医学生物PPT尿失禁保守治疗之种类及选择课件.pptVIP

业精于勤荒于嬉 行成于思毁于随 →【医学生物PPT，欢迎收藏分享】豆丁网友 尿失禁保守治療之種類及選擇 蔡娟秀 慈濟技術學院 護理系 慈濟醫院排尿障礙治療中心 中華民國 九十二 年 八 月 十 日 尿失禁的保守療法 以非藥物及手術的方式，改善尿失禁 又稱為行為治療 常見的治療方式包含 生活型態改變及行為重建 骨盆底肌肉運動 排尿訓練 電刺激 輔助控尿的醫材使用 選擇保守治療影響因素 尿失禁與骨盆底鬆弛之嚴重度 病人之認知狀態及動機 骨盆底肌肉之功能及隨意收縮之能力 活動及日常生活自理能力 病患評估 History Onset and clinical course Frequency and volume of accidents Circumstance of causing urine loss Bladder habits Daily fluid intake Self-management technique Urinary symptoms and bowel habits Related medical diagnosis and medication Pelvic examination Atrophic changes Vaginitis Cystocele Rectocele Uterine prolapse Laxity and Levator ani structure Functional assessment ADL function. Mobility and toileting ability Mental and cognitive status Environmental Assessment The distance to reach the toilet Any barrier between the client’s usual location and the toilet: poor lighting, furniture or other objects, steps The size of the bathroom The toilet height The presence or absence of grab bars The availability of caregiver or nursing staff assistance The availability of emergency call Lifestyle Modification生活型態改變及行為重建 Posture correction Smoke cessation Weight reduction Good bowel habits Caffeine reduction Dietary and fluid modification 骨盆底肌肉訓練 個別指導 團體指導 居家訓練 生理回饋輔助訓練 陰道錐重力訓練 運動器材輔助訓練 骨盆底肌肉運動訓練之選擇 Digital Examination Brink(1989) methods: two fingers Digital Examination Worth(1986) methods: one finger The P.E.R.F.E.C.T. Scheme P/E/R/F 2/3/4/6 P=Power E=Endurance R=Repetitions F=Fast ECT=Every Contraction timed 單純骨盆底肌肉訓練 Used of stress, urge, and mixed UI, cognitively intact and highly motivated Able to perform isolated PFM contraction Regular exercise with stress strategy (knack) and urge strategy Biofeedback Use electronic or mechanical instruments to display visual or auditory information about neuromuscular or bladder activity UI patients, able to interpret analog or digital signals, motivated, with very weak PFM or unable to preformed isolated con