Archive:Urinary Incontinence: Difference between revisions
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'''Types of incontinence''' | =='''Types of incontinence'''== | ||
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|'''Type''' | |'''Type''' | ||
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HPI: | ==HPI:== | ||
Timing | ===Timing=== | ||
*When: day/night | *When: day/night | ||
*Duration | *Duration | ||
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*New or ongoing | *New or ongoing | ||
Urinary Sx | ===Urinary Sx=== | ||
*Dysuria | *Dysuria | ||
*abnormal urine | *abnormal urine | ||
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*post void dribble | *post void dribble | ||
Systemic | ===Systemic=== | ||
*fever | *fever | ||
*polydipsea | *polydipsea | ||
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*stool incontinence | *stool incontinence | ||
PMHx | ==PMHx== | ||
Medical | ===Medical=== | ||
*Cancer | *Cancer | ||
*Diabetes | *Diabetes | ||
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*prostatic hypertrophy | *prostatic hypertrophy | ||
Surgical | ===Surgical=== | ||
*Vaginal/pelvic | *Vaginal/pelvic | ||
*prostate | *prostate | ||
Gyne | ===Gyne=== | ||
*Gestation/Parity | *Gestation/Parity | ||
Medications | ==Medications== | ||
*Sedatives | *Sedatives | ||
*Tranquilizers | *Tranquilizers | ||
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*diuretics | *diuretics | ||
Family history | ==Family history== | ||
*any similar problems in family? | *any similar problems in family? | ||
Social history | ==Social history== | ||
*Function at home | *Function at home | ||
*restricted mobility | *restricted mobility | ||
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Review of systems | ==Review of systems== | ||
*endocrine | *endocrine | ||
**menopause/atrophic vaginitis | **menopause/atrophic vaginitis | ||
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**constipation/diarrhea | **constipation/diarrhea | ||
Etiology | ==Etiology== | ||
*DRIP | *DRIP | ||
**Dementia/Delerium | **Dementia/Delerium | ||
Revision as of 20:48, 17 May 2007
Types of incontinence
| Type | Mechanism | Symptoms | Signs | Treatment |
| stress | abdominal pressure against a weakened urethral sphincter | momentary leak with a small amount lost with sneezing laughing, etc. | nonpalpable bladder, atrophy and incontinence | kegel excercises, pessary, consult urology/gyne |
| urge | decreased detrusor contraction
increasing of sensory pathways deconditioned voiding reflex |
urge to void
moderate volume nocturia dysuria |
nonpalpable bladder
signs of CNS disease fecal impaction |
decreased night fluids
pads retrain bladder with regular toileting |
| overflow | poor detruser control
outlet obstruction (ie BPH) decreased bladder sensation |
continuous dribble
decreased stream force urinary obstruction |
large tender bladd
large prostate decreased perineal sensation decreased anal reflex motor disease |
catheter
consult urology for bladder dynamics |
| functional | decreased mobility or environmental | incontinent on way to bathroom or in early morning | non palpable bladder | improve mobility
change environment |
| true | fistula
ectopic ureteric orifice |
constant dribble
small amount of urine |
urine from vagina or ectomic orifice | surgery |
| post void dribble | psychogenic
prostatitis obstruction |
HPI:
Timing
- When: day/night
- Duration
- Flow
- Activity
- Intermittent/constant
- New or ongoing
Urinary Sx
- Dysuria
- abnormal urine
- hesitancy
- urgency
- quality of stream
- volume
- aware of urine loss
- relieving/aggrevating factors
- post void dribble
Systemic
- fever
- polydipsea
- decreased perineal sensation
- stool incontinence
PMHx
Medical
- Cancer
- Diabetes
- Stones
- CVA/Parkinson's/Dementia
- hypercalcemia (exhibits polyurea and polydipsea)
- prostatic hypertrophy
Surgical
- Vaginal/pelvic
- prostate
Gyne
- Gestation/Parity
Medications
- Sedatives
- Tranquilizers
- anticholinergics
- symptomatic blockers
- diuretics
Family history
- any similar problems in family?
Social history
- Function at home
- restricted mobility
- employment
- EtOH
- Caffiene
- smoking
Review of systems
- endocrine
- menopause/atrophic vaginitis
- neuro
- sensory or motor changes?
- GI
- constipation/diarrhea
Etiology
- DRIP
- Dementia/Delerium
- Restricted mobility
- Infection
- Pharmacy
Other OSCE modules
Acute Confusion - Acute Coronary Syndrome Orders - Anemia - Arterial Blood Gasses - Asthma - Blood Pressure - Chest pain - Chest XRay - CHF - Coma - COPD - Cranial Nerves - Diabetic History - Diabetic Foot - Dysphagia - EKGs - Gallbladder and Liver - Liver Disease - Gait and Balance - Headache - Hematemesis - Hypertension - Jugular Venous Pulses - Knee Exam - Lymph Nodes - Community Acquired Pneumonia - Parkinson Disease - Peripheral Arterial Insufficiency - Pneumonia Examination - Precordial Exam - STD's - Spleen - Swollen Leg Exam - Thyroid Exam - Upper vs Lower Motor Neuron Lesions - Urinary Incontinence