of devices. Interventions are more involved and require a multidisciplinary approach. Nursing interventions include timed/prompted voiding. Mixed Incontinence is also often multifactorial and may be attributed to medication side effects. Techniques to manage symptoms are similar to interventions for functional incontinence (most important is a custom, team-oriented approach).
This chapter will describe various underlying etiologies of urinary retention as indicated by PVRs (using bladder scanning) that are consistently greater than 150cc, or if the patient reports no urge sensation to void (common with neurogenic bladder).