Lesson 3: Acute Urinary Incontinence + Voiding Dysfuction Flashcards
TOILETED - T
T: thin, dry, vaginal + urethral epithelium
- Atopic urethritis caused by estrogen deficiency
- Drying/thinning of urethra + vagina
- Reduced mucous production
- Inflammation of urethra + bladder
Assessment
- Vaginal mucosa is dry + non-ruggated
- Pale or inflamed
- Urethral caruncle = abnormally prominent, cherry red
- Urgency, frequency, dysuria
- UTIs in older women
Management
- Topical estrogen replacement
TOILETED - O
O: Obstruction (stool impaction/constipation)
- Full rectum may partially obstruct urethra
— Causes incomplete bladder emptying
— Urethral obstruction = bladder irritability
— Severe impaction = outlet obstruction + retention
Assessment
- Abdo exam - palpate and percuss
- Rectal exam
Management
- Colonic clean out PRN
- Routine bowel care
TOILETED - I
I: Infection
- Increases signaling of bladder fullness by urothelium
- Causes urgency and frequency
Assess for UTI
- Frequency
- Dysuria
- Fever
- Chills
- Change in function/cognition
- Suprapubic or flank tenderness
- Cloudy, malodorous urine
Management
- Treat if symptomatic only
Impact of irritants
- Contribute to bladder irritability + contractility
- Result of increased urothelial signally regarding bladder fullness
- Includes
— Caffeine
— Nicotine
— Aspartame
— Citruses
— Carbonated beverages
— Topical agents
TOILETED - L
L: Limited mobility
- Patients require extra time to reach the toilet
- Contributes to leakage episodes/functional incontinence
Assessment
- Ambulatory status
- Needs for aids
- Time required to move to toilet + prepare to void
Management
- Environmental modification
- Bedside commode
— Urinal
— Assistive devices
- Clothing modifications
TOILETED - E
E: Emotional Issues +/- Depression
- Altered motivation to respond to urge to void
- Depleted neurotransmitters at impair sphincter function + continence
Assessment
- Screening for depression
Management
- Refer to psych for work-up and treatment
TOILETED - T
T: Therapeutic Medications
Contribute to incontinence
- Diuretics
- Alcohol
- Sedatives/hypnotics
- Alpha adrenergic antagonists
- ACE inhibitors
Increase risk for voiding dysfunction
- Anticholinergic agents
- Calcium channel blockers
- Adrenergic agonists
All are contributing factors for
- Overactive bladder
- Urge incontinence
Stress incontinence
- Voiding dysfunction
Management
- Pharmacist to review meds to identify offenders
- Consider timing of certain medications
TOILETED - E
E: Endocrine Disorders
Poorly controlled diabetes with hyperglycemia
Causes increased urine production → enuresis in children → incontinence in adults
Diabetes insipidus
- production of high volume urine overwhelms continence mechanism
Hypercalcemia
- Increased bladder contractility
- Constipation
Management
- Optimal glucose control
- Address reversible conditions
TOILETED - D
D: Delirium
- Reversible alteration in mental status
- Results in diminished ability to respond appropriate to bladder filling
Causes
- Infection
- Electrolytes
- Medications
- Anaesthetics
Can have baseline dementia with superimposed delirium
Management
- Correct etiologic factors
- Use of containment products until cognition restored
