Continence Care Part 2: Evidence Based Bladder Assessment

1. Introduction of Normal Bladder Physiology

This chapter will introduce normal bladder function, using graphic images to present structures and function of the bladder, ureters, kidneys, and urethra. Similarly, the neurological system including spinal nerves, spinal cord, micturition center, and cerebral cortex. Neurological and neuromuscular controls that guide bladder filling, storage and elimination will be presented with a description of the parasympathetic/sympathetic and somatic nervous systems. Abnormal bladder function will be introduced briefly using graphics to discuss trauma and other various disease states that can result in bladder dysfunction.

2. Determine Risk Factors for Urinary Dysfunction

This chapter provides description of various risk factors for urinary dysfunction. Each element will be briefly described in simple terms. Nine risk factors will be presented, including neuro-cognitive (cog impairment, neurological injury), structural (previous indwelling catheter, obstructive conditions, obesity, limited mobility, pelvic organ prolapse among women), and disease-state/intrinsic (diabetes, medication side effects, infection).

3. The Patient Interview: Screening for Urinary Symptoms

This chapter will present a systematic interview with patients to identify problematic bladder patterns. This interview is based upon validated instruments and evidential recommendations from the literature. Then, urinary dysfunction patterns will be explained (urge incontinence, stress incontinence, mixed incontinence and functional incontinence).

4. The Physical Assessment

This chapter will introduce a systematic approach to conducting a patient assessment to establish various physical contributors to bladder dysfunction. These will include examination of oral/swallow ability, a focused neurological exam, an abdominal exam, inspection of the perineal skin and urethral meatus. Finally, a functional assessment is described including mobility, comprehension, problem solving and balance.

5. Data Collection

This chapter will introduce the importance of collecting data to evaluate a patient’s urinary pattern. This module proposes the use of a specially designed frequency-volume/elimination chart. Additional data to collect includes urine microscopy, bladder scanning to evaluate filling and post-void residual volumes, last bowel movement and bowel function affecting urinary patterns, and a comprehensive medication review.

6. Symptom Identification & Nursing Diagnosis

This chapter then introduces the “next steps” after performing a comprehensive assessment of the patient and provides instructions on defining incontinence: potential causes, and utilization of an algorithmic approach to care. If the patient is predominantly demonstrating urinary incontinence symptoms (leakage of any kind), the nurse will be prompted to utilize recommendations for incontinence management. If the patient is predominantly demonstrating urinary retention (incomplete elimination of post-void volumes > 150cc), the nurse will be prompted to utilize recommendations for urinary retention/dysfunction management.