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maturing family > ch 16 - elimination > Flashcards

ch 16 - elimination Flashcards

1
Q

what urinary problems should never be regarded as normal aging (2)

A
  • urinary incontinence

- urinary frequency

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2
Q

what electrolyte imbalance is more common in older adults

A

hyperkalemia

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3
Q

tips to promote a healthy bladder (7)

A
  • 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
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4
Q

high risk factor for urinary incontinence

A

dementia

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5
Q

risk factors for urinary incontinence

A
  • 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)
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6
Q

consequences associated with urinary incontinence

A
  • falls
  • fractures
  • hospitalization
  • skin breakdown
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7
Q

2 types urinary incontinence

A
  • transient (acute)

- established (chronic)

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8
Q

what can cause transient urinary incontinence (5)

A
  • UTI
  • delirium
  • constipation
  • stool impaction
  • increased urine production
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9
Q

type of urinary incontinence:

  • sudden onset
  • present less than 6 months
  • caused by treatable factors
A

transient UI

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10
Q

type of urinary incontinence:

  • sudden or gradual onset
  • 5 subcategories
A

established UI

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11
Q

5 subcategories within established UI

A
  • stress
  • urge
  • overflow
  • functional
  • mixed
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12
Q

type of established UI:

  • loss of small amount of urine with certain activities (coughing, sneezing, exercising, bending, lifting)
  • more common in women
A

stress UI

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13
Q

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
A

urge UI

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14
Q

type of established UI:

  • nearly constant urine loss (dribbling)
  • hesitancy in starting urine
  • slow urine stream
  • feeling of incomplete bladder emptying
A

overflow UI

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15
Q

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
A

functional UI

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16
Q

type of established UI:

  • combination of more than one UI problem
  • usually stress + urge
A

mixed UI

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17
Q

urinary screening tools

A
  • urogenital distress inventory
  • incontinence impact questionnaire
  • male urinary distress inventory
  • bladder diary
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18
Q

red flags on assessment of urinary system (2)

A
  • hematuria

- pain on urination

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19
Q

meds that could contribute to UI (6)

A
  • diuretics
  • anticholinergics
  • psychotropics
  • a blockers
  • a agonists
  • calcium channel blockers
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20
Q

what med should be avoided in older adults because it is associated with increased likelihood of cognitive impairment

A

oxybutynin

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21
Q

lifestyle interventions for UI (6)

A
  • fluid intake
  • weight reduction
  • stop smoking
  • bowel management
  • avoiding caffeine and alcohol
  • physical activity
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22
Q

environmental interventions for UI (4)

A
  • toilet grab bars
  • raised toilet seats
  • toilet visibility, signs, images
  • timely toilet assistance
23
Q

behavioral interventions for UI (4)

A
  • scheduled voiding
  • pelvic floor exercises
  • habit/bladder training
  • prompted voiding
24
Q

meds for UI (2)

A
  • anticholinergics

- antimuscarinics

25
Q

2 surgical interventions for UI

A
  • colposuspension

- slings

26
Q

indicators for intermittent cath (3)

A
  • weak detrusor muscle
  • blockage of urethra
  • reflux incontinence
27
Q

what puts pts at higher risk for long term cath placement

A
  • cognitive impairment

- pressure injuries

28
Q

most common cause of bacterial sepsis

A

UTI

29
Q

long term cath use increases risks for what adverse events (5)

A
  • recurrent UTIs (CAUTI)
  • urosepsis
  • urethral damage in men
  • urethritis
  • fistula formation
30
Q

Defined as the reduction in the
frequency of stool or difficulty
in formation or passage of
stool

A

constipation

31
Q

Involuntary loss of liquid or solid stool that is

a social and hygienic problem

A

fecal incontinence

32
Q

high prevalence of fecal incontinence is seen in pts with what diseases/injuries (5)

A
  • diabetes
  • IBS
  • stroke
  • MS
  • spinal cord injury
33
Q

interventions for constipation/fecal impaction

A
  • physical activity (20-30 min walk)
  • positioning (squatting/sitting on toilet)
  • toilet regimen (bowel retraining)
  • meds (laxatives)
  • enemas
  • digital removal of impaction
34
Q

interventions for fecal incontinence

A
  • environmental changes (accessible toilet)
  • diet changes
  • habit training schedule
  • pelvic floor exercises, sphincter training
  • improving transfer and ambulation ability
  • biofeedback
  • meds
  • surgery
35
Q

first line laxative because low cost and few side effects

A

bulk forming laxative (psyllium, methylcellulose)

36
Q

types of laxatives (3)

A
  • bulk forming (psyllium, methylcellulose)
  • emollient and lubricant (docusate sodium, mineral oil)
  • osmotic laxative (milk of magnesia, lactulose, sorbitol, polyethylene glycol, miralax)
37
Q

when should a bulk forming laxative not be used

A

obstruction or compromised peristaltic activity

38
Q

when should bulk forming laxative be used with caution (3)

A
  • frail older adults
  • bedbound pts
  • those with swallowing problems
39
Q

nursing admin of bulk forming laxative

A

take with adequate fluids

40
Q

when should emollient/lubricant laxative be used with caution

A

-frail older adults who don’t have strength to “push”

41
Q

why should the emollient laxative mineral oil be avoided

A

risk of lipoid aspiration pneumonia

42
Q

what pt should not receive milk of magnesia laxative

A

-renal insufficiency (leads to hypermagnesemia/phosphatemia)

43
Q

pt interventions for accidental fecal incontinence

A
  • have pt keep bowel diary and identify triggers
  • encourage being prepared
  • avoid greasy foods, dairy, nuts, spicy foods..
44
Q

interventions to prevent CAUTI (ABCDE)

A

-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

45
Q

first line of Tx for UI (5)

A
  • scheduled voiding
  • prompted voiding
  • habit retraining
  • bladder retraining
  • pelvic floor muscle exercises
46
Q

what pt should not take UI meds (specifically anticholinergic meds)
what med should not be combined with UI meds?

A
  • pt with narrow angle glaucoma

- can’t be combined with cholinesterase inhibitors

47
Q

S+S of constipation in cognitively impaired or frail older adult (5)

A
  • altered cognitive status
  • incontinence
  • increased temp
  • poor appetite
  • unexplained falls
48
Q

what pts are at high risk for fecal impaction

A

immobile older adults

pts taking narcotic meds

49
Q

S+S fecal impaction

A
  • fatigue
  • loss of appetite
  • abdominal pain
  • N/V
  • urinary retention
  • elevated temp
  • leaking of stool
  • altered cognitive status
  • incontinence bladder/bowel
50
Q

assessment tools for constipation

A
  • bowel diary

- bristol stool form scale

51
Q

what meds are needed to overcome constipation caused by opioids

A
  • senna

- osmotic laxative

52
Q

best choice of enema for constipation/impaction

A

normal saline/tap water (500-1000 mL) at 105 degrees

53
Q

what type of enemas should not be used in older adults because they can lead to severe metabolic disorders

A

sodium phosphate enemas

54
Q

risk factors fecal incontinence

A
  • pregnancy
  • diabetes
  • previous anorectal surgery
  • UI
  • smoking
  • obesity
  • inactivity
  • white race
  • neurological disease

maturing family (36 decks)

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