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PatientInterface-Omeis

PatientInterface-Omeis
PatientInterface-Omeis

Betsy Omeis, RN, BSN

Assessment ?History

?Bladder Record (Bladder diary)?General Physical Exam

?Abdominal Examination

?Genitalia

?Anorectal Examination

?Neurological Examination

History

?Do you leak when:–sneeze, cough, laugh –get up from a chair ?Do you leak when:–strong urge –running water ?How many times do you urinate:

–daytime

–once asleep ?Do you feel you are not finished?–strain ?Do you wear pads?–how many –what types ?Medications ?Surgeries ?Previous treatments ?Bowels

Female Anatomy

Rectal Exam

Sample Voiding Diary

Urological Testing

?Urinalysis

?Postvoid Residual Urine Volume ?Pad Test

?Cough Test

?Uroflow

?Urodynamics

?Cystoscopy

?Ano-rectal Physiology

Urinalysis

?Microorganisms,

RBC, glucose,

specific gravity

?clean mid-stream

?Urine Culture &

Sensitivity when

symptomatic

?Catheterize for C&S

?>100,000 bacteria-

UTI

Post-Void Residual Urine ?Amount of fluid remaining in bladder immediately following urination

?<10% or <100cc

?Performed by:

–Abdominal Palpation

–Catheterization

–Pelvic Ultrasound

–Radiographic imaging

Catheterizing a Female

Foley Catheter

?urinary retention

?urethral obstruction

?14-18 fr size catheter

?5cc balloon

?drainage bag

?irritation, urgency

?urosepsis

?erosions

?stones

30cc Balloon vs 5cc balloon

Drainage bags

Cough Stress Test Pad Test

Why do we need to test?

?Q Tip Test

–Test for mobility

–>30 degree

–zylocaine jelly Simple Tests

?

Q Tip Test

–Test for mobility

–>30 degree

?Simple CMG

–Urethral catheter

–Manometer or

–Toomey Syringe Simple Tests

Urodynamics

?A series of diagnostic studies used to evaluate a patient’s ability to store and eliminate urine.

?The goal is to reproduce bladder filling/storage and voiding/emptying symptoms to identify underlying causes

Uroflowmetry ?Measures how much

and how fast the urine

comes out

?Provides a pattern

?Measure the PVR

?prep-full bladder

Normal Flow

Explosive Flow

Low Flow Intermittent Flow

Urodynamic Machine

Urethral and Rectal Catheters Complex Urodynamics

Normal Study

Cystoscopy

?Diagnose urinary tract

disorders

?Provide direct view of

urethra and bladder

?Flexible instrument

?Needs water to fill

?Local anesthetic Cystoscopy of Female Urethra

Cystoscopy of Bladder Neck

Cystoscopy

Glomerulations

Trabeculated Bladder

Voiding Cystourethrogram

Exams of the Urinary System

?Non fluoroscopic

?Antegrade studies

–intravenous pyelogram

(IVP)

–contrast media

?iodine compound

injected into

bloodstream

–Timed set of

exposures

Ano-rectal Physiology Tests

?Ano-rectal Manometry

?Pudendal Nerve Latency Test ?Endorectal Ultrasonography ?Defecotography

?Prep-enemas x2 one hour prior

Anorectal manometry

?Measures resting

tone of the internal

sphincter

?measures contractility

of external sphincter

?Measures functional

length of the anal

canal

Anorectal Manometry

Tracings

Pudendal Nerve Latency Test ?Assess nerve

innervation of

external sphincter

?How fast does the

muscle (motor unit)

react to electrical

stimulation

Defecotography

?Fluoroscopic

examination of

changes that occur in

the pelvic floor during

defecation

Rectal Ultrasound ?Assess pelvic floor

function

?assess the internal

and external sphincter

?look for any defects

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