COMPLICATIONS

 Skin rash from wet underwear PATHOPHYSIOLOGY

 Emotional stress and embarrassment OVERACTIVE BLADDER
 Loss of opportunities for social activities

MODIFIABLE NON-MODIFIABLE
DESCRIPTION STRESS
CONSTIPATION (EXACT
HIGH FLUID INTAKE AFTER ETIOLOGY UNKNOWN)
 It is a condition wherein the patient DINNER
LABORATORY AND DIAGNOSTIC experiences urinary urgency, usually
TESTING accompanied by frequency and nocturia. BLADDER FILLING
 Urinalysis specific gravity (1.016-1.022) Overactive bladder can cause urinary
 (-) protein, glucose, ketone, nitrites incontinence, which is the involuntary
 WBC: <1 release of urine.
REDUCTION IN INHIBITORY
 RBC: <1 NEURAL IMPULSES
 Presence of bacteria: Absent to few
 Intravenous pyelogram (IVP)
SIGNS AND SYMPTOMS
 Voiding cystourethrogram (VCUG)  Sudden urge to urinate DETRUSOR MUSCLE STRETCHED
 Difficulty in controlling urge to urinate
 Urinate frequency
NURSING ASSESSMENT  May experience incontinence (enuresis) MICTURINITION REFLEX IS
 History taking ACTIVATED
 Stronger urge or need to urinate at night
 Rule out all organic causes/pathologies (waking up to urinate)
 Assess for stress factors INDUCED MUSCLE CONTRACTION
 Assess for signs and symptoms of UTI
 Assess for signs and symptoms of constipation or the bowel


movements difficulties
Assess for incontinence
RISK FACTORS
VOIDING URGENCY SENSATION
 GENDER
 GENETICS
THERAPEUTIC MANAGEMENT
 Timing the voiding intervals is important
 CONSTIPATION
 Limit fluid intake after dinner or at bedtime
 Any liquid containing caffeine, chocolate, or citrus is limited or not
allowed
 Use of footstool during voiding is recommended
OXYBUTYNIN
Classification: Anticholinergics/Antimuscarinics
Action: Oxybutynin acts to relax the bladder by inhibiting the muscarinic
action of acetylcholine on smooth muscle, leads to increased urine capacity
in the bladder, decreasing urinary urgency and frequency. In addition,
oxybutynin delays the initial desire to void
 Assess for s/sx of angioedema and discontinue if present
NURSING DIAGNOSIS: URGE URINARY INCONTINENCE
RELATED TO SMALL BLADDER CAPACITY
INDEPENDENT:
 Assess and rule out other causes for overactive bladder
(stressors/environmental)
 Assess for voiding pattern
 Determine time between urge to void and need to void
 Record how long the client delay urination
 Determine volume of each void
 Limit fluid intake after dinner, have child void before bedtime
DEPENDENT:
 Administer medication if prescribed, educate parents about proper
administration of medication
COLLABORATIVE:
 Initiate bladder reconditioning program

HEALTH TEACHING
INNOVATIONS
 Provide an opportunity to void on awakening; after meals, physical
exercise, bathing, and before going to sleep  Sacral nerve stimulation (SNS) has been used to treat OAB for
 Explain to parents and child the relation between incontinence and several decades. The SNS device is implanted above the buttocks.
intake of alcohol, caffeine, and colas A lead sends electrical impulses to the sacral nerves to calm the
 Encourage parents to verbalize feelings during this event, as this may bladder
also be very stressful for them  83 % of OAB patients who use the device experience a significant
 Instruct on proper administration of medication if child is prescribed reduction in symptoms (an average of 2.3 fewer leaks per day or 5
one
fewer voids).
 Encourage child to try to “hold” urine until time to void, if possible
 Downside: Potential need for battery replacement as early as three
 Explain the risk of insufficient fluid intake and its relation to
years after implantation, patients generally cannot undergo non-
infection and concentrated urine
head MRIs because of potential damage to the device and injury to
 Instruct the parents to give positive reinforcement
the patient
 Communicate to parents the need of respond rapidly to child’s
request for assistance for toileting