ch 16 - elimination Flashcards
what urinary problems should never be regarded as normal aging (2)
- urinary incontinence
- urinary frequency
what electrolyte imbalance is more common in older adults
hyperkalemia
tips to promote a healthy bladder (7)
- drink 8-10 glasses water/day
- eliminate/reduce use of caffeine and alcohol especially before bedtime
- empty bladder completely before and after meals and at bedtime
- urinate when urge arises
- limit use of sleeping pills, sedatives and alcohol
- ideal body weight, physical exercise
- no smoking
high risk factor for urinary incontinence
dementia
risk factors for urinary incontinence
- immobility
- impaired cognitive function
- smoking
- high caffeine intake
- low fluid intake
- obesity
- constipation
- pregnancy
- diabetes, CVA, parkinsons, MS
- malnutrition
- hysterectomy or prostate surgery
- meds (diuretics, anticholinergics, sedatives, hypnotics, tranquilizers)
consequences associated with urinary incontinence
- falls
- fractures
- hospitalization
- skin breakdown
2 types urinary incontinence
- transient (acute)
- established (chronic)
what can cause transient urinary incontinence (5)
- UTI
- delirium
- constipation
- stool impaction
- increased urine production
type of urinary incontinence:
- sudden onset
- present less than 6 months
- caused by treatable factors
transient UI
type of urinary incontinence:
- sudden or gradual onset
- 5 subcategories
established UI
5 subcategories within established UI
- stress
- urge
- overflow
- functional
- mixed
type of established UI:
- loss of small amount of urine with certain activities (coughing, sneezing, exercising, bending, lifting)
- more common in women
stress UI
type of established UI:
- loss of moderate to large amount urine before getting to toilet
- inability to suppress need to urinate
- frequency and nocturia may be present
- may be associated with overactive bladder
urge UI
type of established UI:
- nearly constant urine loss (dribbling)
- hesitancy in starting urine
- slow urine stream
- feeling of incomplete bladder emptying
overflow UI
type of established UI:
- individual unable to reach toilet due to environmental barriers, physical limitations, cognitive impairment, lack of assistance, difficulty managing clothing
- more common in pts who are institutionalized
functional UI
type of established UI:
- combination of more than one UI problem
- usually stress + urge
mixed UI
urinary screening tools
- urogenital distress inventory
- incontinence impact questionnaire
- male urinary distress inventory
- bladder diary
red flags on assessment of urinary system (2)
- hematuria
- pain on urination
meds that could contribute to UI (6)
- diuretics
- anticholinergics
- psychotropics
- a blockers
- a agonists
- calcium channel blockers
what med should be avoided in older adults because it is associated with increased likelihood of cognitive impairment
oxybutynin
lifestyle interventions for UI (6)
- fluid intake
- weight reduction
- stop smoking
- bowel management
- avoiding caffeine and alcohol
- physical activity
environmental interventions for UI (4)
- toilet grab bars
- raised toilet seats
- toilet visibility, signs, images
- timely toilet assistance
behavioral interventions for UI (4)
- scheduled voiding
- pelvic floor exercises
- habit/bladder training
- prompted voiding
meds for UI (2)
- anticholinergics
- antimuscarinics
2 surgical interventions for UI
- colposuspension
- slings
indicators for intermittent cath (3)
- weak detrusor muscle
- blockage of urethra
- reflux incontinence
what puts pts at higher risk for long term cath placement
- cognitive impairment
- pressure injuries
most common cause of bacterial sepsis
UTI
long term cath use increases risks for what adverse events (5)
- recurrent UTIs (CAUTI)
- urosepsis
- urethral damage in men
- urethritis
- fistula formation
Defined as the reduction in the
frequency of stool or difficulty
in formation or passage of
stool
constipation
Involuntary loss of liquid or solid stool that is
a social and hygienic problem
fecal incontinence
high prevalence of fecal incontinence is seen in pts with what diseases/injuries (5)
- diabetes
- IBS
- stroke
- MS
- spinal cord injury
interventions for constipation/fecal impaction
- physical activity (20-30 min walk)
- positioning (squatting/sitting on toilet)
- toilet regimen (bowel retraining)
- meds (laxatives)
- enemas
- digital removal of impaction
interventions for fecal incontinence
- environmental changes (accessible toilet)
- diet changes
- habit training schedule
- pelvic floor exercises, sphincter training
- improving transfer and ambulation ability
- biofeedback
- meds
- surgery
first line laxative because low cost and few side effects
bulk forming laxative (psyllium, methylcellulose)
types of laxatives (3)
- bulk forming (psyllium, methylcellulose)
- emollient and lubricant (docusate sodium, mineral oil)
- osmotic laxative (milk of magnesia, lactulose, sorbitol, polyethylene glycol, miralax)
when should a bulk forming laxative not be used
obstruction or compromised peristaltic activity
when should bulk forming laxative be used with caution (3)
- frail older adults
- bedbound pts
- those with swallowing problems
nursing admin of bulk forming laxative
take with adequate fluids
when should emollient/lubricant laxative be used with caution
-frail older adults who don’t have strength to “push”
why should the emollient laxative mineral oil be avoided
risk of lipoid aspiration pneumonia
what pt should not receive milk of magnesia laxative
-renal insufficiency (leads to hypermagnesemia/phosphatemia)
pt interventions for accidental fecal incontinence
- have pt keep bowel diary and identify triggers
- encourage being prepared
- avoid greasy foods, dairy, nuts, spicy foods..
interventions to prevent CAUTI (ABCDE)
-Adherence to general infection control protocols
-Bladder ultrasound may avoid indwelling cath
-Condom caths or intermittent caths should be considered
-Do not irrigate unless obstruction is anticipated
(+Do not clean periurethral area with antiseptics)
-Early removal
first line of Tx for UI (5)
- scheduled voiding
- prompted voiding
- habit retraining
- bladder retraining
- pelvic floor muscle exercises
what pt should not take UI meds (specifically anticholinergic meds)
what med should not be combined with UI meds?
- pt with narrow angle glaucoma
- can’t be combined with cholinesterase inhibitors
S+S of constipation in cognitively impaired or frail older adult (5)
- altered cognitive status
- incontinence
- increased temp
- poor appetite
- unexplained falls
what pts are at high risk for fecal impaction
immobile older adults
pts taking narcotic meds
S+S fecal impaction
- fatigue
- loss of appetite
- abdominal pain
- N/V
- urinary retention
- elevated temp
- leaking of stool
- altered cognitive status
- incontinence bladder/bowel
assessment tools for constipation
- bowel diary
- bristol stool form scale
what meds are needed to overcome constipation caused by opioids
- senna
- osmotic laxative
best choice of enema for constipation/impaction
normal saline/tap water (500-1000 mL) at 105 degrees
what type of enemas should not be used in older adults because they can lead to severe metabolic disorders
sodium phosphate enemas
risk factors fecal incontinence
- pregnancy
- diabetes
- previous anorectal surgery
- UI
- smoking
- obesity
- inactivity
- white race
- neurological disease
