Care of Aging Adult II part 4

Question 1

What type of urinary incontinence will men most likely have?

Answer 1

overflow incontinence caused by urinary retention

Question 2

What type of UI will women most likely have?

Answer 2

stress and urge incontinence

Question 3

Urinary incontinence: etiology, pathophysiology, and diagnosis. pneumonic

Answer 3

DRIPD

• D: delirium, dehydration, depression
• R: restricted mobility, rectal impaction
• I: infection, inflammation, impaction
• P: polyuria, polypharmacy
• D: diagnosis, H&P, bladder/ voiding record, labs, post void residual

Question 4

Is UI a normal sign of aging?

Answer 4

no

-early identification is important for the older adult population

Question 5

Describe functional incontinence.

Answer 5

• loss of urine resulting from cognitive, functional, or environmental factors.
• Cause: trouble getting to the bathroom because of balance/mobility problems.
• Tx: facilitate access to the bathroom (lighting, clothing, safety, assistance)

Question 6

Describe incontinence after trauma or surgery.

Answer 6

• women: vesicovaginal or urethrovaginal fistula. Men: proximal & distal urethral sphincter
• cause: fistulas from birth, hysterectomy, cancer, or radiation. prostatectomy
• Tx: condom catheter, penile clamp, artificial sphincter, fistula surgery, urinary diversion surgery.

Question 7

Describe overflow incontinence.

Answer 7

• pressure of urine in overfull bladder overcomes sphincter control.
• Cause: bladder or urethral outlet obstruction or underachieve detrusor muscle. Can happen after surgery (anesthesia).
• Tx: catheter, adrenergic blockers, intravaginal device for prolapse, surgery.

Question 8

Describe reflex incontinence.

Answer 8

• no warning or stress before periodic involuntary urination. Urination is frequent, moderate volume, and equal day and night.
• Cause: spinal cord lesion above S2. detrusor hyperreflexia, interferes with detrusor contraction and sphincter relaxation.
• Tx: treat underlying cause, bladder decompression, self-catheterization, surgery, medication.

Question 9

Describe stress incontinence.

Answer 9

• sudden increase in intraabdominal pressure causing involuntary urination. (Mom bladder)
• Cause: relaxed pelvic floor muscles (delivery), atrophy from estrogen decrease, prostate surgery/cancer.
• Tx: pelvic floor muscle exercises, weight loss (obese), stop smoking, topical estrogen, penile clamp.

Question 10

Describe urge incontinence.

Answer 10

• overactive bladder, involuntary urination preceded by urinary urgency, large amount of periodic/frequent leakage, nocturnal.
• Cause: uncontrolled contraction or overactive detrusor muscle. Nervous system disorders: stroke, alzheimer’s, Parkinson’s, Bladder dx, spinal inhibitory pathways, bladder outlet obstruction.
• Tx: treat underlying cause, anticholinergic drugs, calcium channel blockers.

Question 11

What do overactive bladder (urge incontinence) medications do?

Answer 11

blocks actions of acetylcholine

Question 12

What are the symptoms of overactive bladder?

Answer 12

urgency
frequency
urge incontinence
nocturia

Question 13

What is the treatment for overactive bladder?

Answer 13

medications

behavioral mods

Question 14

What is the pharm class for OAB medications?

Answer 14

• anticholinergenic

- blocks muscarinic receptors on bladder detrusor

Question 15

What is the mechanism of action and therapeutic effect of OAB?

Answer 15

• relaxes smooth muscle of bladder by antagonizing muscarinic receptors
• relieves symptoms of OAB

Question 16

What are the 2 medications for OAB?

Answer 16

• Oxybutynin

- Tolterodine