AIIMS Delhi NO - 2017: The nurse is teaching the patient with a flaccid bladder. What should the care plan include for this patient.

AIIMS Delhi NO - 2017

Medical Surgical Nursing

Medium

Appeared in: AIIMS Delhi NO - 2017

Explanation

A flaccid bladder is a lower motor neuron problem where the detrusor muscle is atonic (lacks tone) and cannot contract to empty urine.
This condition leads to urinary retention, where the bladder becomes overstretched and distended with urine.
Credé's maneuver involves applying firm, gentle pressure over the suprapubic area to manually compress the bladder and express the urine.
This technique mechanically substitutes for the non-functional detrusor muscle, helping to empty the bladder and prevent complications like UTIs and kidney damage from urinary stasis.

Option A: Kegel exercises strengthen the pelvic floor muscles (outlet), which is counterproductive for a flaccid bladder where the primary issue is retention (inability to empty). Strengthening the outlet could worsen the retention.
Option C: A patient with a flaccid bladder cannot voluntarily empty it on command because the detrusor muscle does not contract. Therefore, simply encouraging them to empty it frequently is an ineffective strategy.
Option D: While adequate fluid intake is crucial for preventing urinary tract infections (a risk with urinary retention), it does not address the primary problem of emptying the bladder.

Clinical Relevance

Nursing practice connection: Use the key finding related to Management of Flaccid Neurogenic Bladder to guide bedside assessment, documentation, and the next nursing action.
Nurses play a key role in teaching patients and their families the correct technique for Credé's maneuver or intermittent self-catheterization, which are essential skills for managing a flaccid bladder at home.
Consistent and complete bladder emptying is critical to prevent urinary stasis, which significantly increases the risk of urinary tract infections (UTIs), bladder stones, and potential kidney damage (hydronephrosis).
What if? If the patient had a spastic (upper motor neuron) bladder instead of a flaccid one, Credé's maneuver would be contraindicated. Instead, the nurse would teach triggering techniques (like tapping the suprapubic area or stroking the inner thigh) to stimulate a reflex void.

How to Approach the Question

First, identify the key term in the question: 'flaccid bladder'.
Recall the pathophysiology of a flaccid bladder. It means the bladder muscle (detrusor) is weak or atonic and cannot contract. The primary problem is urinary retention.
Analyze each option in the context of urinary retention due to a non-contracting bladder.
Evaluate Option A (Kegel Exercise): These strengthen the outlet muscles. This would make it harder, not easier, to empty the bladder. Eliminate this option.
Evaluate Option B (Crede's maneuver): This is a manual method to compress the bladder from the outside to push urine out. This directly addresses the inability of the bladder to contract on its own. This is a plausible answer.
Evaluate Option C (Encourage frequent emptying): The patient lacks the muscular ability to empty the bladder, so encouragement alone is ineffective. Eliminate this option.

Concept Tested & Keywords

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E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 251-253

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