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Geriatrics
Urodynamic
Courses of Geriatrics
 


 

General information:

A - DEFINITION:

Relate to the low part of the urinary tract.

Dysfunction of the bladder and the urethra.

The Urodynamic one is the study of the vesical and urethral pressures.

Examination which is practised in various stages:

a) Debimetry:

Study of the micturition.

b) Cystomanometry:

Study of the pressure intra-vesical during the filling and of the micturition.

c) Profilometry:

Study of the intra-urethral pressures

B - COLLECTION OF DATA ACCORDING TO ANADI'S:

1) SUBJECTIVE DATA:

Anomalies:

• In the need

• In the frequency of the micturitions

• In the volume of a micturition

• In the flow of the urines

• In the release of the micturition

2) OBJECTIVE DATA:

• Incapacity to reach the toilets in time

• Weak emissions of urine or abundant emissions

• Absence of emission of urine

C - DISCOUNTS RESULTS:

They represent at the same time the objectives and the criteria of evaluation.

- > the patient includes/understands his state.

- > the patient into practice puts conduits or techniques aiming at the control or the correction of his dysfunction.

Interventions nurses:

A - PRIORITY N° 1:

1) TO EVALUATE the DISABILITY RATE:

The catalogue mictionnel:

• Date

• Hour

• Need

• Volume of the micturition

• Escapes

• Residue in ml

• Survey in ml

• Hydrous Contributions

• Observations

2) TO EVALUATE the DEGREE Of AUTONOMY AND DISABILITY:

Support:

Pictogram

• Name/first name

• Date

Neurological

• Communication and functions

• Food

• Urinary and fecal Elimination

• Mobility/installation

• Toilet/clothing

• Prostheses Pastilles:

• Green: the person is autonomous

• Blue: the person is autonomous but must be stimulated

• Yellow: the person is only partially autonomous (to make with it)

• Red: the person is completely dependent (to make for it)

3) TO EVALUATE the FACTORS Of ETIOLOGY:

Which are the factors precipitants:

a) Signs of irritation vésico-sphinctérienne

• Urinary Infection

• Recent Ablation of SAD

• Irritating Spines: fécalome, escarre, inflammatory area périnéale

b) Signs of increase in the diuresis or the urinary concentration

• Excess of alcohol

• Cafeine.

c) Signs of weakening of the nervous control of the continence

• Be delirious or confusional states

• Depression

• Drugs: recent regulations

• Metabolic Disorders: hypoxia, dehydration, hypo or hyperglycemia

d) Ecological signs with loss of mobility

• Pain

• Breathlessness

• Orthostatic Hypotension

e) Signs of confusion

• Hospitalization

• Change of room

f) Signs of inadequacy of the environment

• Racks the night

• Distant or inaccessible Toilets with a deambulator

B - PRIORITY N° 2:

To collaborate in the treatment or the prevention.

a) Nychthemeral adaptation:

To increase the liquid contribution or to decrease it as from certain hours

b) Means of call:

To get to the patient of which mobility is reduced means of requiring of the assistance: bell.

To place the basin or the urinal at its range.

C - PRIORITY N° 3:

To lavish a teaching aiming at the greater comfort of the patient.

a) To incite the patient to restrict the contribution of exciting

b) Palliatives

To advise with the patient to adapt palliatives according to its needs:

• Tenette

• Shell

• Anatomical Exchange

• Complete Exchange

c) To insist on the hygiene of périnée after each micturition

d) To give and explain the protocols corresponding to the assumption of responsibility

• Car-survey

• Ablation SAD

e) To recommend to the patient to wear full and adapted clothing

f) To indicate to the patient the signs urinary complications

He to explain the need for a medical follow-up.

g) To manage the treatment prescribed

D - TO NOTE EC WHAT ONE MAKES:

• What was proposed and made

• What was observed

• What was evaluated

That makes it possible to rehabilitate the assumption of responsibility, where necessary, after a new dialogue of the looking after team.

Conclusion: The phenomenon of ageing is state of a precarious, likely balance of decompensation of the various functions necessary to the maintenance of an autonomous social life, in particular that which is in the center of this subject: the function vésico-shinctérienne.

Therefore all the tools which we can have between the hands must be used advisedly.

Protocol of ablation of a probe has residence (SAD):

1) TO WITHDRAW PROBE A REMAINS:

• To take the end of the probe

• To put It in a sterile bottle

• To send It to the laboratory for culture

• To note the date and the hour of ablation

2) TO PROBE WITH A PROBE BEQUILLEE:

• To inject 50 ml of frozen sterile physiological salt solution

• Then to drain

3) TO SUPERVISE the APPEARANCE Of a MICTURITION:

If appearance of a micturition:

• To quantify the urines

Assessment urodynamic:

A - PHYSIOLOGICAL RECALL:

Three phases:

a) Passive continence:

It is involuntary.

The bladder and the urethra are in the same enclosure of abdominal pressure.

Inhibition concerns the subcortical centers.

During the filling, there are relaxation at the vesical level and reinforcement at the urethral level.

The center of the continence is at the dorso-lumbar level.

b) Active continence:

Reinforcement of the muscles of périnée.

Inhibition of the reflex mictionnel on the level of the crowned and dorso-lumbar centers.

c) micturition:

Its release is voluntary.

There is muscular relaxation.

The center of the ordering of the micturition is at the crowned level.

B - VARIOUS FORMS Of INCONTINENCE:

The functional vesical capacity is 300 ml.

The difference between the first need and the imperative need must be 100 ml.

The residue mictionnel must be lower than 20% of the micturition or 100 ml.

The micturition can be stopped by voluntary contraction of the périnéaux muscles.

Mictionnelle urgency

Leakages out of jet which appear even at rest.

Imperative need from the start.

Urinary incontinence of effort (IUE)

Escapes concomitant and proportional to the effort.

In general, the micturitions are preserved.

Mixed symptomatology

Urgency and of effort

Retention

Description by the survey mictionnel of the existence of a residue.

Sometimes, at retentionnist, there are micturitions by clogging.

Post-mictionnelle incontinence.

Generally meets at the man.

Permanent incontinence.

C - ASSESSMENT:

It is important for the doctor to know the behavior mictionnel of the patient.

Nature and quantity of protections used.

Surgical antecedents.

A MMS is practised.

One evaluates the mobility of the patient: utility of the pictogram.

To check the existence of a prolapsus.

Test of the order.

Study of the reflexes and the sensitivity.

One asks the person to cough to check the escapes of effort.

Assessment itself

a) Debimetry:

Recording of the micturition.

• Form of bell

• Lower than one minute

b) Survey for checking of the residue post-mictionnel:

c) Cystomanométire:

Study of the vesical pressures.

Pose of a sensor in the bladder.

One fills it with air.

One asks the person to announce what it feels.

One measures the relationship between pressures and needs.

d) Profilometry:

One studies the pressures on the level of the urethra.

• Static Profilometry: one measures the pressures all along the urethra by withdrawing the sensor

• Dynamic Profilometry: one places the sensor at the point of stronger pressure and one appreciates stability

• One requires of the patient to contract his muscles

• One appreciates the Mise fatigability in obviousness of the various mechanisms of dysfunction:

e) vesical Hypo-activity:

• Neurological Problems

• Obstacle

f) Vesical hyperactivity:

• Too sensitive Bladders

g) Vesical instability:

• Variation of the pressures

h) Sphinctérienne insufficiency:

The striated muscle does not have a sufficient contractility to ensure the continence.

i) Instability sphinctérienne

j) Urethral hypertonicity

k) Urethral instability

l) Defect of transmission of the pressures

Treatment:

A - EDUCATION MICTIONNELLE:

a) Behavioral education

b) Mictionnelle reprogramming

c) Adaptation of the environment to the patient

B - MEDICAL TREATMENT:

• Vesical Hyperactivity: anticholinergic (DITROPAN)

• Hypoactivité vesical: iterative surveys + parasympatomimetic

• Sphinctérienne Insufficiency: rehabilitation

• Urethral Hypertonicity: alpha - XATRAL

C - ITERATIVE SURVEY:

A number proportional to the withdrawn quantity.

Never more than 200 ml each time.

D - REHABILITATION:

Biofeedback.

Manual work.

E - SURGERY:

• Prolapsus

• Bladder

• Prostate

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