Bladder Issues Flashcards
Define Incontinence
Involuntary leakage of urine in sufficient volumes of frequency so as to cause hygienic or social problems
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
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?
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?
Specific History Outside of Urinary Symptoms
Fluid intake Medications GYN/urologic surgeries Medical conditions: DM, MS, UTIs Radiation treatment for GYN/urologic CA
Women Physical Exam for Incontinence
Lungs Heart Abdomen Pelvic: atrophy, prolapse, masses Stress test Q-tip test Rectal: sphincter tone, impaction
Men Physical Exam for Incontinence
Genitalia
Rectal: prostate, sphincter tone, impaction
Transient Causes of Incontinence
Delirium Infection Atrophy Pharmaceuticals Psychologic Endocrine or excess urine output Restricted motility Stool impaction
Common Pharmaceutical Causes of Incontinence
Anticholinergics Alpha agonists Alpha antagonists Diuretics (caffeine) CCBs Sedative hypnotics & any CNS depressants
Required Lab Tests for Incontinence
U/A
Urine culture & sensitivities
Useful Lab Tests for Incontinence
BUN, creatinine
Glucose
Calcium
Electrolytes
How can incontinence affect the elderly?
Decreases self esteem
Social isolation
Institutionalization
Depression
Behavioral Approaches for Incontinence
Reduce caffeine, liquids
Timed voiding
Bladder training
Prompted voiding: positive reinforcement for dryness
Treatment for Incontinence
Timed voiding Bladder training Prompted voiding Biofeedback Electrical stimulation Anticholinergics
Anticholinergics Used for Incontinence
Oxybutinin XL (Ditropan XL) Oxybutinin Tolterodine Imipramine or other TCAs Dicyclomine, propantheline
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
Causative Agents of UTIs in the Elderly
E. coli Proteus Staph aureus Klebsiella Pseudomonas Enterococcus
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
Therapy for UTI in Older Women Based on
Location of infection
Likely causative agent
UTI in Older Men
Complicated/high risk
Not appropriate: short courses
Signs & Symptoms of UTIs in the Elderly
Nocturia, incontinence Confusion Lethargy Anorexia Fever or hypothermia Failure to thrive Pain/dysuria Behavioral changes
Diagnostic Tests for UTI in the Elderly
UA Rapid tests for bacteria in urine Gram stain of urine Urine culture & sensitivity WBC with differential
Things to Look for on UA
Pyruia
Bacteria
Blood cells
Bacterial count >100,000/mL
Things to Look at on Rapid Tests for Bacteria in Urine
Nitrite dipstick
Leukocyte esterase test
Gram Stain of Urine Results
Identify shape & characteristics
Obtain clean catch urine
WBC with Differential Results
Leukocytosis
Increased # of neutrophils
Define Sepsis
Septicemia refers to the active multiplication of bacteria in the bloodstream that results in an overwhelming infection
Affect of Cytokines in Sepsis
Impaired pulmonary, hepatic, or renal function
Risk Factors for Urosepsis
BPH DM SLE Alcohol: excessive intake Taking steroids
Pathogenesis of Urosepsis
UTI
BPH
Pyelonephritis
Signs & Symptoms of Urosepsis
Hypotension Tachycardia Tachypnea Rales Respiratory distress Anorexia N/V
Urosepsis Workup
Blood
UA & culture
CT/MRI/US
Catheterization
Blood Work for Urosepsis
Kidney functions
CBC
Chem8
Treatment of Urosepsis
Immediate hospitalization
Treat for shock: pressers
Fluids: NS
IV broad-spectrum antibiotics
Types of IV Broad-Spectrum Antibiotics
Imipenem
Meropenem
Piperacillin-tazobactam
Sulbactam-ampicillina
