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Flashcards in Bladder Issues Deck (35):
1

Define Incontinence

Involuntary leakage of urine in sufficient volumes of frequency so as to cause hygienic or social problems

2

Clinical Importance of Incontinence

Common especially in women
Common cause of institutionalization, social isolation, & decline in function
Increased risk of fractures
Often not mentioned to providers
Providers ill prepared to deal with it

3

Screening Question for Incontinence

Do you ever lose your urine & get wet?
How long have you had this problem?
What caused it to begin?
How often does it occur?
How much urine leaks out?
When does the leakage occur?
What precipitates the leakage?

4

Important History for Incontinence

Leak when you cough, sneeze, or strain?
Feel urge to urinate, urine leaks before you get to the bathroom?
Feel your bladder doesn't empty completely?
Hurt to urinate?
Blood in urine?
Trouble starting urine stream?
Treatment for leakage?
Use pads to catch leakage?
How many pads in a day?

5

Specific History Outside of Urinary Symptoms

Fluid intake
Medications
GYN/urologic surgeries
Medical conditions: DM, MS, UTIs
Radiation treatment for GYN/urologic CA

6

Women Physical Exam for Incontinence

Lungs
Heart
Abdomen
Pelvic: atrophy, prolapse, masses
Stress test
Q-tip test
Rectal: sphincter tone, impaction

7

Men Physical Exam for Incontinence

Genitalia
Rectal: prostate, sphincter tone, impaction

8

Transient Causes of Incontinence

Delirium
Infection
Atrophy
Pharmaceuticals
Psychologic
Endocrine or excess urine output
Restricted motility
Stool impaction

9

Common Pharmaceutical Causes of Incontinence

Anticholinergics
Alpha agonists
Alpha antagonists
Diuretics (caffeine)
CCBs
Sedative hypnotics & any CNS depressants

10

Required Lab Tests for Incontinence

U/A
Urine culture & sensitivities

11

Useful Lab Tests for Incontinence

BUN, creatinine
Glucose
Calcium
Electrolytes

12

How can incontinence affect the elderly?

Decreases self esteem
Social isolation
Institutionalization
Depression

13

Behavioral Approaches for Incontinence

Reduce caffeine, liquids
Timed voiding
Bladder training
Prompted voiding: positive reinforcement for dryness

14

Treatment for Incontinence

Timed voiding
Bladder training
Prompted voiding
Biofeedback
Electrical stimulation
Anticholinergics

15

Anticholinergics Used for Incontinence

Oxybutinin XL (Ditropan XL)
Oxybutinin
Tolterodine
Imipramine or other TCAs
Dicyclomine, propantheline

16

Risk Factors for UTIs

Advanced age
Fecal incontinence or impaction
Neurogenic bladder
Vaginal atrophy/estrogen deficiency
Pelvic prolapse/cystocele
Insufficient fluid intake/dehydration
Indwelling foley catheter or instrument procedure
BPH
DM

17

Causative Agents of UTIs in the Elderly

E. coli
Proteus
Staph aureus
Klebsiella
Pseudomonas
Enterococcus

18

Confirmed UTI Symptoms in Women >65 Years Old

Fever (>38 degrees C)
Frequency, urgency, dysuria, suprapubic tenderness or CVA tenderness
Positive urine culture of at least 10^5 CFUs with no more than 2 species of microorganisms
Pyuria

19

Therapy for UTI in Older Women Based on

Location of infection
Likely causative agent

20

UTI in Older Men

Complicated/high risk
Not appropriate: short courses

21

Signs & Symptoms of UTIs in the Elderly

Nocturia, incontinence
Confusion
Lethargy
Anorexia
Fever or hypothermia
Failure to thrive
Pain/dysuria
Behavioral changes

22

Diagnostic Tests for UTI in the Elderly

UA
Rapid tests for bacteria in urine
Gram stain of urine
Urine culture & sensitivity
WBC with differential

23

Things to Look for on UA

Pyruia
Bacteria
Blood cells
Bacterial count >100,000/mL

24

Things to Look at on Rapid Tests for Bacteria in Urine

Nitrite dipstick
Leukocyte esterase test

25

Gram Stain of Urine Results

Identify shape & characteristics
Obtain clean catch urine

26

WBC with Differential Results

Leukocytosis
Increased # of neutrophils

27

Define Sepsis

Septicemia refers to the active multiplication of bacteria in the bloodstream that results in an overwhelming infection

28

Affect of Cytokines in Sepsis

Impaired pulmonary, hepatic, or renal function

29

Risk Factors for Urosepsis

BPH
DM
SLE
Alcohol: excessive intake
Taking steroids

30

Pathogenesis of Urosepsis

UTI
BPH
Pyelonephritis

31

Signs & Symptoms of Urosepsis

Hypotension
Tachycardia
Tachypnea
Rales
Respiratory distress
Anorexia
N/V

32

Urosepsis Workup

Blood
UA & culture
CT/MRI/US
Catheterization

33

Blood Work for Urosepsis

Kidney functions
CBC
Chem8

34

Treatment of Urosepsis

Immediate hospitalization
Treat for shock: pressers
Fluids: NS
IV broad-spectrum antibiotics

35

Types of IV Broad-Spectrum Antibiotics

Imipenem
Meropenem
Piperacillin-tazobactam
Sulbactam-ampicillina