The student nurse is assisting the nurse in caring for a 31-year-old female in the outpatient clinic.
Item 1 of 1
- Nurses' Note
1415: The client requested her annual physical be moved up because of urinary symptoms that started nine months ago. She states that she has managed so far with them, but she is starting a new traveling job and would like to get any necessary treatment. She states that every time she laughs or sneezes, she leaks a small amount of urine. She reports that this also occurs while performing intense physical exercise. The symptoms occur daily. She denies increased frequency, urgency, and burning upon urination. She denies having any vaginal discharge. She was treated for a urinary tract infection two months ago with antibiotics.
- Diagnostic Results
1500:
Bladder scan - post-void residual
20 mL
- Medical History
- Chronic low back pain following a motor vehicle crash
- Obstetric history - G = 2, T = 2 (vaginal deliveries), P = 0, A = 0, L = 2
The nurse reviews the concept of urinary incontinence, its causes, and symptoms with the student nurse.
Click to specify if the causes or symptoms are consistent with the disease process of stress incontinence, overflow incontinence, or urge incontinence.
Note: Each row must have 1 response option selected.
The nurse reviews the concept of urinary incontinence, its causes, and symptoms with the student nurse.
Click to specify if the causes or symptoms are consistent with the disease process of stress incontinence, overflow incontinence, or urge incontinence.
Note: Each row must have 1 response option selected.
| Causes or clinical manifestations | Stress Incontinence | Overflow Incontinence | Urge Incontinence |
|---|---|---|---|
Urine loss with physical exertion, cough, sneeze, or exercise | |||
Palpable bladder during assessment | |||
Caused by neurologic disorders, such as multiple sclerosis or spinal cord damage | |||
Caused by vaginal prolapse from vaginal birth or aging | |||
Caused by bladder irritants, such as artificial sweeteners, caffeine, alcohol | |||
Caused by constipation | |||
Loss of large amounts of urine with each occurrence |
Statistics
Subject/Lesson
Subject
Adult Health
Lesson
Urinary/Renal/Fluid and Electrolytes
Client Need
Test Plan
Physiological Adaptation
Related Topic
Alterations in Body Systems
Item Type
Item Type
AnalyzeCues
Explanation
The client in this scenario is demonstrating manifestations of stress incontinence. The client's previous vaginal deliveries are likely the cause of this type of incontinence. Additionally, the client has a low post-void residual, which is common with stress incontinence.
Stress incontinence
- Stress incontinence can be caused by the weakening of the bladder and neck related to childbirth.
- This causes the inability to tighten the urethra sufficiently to overcome the increased detrusor pressure, leading to urine leakage.
- This leakage can be caused by physical exertion, coughing, and sneezing.
- The post-void residual is usually less than 50 mL. Voiding habits are usually normal.
Overflow incontinence
- Overflow incontinence is characterized by underactivity of the detrusor muscle or bladder outlet obstruction.
- Anticholinergic medications, constipation, benign prostatic hypertrophy, and some neurologic disorders, such as multiple sclerosis or spinal cord damage, may cause this incontinence.
- A large post-void residual, bladder distention, constant dribbling of urine, and a sense of incomplete emptying of the bladder are manifestations associated with overflow incontinence.
Urge incontinence
- Urge incontinence is an involuntary loss of urine associated with a strong desire to urinate.
- The causes of this incontinence include idiopathic, neurologic disorders, such as stroke, Benign prostatic hypertrophy, and bladder inflammation. Bladder irritants, such as artificial sweeteners, caffeine, alcohol, citric intake, drugs, and nicotine, may cause this incontinence.
- Manifestations of urge incontinence include an abrupt and strong urge to void (urinary urgency), increased urinary frequency, nocturia, and a loss of large amounts of urine with each occurrence.
Additional Info
✓ Medications that may cause an alteration to normal urinary elimination include anticholinergic medications (e.g., diphenhydramine, paroxetine, cetirizine), diuretics (e.g., spironolactone), cholinergics (e.g., bethanechol), and opioids (e.g., oxycodone).
