Urinary Incontinence, UTI’s and Urosepsis in the Elderly Flashcards Preview

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Flashcards in Urinary Incontinence, UTI’s and Urosepsis in the Elderly Deck (30):
1

Definition of Incontinence

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

2

UI can cause?
4

Common cause of
1. institutionalization,
2. social isolation, and
3. decline in function
4. Increased risk of fractures

3

What factors do you want to look for in the history that may be causing this? 5

1. Fluid Intake
2. Medications
3. Gynecologic / Urologic Surgeries
4. Medical Conditions – DM, MS, UTIs
5. Radiation Treatment for Gynecologic / Urologic Cancer

4

1. For women with UI: What are you looking for on the pelvic exam? 3

2. Rectal exam? 2

3. Other tests to perform? 2

4. Genitalia and Rectal exam for men? 3

1.
-atrophy,
-prolapse,
-masses

2.
-sphincter tone,
-impaction

3.
-Stress test
-Q-tip Test

4.
-prostate,
-sphincter tone,
-impaction

5

Rule out Transient Causes
DIAPPERS?

D elirium
I nfection
A trophy
P harmeceuticals
P sychologic
E ndocrine or excess urine output
R estricted mobility
S tool impaction

6

Common Drug Causes of Incontinence

7

1. Anticholinergics
2. Alpha agonists
3. Alpha antagonists
4. Diuretics (including caffeine)
5. Calcium channel blockers
6. Sedative hypnotics and any 7. CNS depressants, including ETOH

7

1. Required Lab tests? 2

2. Useful? 4

1. REQUIRED:
-U/A
-Urine C&S

2. USEFUL:
-BUN, Creatinine
-Glucose
-Calcium
-Electrolytes

8

Behavioral Approaches to UI?
4

1. Reduce caffeine, liquids

2. Timed voiding - go often enough to avoid accidents

3. Bladder training - lengthen time between voids gradually

4. Prompted voiding - caregiver positively reinforces dryness, neutral response to wetness

9

Treatments options for UI? 3

1. Timed voiding, bladder training, prompted voiding
2. Biofeedback & electrical stimulation
3. Anticholinergics

10

Anticholinergics options? 5

1. Oxybutinin XL (Ditropan XL) 5-30 mg QD
2. Oxybutinin 2.5mg QD - 5mg TID
3. Tolterodine 1-2mg PO BID
4. Imipramine 25-50mg QD or other TCAs
5. Dicyclomine, propantheline

11

What will establish pattern in most chronic cases of UI? 3

1. Bladder diary,
2. simple H&P,
3. PVR

12

UTI in the elderly: Risk factors?
9

1. Advanced age
2. Fecal incontinence/impaction
3. Neurogenic bladder
4. Vaginal atrophy/estrogen deficiency
5. Pelvic prolapse/cystocele
6. Insufficient fluid intake/dehydration
7. Indwelling foley catheter or instrument procedure
8. BPH
9. Diabetes

13

UTI in elderly: Causitive aganets:
1. Top 2?
2. Other 4?

1.
-E. coli ~30%
-Proteus species (GI tract) ~30%

2.
-Staph. Aureus,
-Klebsiella,
-psuedomonas (gram neg), &
-Enterococcus (gram pos) ~40%

14

UTI in women > 65YO be defined by at least 2 of the following? 4

1. Fever (>38 degrees C)

2. Frequency, urgency, dysuria, suprapubic tenderness or CVA tenderness

3. Positive urine culture of at least 10 to the 5th colony-forming units/mL with no more than 2 species of microorganisms

4. Pyuria (>/= 10 WBCs/mm3 of unspun urine)

15

Urine cultures in infected elderly patients may have lower colony counts: Such as?

10 to 2nd or 10 to the 3rd**

16

Therapeutic antibiotic “trials” are not recommended, to avoid drug toxicity and antimicrobial resistance

1. When the diagnosis of UTI is in doubt manage how?

2. _____% or older women with UTI sx will improve in this time frame without therapy

1. withold antibiotics for 1 week and follow-up (outpatients)


2. 25-50

17

1. When a true UTI is documented in an older woman, therapy is based on: what?

2. UTI in older men is frequently caused by what?

1.
-The location of the infection
-Likely causative agent

2. by concomitant prostate disease or functional bladder impairment
-UTIs in these populations are considered high risk

18

What should be obtained when patients develop fever or otherwise unexplained systemic manifestations compatible with infection (eg, altered mental status, fall in blood pressure, metabolic acidosis, and respiratory alkalosis)?

Blood and urine cultures

19

UTI in the elderly: Signs and Symptoms?
8

1. Nocturia, incontinence
2. Confusion
3. Lethargy
4. Anorexia
5. Fever or hypothermia
6. FTT [failure to thrive]
7. Pain/dysuria
8. Behavioral changes

20

Dx of UTI in Elderly?
4

1. UA
2. Rapid tests for bacteria in urine
3. Gram stain of urine
4. Urine culture and sensitivity
5. CBC with diff

21

What would the following show for UTI:
1. UA? 3
2. Rapid tests for bacteria in urine? 2
3. Gram stain of urine? 2
4. Urine culture and sensitivity: Culture requires how long for results?
5. CBC with diff? 2

1. Urinalysis:
-assess pyuria,
-bacteria (Bacterial count >100,000 /ml indicative of infection)
-blood cells in urine;

2. Rapid tests for bacteria in urine***
-Nitrite dipstick (turning pink = presence of bacteria)
-Leukocyte esterase test (identifies WBC in urine)

3. Gram stain of urine: identify by
-shape
-characteristic (gram positive or negative);
(obtain by clean catch urine or catheterization)

4. Urine culture and sensitivity: identify infecting organism and most effective antibiotic; culture requires 24 – 72 hours for results; obtain by clean catch urine or catheterization

5. WBC with differential:
-leukocytosis and
-increased number of neutrophils

22

Definition of sepsis?

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

23

1. Excess cytokines indicate? 3

2. Prognosis depends on what?

3. Death by?

1. Impaired
-pulmonary,
-hepatic, or
-renal function

2. Prognosis depends on underlying health status and host defenses

3. Death by multi-system organ failure

24

Urosepsis risk factors? 5

1. BPH
2. DM
3. SLE
4. Alcohol—excessive intake
5. Taking steroids

25

Urosepsis: Pathogenesis?
3

1. UTI
2. BPH
3. Pyelonephritis

26

Urosepsis
Signs and Symtpoms?
6

1. Hypotension
2. Tachycardia
3. Tachypnea
4. Rales
5. Respiratory distress
6. Anorexia, nausea, vomiting

27

Urosepsis Workup

4

1. Blood tests
2. UA & Culture
3. CT/MRI/US
4. Catheterization

28

What blood tests would you do for urosepsis? 3

1. Kidney functions
2. CBC
3. Chem 8

29

Urosepsis
Tx?
4

1. Immediate hospitalization
2. Treat for shock
3. Fluids
4. Broad-spectrum antibiotics IV

30

Which Broad-spectrum antibiotics IV? 4

1. Imipenem
2. Meropenem
3. Piperacillin-tazobactam
4. Sulbactam-ampicillin