EXAM 3: Neurogenic Bladder Disorders

flaccid bladder

bladder dysfunction caused by nerve damage, so the nerves that tell the bladder to contract do not work correctly

• pelvic nerve: helps bladder contract

• pudendal nerve: holds urine from emptying

• hypogastric nerve: storage of urine

failure to empty urine

diabetes mellitus

main cause of flaccid bladder?

large post-void residual, urinary stasis, reflux increasing risk for kidney disease

What happens in the body from flaccid bladder?

flaccid bladder treatment

frequent voiding, every 3-4 hours

abdominal compression

intermittent catherization

goals of treatment for neurogenic bladder

prevent overdistention

prevent UTI

prevent kidney damage

neurogenic bladder treatment

all of the above

antimuscarinics

decrease muscle tone and increase bladder capacity

cholinergic

stimulate parasympathetic receptors to increase tone

muscle relaxants

decrease sphincter tone

MOA - cholinergic agonists: Bethanechol

mimic ACh and stimulate muscarinic receptors in the smooth muscle of the bladder, increases tone and contractions of bladder

Indication - cholinergic agonists: Bethanechol

• non-obstructive urinary retention post-op

• postpartum

• neurogenic bladder

contraindications - cholinergic agonists: Bethanechol

• asthma

• hyperthyroidism

• PUD

• epilepsy

• CV disease

client education - cholinergic agonists: Bethanechol

• GI: diarrhea, nausea, salivation, vomiting

• report bradycardia, hypotension, bronchospasms

• change positions slowly

MOA - anticholinergic: Oxybutynin

• inhibits acetylcholine to relax smooth muscle, allows for relief of bladder spasms and overactive bladder

indications - anticholinergic: Oxybutynin

• urinary antispasmodic

• overactive bladder

contraindications - anticholinergic: Oxybutynin

• urinary retention

• intestinal obstruction

• narrow angle glaucoma

client education - anticholinergic: Oxybutynin

side effects: constipation, dry mouth, dry mouth, dry eyes, urinary retention

report confusion, hallucinations, CP, and angioedema

avoid driving

stress incontinence

involuntary loss of urine during times of increased intra-abdominal pressure

• coughing, laughing, sneezing, lifiting

overactive bladder/ urge incontinence

involuntary loss of urine associated with a strong desire to void

• urinary urgency

overflow incontinence

involuntary loss of urine as the result of elevations in travesical pressires that exceed the maximal urethral pressure

• bladder distention… results in nighttime incontinence