Chapter 11 Elimination Flashcards
Age-related changes in bladder function
- Decreased capacity
- Increased irritability
- Contractions during filling
- Incomplete emptying
- May lead to frequency, nocturia, urgency, and vulnerability to infection.
Bowel and bladder function
are only slightly altered by normal physiological changes in aging
Urinary Incontinence
- Involuntary loss of urine significant enough to affect ADLs and quality of life.
- A condition that requires assessment and treatment, not simply “containment” strategies
- A neglected geriatric syndrome
- More than 50% of nursing home residents are incontinent upon admission (most are female)
How many UTIs within a 4 year period are considered “uncommon”?
2
Urinary incontinence is associated with
Falls Skin irritations/breakdowns/infection UTI Pressure ulcers Sleep disturbances Loss of dignity Loss of self-esteem
Urinary incontinence Risk Factors
Diabetes (altered sensation) Chronic conditions Alzheimer's disease Other cognitive impairment Limitations in ADL's Institutionalization
Urge incontinence
Involuntary loss of urine soon after urge to void
Overactive bladder contributes to this
Post void residuals are low
Stress incontinence
- Involuntary loss of less than 50cc of urine associated with activities that increase intra-abdominal pressure
- Post void residual is low
Urge, mixed stress with high post-void residuals
Bladder becomes over extended Frequent nearly constant urine loss Hesitancy in starting stream Slow stream Feelings of incomplete bladder emptying
Functional incontinence
- Lower urinary tract is intact
- Unable to reach bathroom (environmental barriers, physical barriers, cognitive impairment)
Mixed incontinence
Usually a mix of stress and urge
Most prevalent form of incontinence in women
Behavioral interventions for urinary incontinence
Scheduled voiding Prompted voiding Bladder training Biofeedback Pelvic floor muscle exercised (kegel)
Lifestyle modification Intervention for urinary incontinence
Diet: increased fluid and avoidance of caffeine Weight reduction Smoking cessation Bowel management Physical activity
Intermittent catheterization for specific physiological and neurological disorders
Weak detrusor muscle
Blockage of urethra
Reflux incontinence with spinal cord injury
Anticholinergic agents
- Treats urinary incontinence
- Antimuscinaric
- Blocks the effects of Ach (going for the antispasmotic effect and the urine retention effect)
- Do not use with BPH (Benign Prostatic Hypertrophy)
Oxybutynin (Ditropan)
- Decreased muscle spasms and irritability of bladder
- Used: Frequent urination and Urge incontinence
Tolterodine (Detrol)
- Antimuscarinic
- Urinary incontinence and Overactive bladder
Toviaz
- Treats urinary incontinence
- Antimuscarinic
BPH Treatment (alpha blockers)
- BPH = Benign Prostatic Hypertrophy (enlarged prostate)
- Relax the smooth muscle in the prostate at the opening to the bladder
- 5-Alpha Reductase Inhibitors (interfere with androgen effects on the prostate)–slow the growth and reduce size
- Treats urinary incontinence
Ach
acetylcholine
androgen
primary sex hormone
Surgical interventions for urinary incontinence
Suspension or Slinging of the bladder neck
Prostatectomy
Sphincter implantation
Collagen injection
Non-surgical devices (intervention for urinary incontinence)
Pessarie (used to prevent uterine prolapse)
Urethral plugs
Watch for: vaginal infection, low back pain, vaginal mucosa erosion
Urinary Tract Infection (UTI)
- One of the leading causes of death in frail older adults
- Cognitively impaired adults may not display or report classic symptoms
- Further assessment is warranted in any change in baseline function or behavior
What is the most common symptom related to healthcare providers?
Constipation
Fecal Impaction Treatment
Oil enemas followed by digital removal
Watch for Vaso-Vagal reflex
Risk factors for altered bowel function
Hypotonic colon function Immobility and debilitation Central nervous system lesions Inadequate diet and fluid intake Medications that impair bowel function
Interventions for altered bowel function
Medication review Fluid and fiber review Exercise Positioning Establishing regularity Evaluate need for pharmacologic intervention (laxatives/enemas)
Fecal incontinence Risk factors
Diabetes Stroke Spinal cord injury Immobility Dementia Pelvic floor trauma Delayed obstetric injury
Interventions for fecal incontinence
Complete assessment of precipitating factors Review of bowel records Environmental manipulation Diet alterations Habit training Sphincter training exercises Biofeedback Medications Surgery to correct underlying defects
Frequency and defecation is not an indicator of constipation. Must have more, such as:
Alterations in cognitive status Incontinence Increased temperature Poor appetite Unexplained falls
When is the Gastrocolic reflex the strongest?
after breakfast and supper
warm drinks help
Psychosocial impact
- Deviations in normal bowel and bladder can lead to social withdrawal
- Think about meal time: assess each client for incontinence and change them as necessary
Bulking agents
Psyllium, methylcellulose
Stool softeners
Docusate
Osmotic laxitives
Lactulose, Sorbitol
Stimulant laxitives
Senna, Bisacodyl
-These are habit forming
Saline laxitives
Milk of Magnesia (MOM)
Enemas
- Normal saline or tap water (500-1000ml at 105 degrees)
- Oil retention enemas: fecal impaction
- Do not use: Soap-sud and phosphate. Irritate rectal mucosa.
