NORCET 5 mains
Medical & Surgical Nursing
Easy
A patient has a pain in lower abdomen and feels retention of urine. Which maneuver would be used to empty the neurogenic bladder?
Appeared in: NORCET 5 mains
Explanation
- The Crede maneuver is a specific technique for managing urinary retention, particularly in cases of a flaccid (non-contractile) neurogenic bladder.
- It involves applying manual pressure over the suprapubic area to physically compress the bladder and facilitate urine expulsion.
- This method helps prevent complications of urinary stasis, such as urinary tract infections (UTIs) and bladder overdistension.
- The technique should only be performed after consultation with a healthcare provider, as it is contraindicated in certain conditions like a spastic bladder.
Why Other Options Were Wrong
- Option A: The Leopold maneuver is an obstetric assessment tool and has no function related to the urinary system.
- Option C: The Valsalva maneuver increases general intra-abdominal pressure but is not a targeted or recommended method for emptying a neurogenic bladder. It can also cause unwanted cardiovascular effects.
- Option D: The Heimlich maneuver is an emergency procedure for choking and is completely unrelated to bladder function or the urinary tract.
Related Visual
- Visual 1: Diagram - The provided image clearly demonstrates the hand placement and direction of pressure for the Crede maneuver.
- Visual 2: Infographic - A comparative chart showing illustrations and brief descriptions of the Crede, Leopold, Valsalva, and Heimlich maneuvers side-by-side to highlight their different purposes and applications.
Clinical Relevance
- Nursing practice connection: Use the key finding related to Management of Neurogenic Bladder to guide bedside assessment, documentation, and the next nursing action.
- Nurses play a crucial role in teaching patients and their families the correct technique for the Crede maneuver for long-term management of a flaccid bladder at home.
- It is critical to assess for contraindications. The maneuver should not be used with a spastic bladder, as it can increase bladder pressure to dangerous levels and cause vesicoureteral reflux (urine backing up into the kidneys).
- What if the patient had a spastic neurogenic bladder instead of a flaccid one? In that case, the Crede maneuver would be contraindicated. Treatment would focus on medications to relax the bladder (anticholinergics) and intermittent catheterization to ensure complete emptying.
How to Approach the Question
- First, identify the key clinical problem presented in the question: a patient with a neurogenic bladder needs help with emptying urine.
- Next, analyze the options provided, which are all named medical maneuvers.
- Systematically recall or deduce the purpose of each maneuver. For example, 'Heimlich' is for choking, and 'Leopold' is for pregnancy. This allows you to quickly eliminate incorrect options.
- Differentiate between the remaining plausible options. Both Crede and Valsalva can increase pressure, but Crede is a targeted manual compression of the bladder itself, making it the specific procedure for this condition.
- Confirm your choice by matching the specific maneuver (Crede) to the specific condition (emptying a neurogenic bladder).
Concept Tested & Keywords
- Concept Tested: Management of Neurogenic Bladder
- Stem keywords: pain in lower abdomen, retention of urine, neurogenic bladder, maneuver
- Lead-in keywords: Which maneuver
- Clinical cues: The patient's symptom of urine retention combined with a diagnosis of neurogenic bladder points to a need for assisted bladder emptying.
Question ID
QGxdL6j1Ovt-tEb3UJX22l
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Attempt every question from this paper in a timed mock, then review the full solution for each one.
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