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  1. key terms
    • detrusor- a body part that pushes down, such as bladder muscle
    • incontinence- inablity to control excretory function
    • micturition- urination
  2. concepts of elimination
    • elimination is the removal of waste products of the metabolism from the body
    • bowel and bladder functions later in life contribute to the independence of older adults
  3. Bladder function
    • normal bladder function requires:
    • - intact brain and spinal cord
    • - competent lower urinary tract function
    • - motivation to maintain continence
    • - functional ability to use toilet
    • - environment that facilitate the process
    • full bladder signals nervous system to cause contraction- drusen muscle contractions and the urinary sphrinter relaxes
  4. Age related changes in the bladder
    • changes include:
    • - decreased capacity
    • - incr irritability
    • - contractions during fillings
    • - incomplete emptying
    • Changes lead to:
    • - frequency
    • - nocturia
    • - urgency
    • - vulnerabilty to infection- bc of the pooling
  5. Age related changes to bladder other factors
    • physical/functional: hip replacement, dementia
    • psychological
    • social
    • cognitive
    • medications
  6. Urinary Incontinence
    • incontenience is the involuntary loss of urine, which causes a problem
    • not normal part of aging
    • it is underdiagnosed, underreported, and undertreated condition, especially in older adults
    • treatment is not sought because of embrassment, not normal aging, and or the older adut is uneducated about treatment
  7. Risk factor Urinary incontinence
    • it is thought to be related to:
    • - cognitive impairment
    • - limitation of daily activities
    • - institutionalization
    • stroke, dm, obesity, poor general health, dementia, and co-mobidities are associated- not cause but limited functional ability
    • pregnancy, childbirth, menopause
    • meds, constipation, smoking, high caffeine intake
  8. consequences of urinary incontinence
    • associated with falls, skin irritation, UTI's, pressure ulcers, and sleep disturbances
    • affects self esteem and socialization, incre depression and anxiety, and sexual activity is avoided
    • caregiver- stress, frustation
  9. older adults with urinary incontinence
    • older person experience:
    • loss of dignity
    • loss of independence
    • loss of self confidence
    • feelings of shame and embarrassment
  10. types of urinary incontinence
    • it is classified as
    • - transient (acute) or
    • - sudden onset
    • - present for 6 months or less
    • - iatrogenic UI- treatment induce ie duiretics, iv fluids
    • established (chronic)
    • - sudden or gradual onset
  11. established urinary incontinence
    • has a sudden or gradual onset
    • is categorized into one of the following types:
    • 1. urge
    • 2. stress
    • 4. urge, mixed or stressed with high postvoid residual
    • 4. functional
    • 5. mixed
  12. 1. Urge incontinence
    • is the most common type in older adults
    • involuntary urine loss occurs soon after feeling an urgent need to void (overactive bladder)- bladder muscle constanly contracting- causing contraction and relaxation
    • symptoms include:
    • - urinary frequency- more than 8 times in 24 hrs)
    • - nocturia
    • - urgency with or without incontinence
    • - inability to suppress ability to void
  13. 2. stress incontinence
    • involuntary loss of less than 50ml urine
    • is associated with activities that increase the intraabdominal pressure caused by coughing, sneezing, exercise, lifting and bending
    • is more common in women- short urethera
    • appears in men who have had prostatectomy and radiation
    • postvoid residuals are low
    • outlet is incompetent- it should be contracting but the sphrincter relaxes
  14. 3. urge, mixed, or stress urinary incontinence with high postvoid residuals
    • overflow- does not empty completely
    • occurs in bladder that does not empty normally and those that become overdistended with frequency and constant urine loss (dribbling)
    • symptoms include hesitancy in starting urination, slow urine stream, passage of infrequent or small volums or urine, feelings of incomplete bladder emptying and large postvoid residuals- lots of infections
    • risk, diabetes, BPH, meds
    • bladder is not contracting
  15. 4 functional incontinence
    • the lower urinary tract is intact but the individual is unable to reach the toilet bc of environmental barriers, physical limitations, or severe cognitive impairment such as alzheimer disease-
    • occurance increased in institutionalized older adults
    • may be present with other forms of incontinence
  16. Mixed incontinence
    • is a combo of more than one type of incontinence
    • is more prevalent in women with increasing age or older women with stress incontinence
  17. Assessment of UI
    • includes health hx (include meds), targeted examination (abdomen, rectum, genital area) and urialysis
    • postvoid residual urine is determined
    • voiding diary
    • dont forget functional incontinence
  18. Indications for the use of an ultrasound bladder scanner
    • urinary frequency
    • absent or decre urine output
    • bladder distention
    • inablity to void
    • establishing intermittent catheterization schedules
  19. interventions of those with UI
    • Behavioral (HBBS)
    • scheduled voiding
    • prompted voiding
    • bladder training
    • pelvic floor muscle exercise (kegal)
    • ┬ánote kegal exercise ineffective with urinary retention
    • Lifestyle modification
    • weight reduction
    • smoking cessation, limit caffeine
    • physical activity
  20. support interventions
    • Functional:
    • approriate attire, shoes
    • access, clear path, good lighting
    • grab bars
    • assess skin and management
    • absorbent products
    • medications:
    • antichol- overacting bladder
    • - detrol, ditropan
    • - start low, titrate upwards
    • - s/e: antichol dry mouth, blurred vision, redness, confusion, decre sweating, urinary retention, constipation
  21. Interventions for those with urinary incontinence cont
    • surgery
    • non surgical devices
    • - pessaries
    • - electrical stimulation
    • urinary catheters
    • - may be used for urinary retention end stage
    • - last resort
    • - high incidence of UTI
  22. UTI
    • is the most common cause of bacterial sepsis in the older adult- can kill
    • is 10 times more common in women than men
    • older individuals do not report classic symptoms
    • often asymptomatic
    • - confusion
    • - biggest thing is to prevent this from happening
  23. symptoms of UTI in older adults
    • mental status
    • character of urine
    • decre appetite
    • abd pain
    • chills and low back pain
    • urethral discharge in men
    • new onset on incontinence
    • respiratory distress in older adults
  24. diagnostic and treatment
    • diagnostic:
    • U/A- wbc incre, protein + and nitrates +
    • C/s- to know where it came from
    • Treatments: antimicrobials
    • - sulfonamides- s/e rash, crystals formation needs lots of fluid to prevent
    • - fluoroquinolones- GI metallic taste- can affect nutrition, chelation effect if too much iron, mg etc
    • - antiseptic agents- decre bacteria growth preventing reccurance
    • - urinary analgesics (pain control)- pyridum s/e bright orange urine
  25. Bowel elimination
    • normal evacution occurs with:
    • - easy passage of feces
    • - without undue straining
    • - without a feeling of incomplete evacuation
    • constipation is the most common compliant
    • - reflects postponed passage of stool, chronic illness, and s/e of medications (such as narcotics)
    • symptoms
    • review risk factors p163
  26. chronic constipation
    • symptoms persistent for the past 3 months and onset 6m previous
    • at least 2 of the following:
    • - hard/lumpy stools (>25%)
    • - straining >25%
    • - sensation of incomplete emptying
    • - sensation of obstruction/blockage
    • - less than 3 stools a week
    • rare to have loose stools without laxatives
  27. complication with constipation
    • fecal impactation
    • - is common in incapacitated and institutionalized older people
    • symptoms include malaise, urinary retention, elevated temp, incontinence of bladder or bowel, alteration of cognitive status, fissures, hemorrhoids, leakage and intestinal blockage
    • digital examination and x-ray confirm impaction
    • oil retention enemas remove fecal impaction
    • suppostories are not effective
    • key is prevention
  28. assessment and diagnosis
    • precipants and causes of constipation are evaluated
    • physical assessment rules out systemic causes
    • food and fluid intake are reviewed
    • abdomen is examined for massess, distention, tenderness, and bowel sounds
    • rectal examination is performed for painful anal disorders
  29. specific interventions constipation
    • examine medications for constipation- producing effects
    • evaluate:
    • fluid and fiber intake
    • exercise
    • positioning
    • establish regularity of bowel evacuation
    • cautiously use laxatives
    • use enemas
  30. fecal incontinence
    • continuous or recurrent uncontrolled passage of fecal material for 1m is consider fecal incontinence
    • can be associated with UI
    • can be transient or persistent
    • affects social life
    • contributing factors- damage to the pelvic floor, neurological disorder, functional impairment, immobility and dementia
  31. Assessment
    • obtain a complete hx of UI and investigate stool incontinence
    • - type of stools, timing
    • - precipating
    • - use laxatives and enemas
    • digital examination is performed to determine the presence of a mass, impaction
    • occult blood testing
  32. specific interventions
    • environmental manipulation- access to toilet
    • diet alterations
    • habit training schedules (look in book)
    • improve transfer and ambulation abilities
    • sphrincter training exercises
    • biofeedback
    • medications: laxative
    • skin care
    • surgery to correct underlying cause
Card Set:
2015-06-24 20:13:28

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