9. DRUG
Bethanechol has specific affinity for the cholinergic
receptors in the urinary bladder.
It is used to treat non-obstructive postoperative
and postpartum urinary retention to treat neurogenic
bladder atony.
It directly increases detrusor muscle tone and relaxes
the sphincters to improve bladder emptying.
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10. USE OF DRUG
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Bethanechol is approved for
treatment of neurogenic bladder
in children older than 8 years of
age.
11. NURSING ASSESSMENT
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These are the important things the nurse should include in conducting assessment,
history taking, and examination
Assess for contraindications or cautions (e.g. history of allergy to drug, GI obstruction,
pregnancy or lactation status, etc.) to avoid adverse effects.
Establish baseline physical assessment to monitor for any potential adverse effects.
Assess orientation, affect, reflexes to monitor CNS drug effects.
Assess vital signs, especially pulse and blood pressure to monitor for possible excess
stimulation of the cardiac system.
Assess abdomen, auscultating for bowel sounds and palpating for distention.
Monitor intake and output, noting any complaints of urinary urgency to monitor for
drug effects on the urinary system.
12. ANTICHOLINERGIC
Anticholinergics are drugs that block the
action of acetylcholine.
Acetylcholine is a neurotransmitter, or a
chemical messenger. It transfers signals
between certain cells to affect how your body
functions.
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13. USES
• Anticholinergics can treat a variety of
conditions, including:
• urinary incontinence
• overactive bladder (OAB)
• chronic obstructive pulmonary disorder
(COPD)
• certain types of poisoning
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14. 5/14/2020 14
• Urinary incontinence happens when you lose
control of your bladder.
• In some cases, you may empty your bladder’s
contents completely.
• In other cases, you may experience only minor
leakage.
• The condition may be temporary or chronic,
depending on its cause.
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Types
• Stress incontinence
1. Stress incontinence is triggered by certain types of physical activity.
2. For example, you might lose control of your bladder when you’re:
3. exercising
4. coughing
5. sneezing
6. laughing
7. Such activities put stress on the sphincter muscle that holds urine in your
bladder. The added stress can cause the muscle to release urine.
• Urge incontinence
1. Urge incontinence occurs when you lose control of your bladder after
experiencing a sudden and strong urge to urinate. Once that urge hits, you may
not be able to make it to the bathroom in.
• Overflow incontinence
1. Overflow incontinence can occur if you don’t completely empty your bladder
when you urinate. Later, some of the remaining urine may leak from your
bladder. This type of incontinence is sometimes called “dribbling.”
18. CAUSES
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• weakened bladder muscles, resulting from
aging
• physical damage to your pelvic floor muscles
• enlarged prostate
• cancer
• Some of these conditions are easily treatable
and only cause temporary urinary problems.
Others are more serious and persistent.
19. CAUSES
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• Other potential causes of incontinence include:
• constipation
• urinary tract infections (UTIs)
• kidney or bladder stones
• inflammation of your prostate
• interstitial cystitis, or a chronic condition that causes inflammation
within your bladder
• side effects from certain medications, such as blood pressure
drugs, muscle relaxants, sedatives, and some heart medications
• Some lifestyle factors can also cause temporary bouts of
incontinence. For example, drinking too much alcohol, caffeinated
beverages, or other fluids can cause you to temporarily lose control
of your bladder.
20. OAB
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• An overactive bladder (OAB) causes a sudden
urge to urinate. It can also trigger involuntary
loss of urine, known as incontinence.
21. SYMPTOMS
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• n overactive bladder is determined by the frequency
and urgency of urination. Symptoms include:
• an urgent and uncontrollable need to urinate
• frequent involuntary loss of urine
• frequent urination (more than eight times in a 24-hour
period)
• waking up more than once a night to use the bathroom
• Symptoms of overactive bladder can change. They may
be different from person to person, too, which can
make identifying the issue difficult without a doctor’s
help. Knowing the symptoms of overactive bladder can
help you find better treatments faster.
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• Your kidneys produce urine and that urine travels to your bladder. Then, your brain
sends signals that tell your body to urinate. Your pelvic floor muscles relax and
allow urine to exit your body.
• An overactive bladder causes your bladder muscles to contract involuntarily. This
gives the sensation of needing to urinate frequently even if your bladder isn’t full.
• Different conditions and factors can cause symptoms of OAB:
• drinking too much fluid
• taking medications that increase urine production
• urinary tract infections
• consumption of caffeine, alcohol, or other bladder irritants
• failure to completely empty the bladder
• bladder abnormalities, such as bladder stones
• The exact case of an overactive bladder is unknown. The risk of developing this
condition increases with age. But an overactive bladder isn’t a normal part of
aging, so you shouldn’t ignore symptoms. Seeing your doctor can help make sure
you get the correct diagnosis.
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• Anticholinergics
• How they work
• Anticholinergic drugs block the action of a chemical messenger —
acetylcholine — that sends signals to your brain that trigger
abnormal bladder contractions associated with overactive bladder.
These bladder contractions can make you feel the need to urinate
even when your bladder isn't full.
• Anticholinergic medications include:
• Oxybutynin (Ditropan XL, Oxytrol)
• Tolterodine (Detrol)
• Darifenacin (Enablex)
• Solifenacin (Vesicare)
• Trospium
• Fesoterodine (Toviaz)
25. • Nursing Assessment
• These are the important things the nurse should include in
conducting assessment, history taking, and examination:
• Assess for contraindications or cautions (e.g., history of allergy to
drug, GI obstruction, hepatorenal dysfunction, etc.) to avoid
adverse effects.
• Establish baseline physical assessment to monitor for any potential
adverse effects.
• Assess neurological status (e.g., orientation, affect, reflexes) to
evaluate any CNS effects.
• Assess abdomen (e.g., bowel sounds, bowel and bladder patterns,
urinary output) to evaluate for GI and GU adverse effects.
• Monitor laboratory test results to determine need for possible dose
adjustments and to identify potential toxicity.
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