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Geriatrics > Bladder Issues > Flashcards

Bladder Issues Flashcards

1
Q

Define Incontinence

A

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

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2
Q

Clinical Importance of Incontinence

A 
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
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3
Q

Screening Question for Incontinence

A 
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?
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4
Q

Important History for Incontinence

A 
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?
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5
Q

Specific History Outside of Urinary Symptoms

A 
Fluid intake
Medications
GYN/urologic surgeries
Medical conditions: DM, MS, UTIs
Radiation treatment for GYN/urologic CA
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6
Q

Women Physical Exam for Incontinence

A 
Lungs
Heart
Abdomen
Pelvic: atrophy, prolapse, masses
Stress test
Q-tip test
Rectal: sphincter tone, impaction
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7
Q

Men Physical Exam for Incontinence

A

Genitalia

Rectal: prostate, sphincter tone, impaction

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8
Q

Transient Causes of Incontinence

A 
Delirium
Infection
Atrophy
Pharmaceuticals
Psychologic
Endocrine or excess urine output
Restricted motility
Stool impaction
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9
Q

Common Pharmaceutical Causes of Incontinence

A 
Anticholinergics
Alpha agonists
Alpha antagonists
Diuretics (caffeine)
CCBs
Sedative hypnotics & any CNS depressants
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10
Q

Required Lab Tests for Incontinence

A

U/A

Urine culture & sensitivities

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11
Q

Useful Lab Tests for Incontinence

A

BUN, creatinine
Glucose
Calcium
Electrolytes

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12
Q

How can incontinence affect the elderly?

A

Decreases self esteem
Social isolation
Institutionalization
Depression

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13
Q

Behavioral Approaches for Incontinence

A

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

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14
Q

Treatment for Incontinence

A 
Timed voiding
Bladder training
Prompted voiding
Biofeedback
Electrical stimulation
Anticholinergics
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15
Q

Anticholinergics Used for Incontinence

A 
Oxybutinin XL (Ditropan XL)
Oxybutinin
Tolterodine
Imipramine or other TCAs
Dicyclomine, propantheline
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16
Q

Risk Factors for UTIs

A 
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
Q

Causative Agents of UTIs in the Elderly

A 
E. coli
Proteus
Staph aureus
Klebsiella
Pseudomonas
Enterococcus
18
Q

Confirmed UTI Symptoms in Women >65 Years Old

A

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
Q

Therapy for UTI in Older Women Based on

A

Location of infection

Likely causative agent

20
Q

UTI in Older Men

A

Complicated/high risk

Not appropriate: short courses

21
Q

Signs & Symptoms of UTIs in the Elderly

A 
Nocturia, incontinence
Confusion
Lethargy
Anorexia
Fever or hypothermia
Failure to thrive
Pain/dysuria
Behavioral changes
22
Q

Diagnostic Tests for UTI in the Elderly

A 
UA
Rapid tests for bacteria in urine
Gram stain of urine
Urine culture & sensitivity
WBC with differential
23
Q

Things to Look for on UA

A

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

24
Q

Things to Look at on Rapid Tests for Bacteria in Urine

A

Nitrite dipstick

Leukocyte esterase test

25
Q

Gram Stain of Urine Results

A

Identify shape & characteristics

Obtain clean catch urine

26
Q

WBC with Differential Results

A

Leukocytosis

Increased # of neutrophils

27
Q

Define Sepsis

A

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

28
Q

Affect of Cytokines in Sepsis

A

Impaired pulmonary, hepatic, or renal function

29
Q

Risk Factors for Urosepsis

A 
BPH
DM
SLE
Alcohol: excessive intake
Taking steroids
30
Q

Pathogenesis of Urosepsis

A

UTI
BPH
Pyelonephritis

31
Q

Signs & Symptoms of Urosepsis

A 
Hypotension
Tachycardia
Tachypnea
Rales
Respiratory distress
Anorexia
N/V
32
Q

Urosepsis Workup

A

Blood
UA & culture
CT/MRI/US
Catheterization

33
Q

Blood Work for Urosepsis

A

Kidney functions
CBC
Chem8

34
Q

Treatment of Urosepsis

A

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

35
Q

Types of IV Broad-Spectrum Antibiotics

A

Imipenem
Meropenem
Piperacillin-tazobactam
Sulbactam-ampicillina

Geriatrics (15 decks)

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