CH 10: Urinary Elimination Flashcards
age related changes related to urinary elimination
Hypertrophy of the bladder muscle and thickening on the bladder _ urinary frequency & reduced storage capacity
Changes in cortical control micturition _ nocturia
Insufficient neurological control of bladder emptying and weak bladder muscles _ retention _ UTI
Decreased tubular function _ concentrated urine
Decreased kidney filtration _ decreased ability to eliminate drugs _ toxicity
Increase in renal threshold for glucose _ no glycosuria with hyperglycemia
Urgency, nocturia, frequency, retention _ embarrassment
urinary health promotion
diet
avoid catheters
enhance voiding
frequent toileting/schedule
if embarrassed, used a comfortable, nonjudgemental tone
nocturia can cause:
use:
accidents/falls when walking to the bathroom
nightlights and remove hazards
diet for urinary health promotion
fluid intake (reduce at bedtime)
Vitamin C, cranberries, prunes, plums, eggs, cheese, yogurt, fish, grains
ways to enhance voiding
voiding upright
massage bladder
run water and rock back and forth
UTI in older adults
most common infection of older adults
prevalence increases with age
causes of UTIs
poor hygiene
prostate issues
catheterization
dehydration
DM
neurogenic bladders
debilitation
early s/s of UTI
burning
urgency
fever
delirium
possibly asymptomatic from lack of temp change
late s/s of UTI
retention
incontinence
hematuria
severe UTIs can lead to:
septicemia/urosepsis (occurring more frequently in older adults)
treatment for UTIs
-establish urinary drainage and control infection
-monitor I&O
-fluids (except…)
-monitor for s/s of complications
-Vit C (raises acidity of urine)
prevention of UTIs
Promote daily cranberry juice (but can be a bladder irritant when UTI is present)
Avoid catheters, consider alternatives, & question rationale
Convenience for staff, NO-NO!
urinary incontinence in older adults
- Common and bothersome; often goes unreported
- NOT A NORMAL PART OF AGING
- Can be transient (acute) or established (chronic)
- Various types
- Assess for factors that cause incontinence
- Can be embarrassing to discuss
- Do’s and Don’ts
- Interventions for urination, skin, and falls
- Staff training
interventions for urinary incontinence
(depend on the type)
* Kegel Exercises
* Bladder retraining program
* Monitor I&O; assess for wetness every 2 hours
* Proper hygiene
* Avoid bladder irritants (caffeine, alcohol, citrus/fruits, tomatoes, spicy foods, artificial sweeteners)
* Easily accessible bathroom
* Increase fluids except when contraindicated
* Crede’s method
* Avoid indwelling catheters
* Provide meticulous urinary cath care when in use
* Use of containment devices
* Modify environment
* Interventions to protect skin and prevent falls
stress incontinence
due to increased abdominal pressure under stress (weak pelvic floor muscles)
functional incontinence
cannot get to the bathroom in time which causes incontinence
urge incontinence
due to involuntary contraction of the bladder muscles
overflow incontinence
due to blockage of the urethra
neurogenic incontinence
due to disturbed function of the nervous system
common causes of transient incontinence (DIAPPERS)
Delirium
Infection
Atrophic Urethritis
Pharmaceuticals
Psychologic
Excess urine output
Restricted Mobility
Stool Impaction
contributing factors to urinary incontinence
-UTI
-Severe constipation
-Drugs
-Hyperglycemia
-Hypercalcemia
-Restricted mobility
-Acute confusion
If pt is still incontinent after finding contributing factors of urinary incontinence
-establish pattern of urinary loss (diary)
-Measure residual urine volume (by ultrasound)
-Assess for vaginal prolapse and atrophic vaginitis (women)
-assess prostate by rectal examination (men)
help for urge incontinence
bladder retraining
antimuscarinic drugs
help for stress incontinence
pelvic floor muscle training
surgical intervention if unsuccessful
help for overflow incontinence
residual volume >100mL
surgical relief of obstruction
intermittent catheterization if no obstruction
risk factors for bladder cancer
chronic bladder irritation
exposure to dyes
cigarette smoking
s/s of bladder cancer
painless hematuria
frequency
dysuria
tx of bladder cancer
surgery, radiation
chemo
immunotherapy
renal calculi for older adults results from:
immobilization
infection
changes in pH and concentration
chronic diarrhea
dehydration
elimination of uric acid
hypercalcemia
s/s of renal calculi
pain
hematuria
s/s of UTI
symptoms with glomerulonephritis
subtle and nonspecific
careful use of what medications with glomerulonephritis
dig
diuretics
antihypertensives on
kidney/kidney excretion
what is glomerulonephritis
inflammation and damage to the filtering part of the kidneys (glomerulus)
