plan of care

plan of care

anticholinergic medications

Indwelling foley catheters

potential management options for neurogenic bladder

antispasmodics and antidepressants

intermittent catheterization

Urostomies and vesicostomies

suprapubic catheters

Alpha-blockers

Monitor fluid intake with strict I&O documentation

timed voiding with reflex bladder emptying

botulinum toxin injections

Common mistakes

5. It includes imagesand entertains

1. It is clearand structured

Contextualize your topic

6. It represents datawith graphs

2. It tells stories hierarchically

Visual content is a cross-cutting, universal language, like music. We are able to understand images from millions of years ago, even fromother cultures.

7. It usestimelines

3. It matchesyour audience

8. It is animatedand interactive

4. It adapts the fonts and color to the theme

Reflex voiding

Alert: Reflex techniques need to be approved by your healthcare professional or urologist, as the added pressure can cause urine to reflux into the kidneys and rectal prolapse. Individuals with lower-level and/or incomplete SCI may be able to expel urine during their bowel program, tapping over their bladder, using the crede' technique (where one rolls their fingers over the bladder on the skin of the abdomen from top to bottom), bearing down (valsalva) to create pressure in the abdomen to push out urine. This can be added to timed-voiding, and post-void residuals (PVR) may need to be checked initially via a bedside bladder ultrasound machine, to ensure complete bladder emptying.

Bladder ultrasound for measuring post-void residuals.

Here you can put a highlighted title

• Plan the structure of your communication.
• Prioritize it and give visual weight to the main points.
• Define secondary messages with interactivity.
• Establish a flow throughout the content.
• Measure the results.

Share your idea withan image

Bring life to the elements of your creation with animation. It's impossible not to pay attention to moving content!

We are visual beings

We are capable of understanding images from millions of years ago, even from other cultures.

Narrative beings

We have thousands and thousands of stories. Two-thirds of our conversations are stories.

Fluid intake and strict Ins & outs

• Intake:
• Consistent fluid intake is important to prevent overflow incontinence between catheterizations.
• Limit fluid in the evenings to facilitate sleep and continence overnight.
• Individuals may have a fluid goal order that they need to reach every 24 hours
• Example plan for fluid intake if there is a 2000 mL fluid goal
• Up to 400cc/meal
• Up to 600cc between meals
• Up to 200cc after 7pm
• Output:
• Adult bladders can comfortably hold 300-400mL of urine.
• For children less than 2 years old:
• 2 × age (years) + 2 = capacity (ounces)

• For children 2 years old or older:
• age (years) ÷ 2 + 6 = capacity (ounces)
• Catheter volumes greater than expected based on the individual's age should be reported to the provider. There is a concern for overfilling the bladder and urine refluxing back into the kidneys.
• Note whether the patient has an episode of incontinence between caths, urine volume, urine color, and presence of sediment before properly disposing of urine.

Anticholinergic medications

work by blocking cholinergic transmission at muscarinic receptors. These drugs decrease bladder contractions and spasms to reduce and eliminate overflow incontinence. SThey can also help prevent permanent bladder atrophy in indwelling and suprapubic catheters. Side effects are drowsiness, blurred vision, heart palpitations and facial redness, among others. Examples: Ditropan, Detrol

alpha-blockers

treat detrusor sphincter dyssynergia (DSD) and low bladder pressure, and are used with the reflex voiding management method.Detrusor sphincter dyssynergia (DSD) is a neurological condition in which the bladder muscle and urethral sphincter fail to coordinate during urination, leading to urinary obstruction and increased bladder pressure. They should not be used by individuals with extremely low blood pressure or orthostatic hypotension. Examples: Flomax, Hytrin, Cardura

Here you can put a highlighted title

We are in the era of the explosion of digital information. This causes our way of obtaining information to have changed, moving from traditional reading to a cognitive strategy based on navigation.

Write agreat headline

When we are told a story, it moves us; it can even touch our hearts, making us remember stories up to 20 times more than any other content wecan consume.

Suprapubic catheters

They are used for individuals who have high-pressure bladders or are at extreme risk for high bladder pressure. It is usually done early after trauma, but can be recommended anytime in disease processes or with the development of uncontrolled or increased pressures in the bladder. Suprapubic catheters are placed through a surgical opening in the skin above the pubic bone over the bladder. A catheter is then placed through this opening for continuous drainage of urine. Eventually, the skin will heal around the edges of the opening but will remain open around the catheter.Pros: Accessed above the pubic bone, so it opens up opportunities for more caregivers without having to expose the perineal area. Cons: Bladder atrophy.

Suprapubic Catheter

Write agreat headline

Visual content is a cross-cutting, universal language, like music. We are capable of understanding images from millions of years ago, even fromother cultures.

Urostomies and vesicostomies

A urostomy is where the ureters, the two small tubes that drain urine from the kidneys to the bladder, are diverted onto the surface of the abdomen. These tubes are so tiny that they have to be transplanted into a small piece of bowel which forms the stoma. The urine drains continuously into a special bag (appliance) which is then emptied regularly. A vesicostomy is where the bladder is diverted through a small opening directly onto the surface of the abdomen. Intermittent catheterization is performed on a routine schedule into the stoma of the vesicostomy to drain the urine.

These diversions can be helpful for children who have difficulty managing cleanliness in the perineal area while inserting the catheter. It may also be preferred option for those who cannot perform their own catheterization to have more caregivers trained without having to access the perineal area. Depending on the surgical procedure used to create the diversion, they may or may not be reversible.

Mitrofanoff Vesicostomy

botox injections

are used as a treatment directly into the urinary sphincter and/or bladder for detrusor sphincter dyssynergia (DSD). The medication relaxes contraction. Repeated treatments are required, typically every 3 months, to continue effectiveness.

Intermittent catheterization

is the most preferred method of bladder management because it mimics the natural stretching and contracting of the bladder muscle and has less risk of infection. The system can be used by individuals with high- or low-pressure bladders, reflexive or flaccid bladders. The intervention is initially performed every 4 hours, and requires a consistent schedule.

Types of Catheters

• Straight tip: Standard choice when initiating intermittent catheterization

• Coude' tip: This catheter follows the natural curve of the male urethra, and is typically used in males with previous urethral trauma, prostate concerns, difficult catheterizations, and the male anatomy.
• Always insert with the cured tip pointed up.
• You need a provider order to use a coude' tip.
• Use of coude' tip for males is not automatic
• Incorrect insertion can result in trauma to the patient's urethra and surrounding tissue.
• Speedycath or LipStick catheter: These catheters are small (like a tube of lipstick) and discreet. The catheter length is short to accommodate the female anatomy. These are a great option for individuals who can independently transfer to a commode; the urine drains directly into the toilet, and the catheter can be disposed of in a typical restroom hygiene trash can.
• Closed System Catheters: Great choice for SCI patients who need routine catheterization, and are utilized on the inpatient rehabilitation unit.
• Most closed system catheters have incorporated an introducer tip that has been shown to decrease urinary tract infections. This is accomplished by bypassing the first 1 cm of the urethra, which contains the highest level of bacterial concentration. The introducer tip is reported to reduce the number of bacteria pushed into the bladder.
• Advancement of the catheter out of the collection bag prior to insertion into the urethra reduces the potential for contamination of the catheter.

Straight

Coude'

SpeediCath or Lipstick

Please note: this is not an all-inclusive list; there are many brands and types of specialty catheters available. Some come prelubricated or coated with a hydrophilic or antibaacterial substance. There are also specialty catheters that are adapted for individual with limited dexterity.

Closed Systems

indwelling catheters

are mostly used long-term by women with high pressure bladder, an inability to perform intermittent catheterization, or due to lack of external catheter options. Men occasionally use indwelling urethral catheters but less often. The indwelling catheter allows a continuous flow of urine while keeping the urine contained and skin dry which avoids pressure injury. The indwelling catheter is connected to a leg bag or night collection bag. Connecting tubing may or may not be used. Ideally, indwelling catheters are discontinued as soon as possible to prevent recurring UTIs and bladder atrophy.

• Pros: Option for those with a UMN injury who cannot perform their own bladder management, and do not have a caregiver who is available throughout the day for intermittent catheterization.
• Cons: Increased risk of UTIs and bladder atrophy.

ANTIDEPRESSANTS and antispasmodics

• Antidepressants relax the bladder muscle. Typically, tricyclics are used. If an antidepressant is prescribed for mental wellness, a beneficial side effect is bladder muscle relaxation.
• Antispasmodics relax the bladder muscle so more urine can be held prior to elimination. Side effects include interference with activities that require physical coordination and mental alertness

Do you have an idea?

Create a new layer of content with all the functionalities of Genially.

• Generate experiences with your content.
• It has a WOW effect. Very WOW.
• Make your audience remember the message.
• Engage and surprise your audience.

Write agreat headline

Disciplines such as Visual Thinking facilitate the taking of visually rich notes thanks to the use of images, graphs, infographics, and simple drawings. Go for it!