STUDY - Technical - New Dacian's Medicine
bladder
distention (Classical / Allopathic Medicine)
Bladder distention
- abnormal enlargement of the bladder - results from an
inability to excrete urine, leading to its accumulation.
Distention can be caused by mechanical or anatomic
obstruction, a neuromuscular disorder, or the use of certain
drugs. Relatively common in all ages and in both sexes, it's
most common in older men with prostate disorders that cause
urine retention.
Bladder
distention usually develops gradually, but occasionally its
onset is sudden. Gradual distention usually remains
asymptomatic until stretching of the bladder produces
discomfort. Acute distention produces suprapubic fullness,
pressure, and pain. If severe distention isn't corrected
promptly by catheterization or massage, the bladder rises
within the abdomen, its walls become thin, and renal function
can be impaired.
Bladder distention
is aggravated by the intake of caffeine, alcohol, large
quantities of fluid, and diuretics.
ALERT:
If bladder distention is severe, immediately arrange for bladder catheterization. If bladder distention isn't severe, perform a focused assessment.
If bladder distention is severe, immediately arrange for bladder catheterization. If bladder distention isn't severe, perform a focused assessment.
HISTORY:
Review the patient's voiding patterns. Ask him if he has difficulty urinating. Does he use Valsalva's or Credé's maneuver to initiate urination?
Ask the patient if he has urinary urgency or frequency. Is urination painful or irritating?
Ask the patient about the force and continuity of his urine stream and whether he feels that his bladder is empty after voiding.
Review the patient's medical history for urinary tract obstruction or infections; venereal disease; neurologic, intestinal, or pelvic surgery; lower abdominal or urinary tract trauma; and systemic or neurologic disorders.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Review the patient's voiding patterns. Ask him if he has difficulty urinating. Does he use Valsalva's or Credé's maneuver to initiate urination?
Ask the patient if he has urinary urgency or frequency. Is urination painful or irritating?
Ask the patient about the force and continuity of his urine stream and whether he feels that his bladder is empty after voiding.
Review the patient's medical history for urinary tract obstruction or infections; venereal disease; neurologic, intestinal, or pelvic surgery; lower abdominal or urinary tract trauma; and systemic or neurologic disorders.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs.
Percuss and palpate the bladder.
Inspect the urethral meatus. Describe the appearance and amount of discharge.
Take the patient's vital signs.
Percuss and palpate the bladder.
Inspect the urethral meatus. Describe the appearance and amount of discharge.
SPECIAL
CONSIDERATIONS:
Use of an indwelling catheter can result in urine retention and bladder distention if the tubing is kinked or occluded.
If interventions fail to relieve bladder distention or obstruction, the patient will need surgical intervention.
Use of an indwelling catheter can result in urine retention and bladder distention if the tubing is kinked or occluded.
If interventions fail to relieve bladder distention or obstruction, the patient will need surgical intervention.
PEDIATRIC
POINTERS:
Look for urine retention and bladder distention in any infant who fails to void normal amounts. (In the first 48 hours of life, a neonate excretes about 60 ml of urine; during the next week, he excretes about 300 ml of urine daily.)
In males, posterior urethral valves, meatal stenosis, phimosis, spinal cord anomalies, bladder diverticula, and other congenital defects can cause urinary obstruction and resultant bladder distention.
Look for urine retention and bladder distention in any infant who fails to void normal amounts. (In the first 48 hours of life, a neonate excretes about 60 ml of urine; during the next week, he excretes about 300 ml of urine daily.)
In males, posterior urethral valves, meatal stenosis, phimosis, spinal cord anomalies, bladder diverticula, and other congenital defects can cause urinary obstruction and resultant bladder distention.
PATIENT
COUNSELING:
Provide privacy to the patient to help him assume a normal voiding position. Teach him to perform Credé's maneuver, stroke or apply ice to the inner thigh, or relax in a warm tub or sitz bath. Use the power of suggestion to stimulate voiding, such as tapes of aquatic sounds.
Provide privacy to the patient to help him assume a normal voiding position. Teach him to perform Credé's maneuver, stroke or apply ice to the inner thigh, or relax in a warm tub or sitz bath. Use the power of suggestion to stimulate voiding, such as tapes of aquatic sounds.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)