Assignment: Dysfunction of the bladder
Management in a patient who has to frequently self-catheterize.
Research the self-directed learning issue and provide a summary of your findings which is fully supported by appropriate, scholarly, EBM references.
“Neurogenic bladder is defined as the dysfunction of the bladder, causing one to lack bladder control” (Engelke, & Schub, 2017). It can be caused due to neurologic disorders of the central nervous system (CNS) or peripheral nerves that controls micturition. Spinal cord injury (SCI), spina bifida, Parkinson’s disease, multiple sclerosis, diabetes, brain tumors, cerebrovascular accident, neural tube defects and other diseases cause dysfunctional bladder (Engelke, & Schub, 2017). Urologic problems cause an alternation of the lower urinary tract function, which have been a huge cause of morbidity and mortality in patients with SCI (Edokpolo, Stavris, & Foster, 2013).The bladders storage and emptying is affected causing persistent urinary retention. SCI plays an effect on the “urethral sphincter and the function of the detrusor muscle causing neurogenic voiding dysfunction” (Edokpolo, Stavris, & Foster, 2013).
Patients with dysfunctional bladders require intermittent catheterizations in which the bladder is emptied several times throughout each day, usually every four to six hours. There are many barriers that may occur with intermittent catheterizations, such as managing the occurrences, engaging in proper technique during each catheterization, inconvenience of catheterizing, inaccessible bathrooms, restrictions in traveling, and lack of optimal catheter supplies (Wilde, Fairbanks, Parshall, Feng, Miner, Thayer, McMahon, 2015). Complications include urine leakage and urinary tract infection (UTI). The most common complication in SCI patients is UTI. These patients are at risk that may develop “bladder over distention, outlet obstruction, detrusor sphincter dyssynergia, increased intravesical pressure, vesicourecteral reflux, and large post void residuals” (Edokpolo, Stavris, & Foster, 2013).
As providers, it is important to teach patients with intermittent catheterization that self-management skills are required. It is important to learn how to The important to learn how to follow a daily regime, monitor fluid intake and output, prevent leakage and stay hydrated. Patients should also be able to recognize the early symptoms of UTI (Wilde, et al, 2015). “Some signs and symptoms of UTI include fever, chills, lethargy, lower abdominal pain, back pain, flank pain, urgency, painful urination, hematuria, and change in mental status” (Engelke, & Schub, 2017).
Education should be given for basic intermittent catheter self management. Patients should drink more water, limiting coffee and sodas. Limit fluids in the evening. Keep an intake and output diary avoiding bladder distention as well as noticing how often one catheterizes. Note the color and consistency of urine and if there are any changes. Patients should be cautious of changes in activity levels, stress, and overall health (Wilde, et al, 2015). Patients should adhere to single use protocols using sterile technique. Eating foods containing lactobacillus, such as yogurt and taking vitamin C may prevent a UTI (Engelke, & Schub, 2017). Hand washing is most important for patients who self catheterize. Hand washing with soap and water prevents the spread of bacteria and prevent infection.
A study was conducted to evaluate a web-based approach as an intervention for people who frequently use intermittent catheterizations. Reports provide practitioner’s pertinent information about how patients self manage using graphs and tables to monitor intake and output. Specific topics on the website include optimal fluid intake, promote best intermittent catheterization interval, prevent leaking, urine output etc. The interactive diary allows peer led discussions, educational journals and goals (Wilde, et al, 2015). This is a beneficial intervention that patients could use who is using long-term intermittent catheterizations.
Edokpolo, L. U., Stavris, K. B., & Foster, H. E. (2013). Intermittent catheterization and recurrent urinary tract infection in spinal cord injury. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584766/pdf/sci-18-187.pdf
Engelke, Z. R. M., & Schub, T. B. (2017). Pateint education: Home care—Teaching intermittent self catheterization in adults. CINAHL Nursing Guide.
Wilde, M. H., Fairbanks, E., Parshall, R., Feng, Z, Miner, S., Thayer, D., McMahon, J. M. (2015). A web-based self-management intervention for intermittent catheter users. Urologic Nursing, 35(3), 127-138. http://doi- org.chamberlainuniversity.idm.oclc.org/10.7257/1053-816X2015.35.3.127
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