Chapter 11 Elimination

Question 0

Age-related changes in bladder function

Answer 0

• Decreased capacity
• Increased irritability
• Contractions during filling
• Incomplete emptying
• May lead to frequency, nocturia, urgency, and vulnerability to infection.

Question 1

Bowel and bladder function

Answer 1

are only slightly altered by normal physiological changes in aging

Question 2

Urinary Incontinence

Answer 2

• Involuntary loss of urine significant enough to affect ADLs and quality of life.
• A condition that requires assessment and treatment, not simply “containment” strategies
• A neglected geriatric syndrome
• More than 50% of nursing home residents are incontinent upon admission (most are female)

Question 3

How many UTIs within a 4 year period are considered “uncommon”?

Answer 3

2

Question 4

Urinary incontinence is associated with

Answer 4

Falls
Skin irritations/breakdowns/infection
UTI
Pressure ulcers
Sleep disturbances
Loss of dignity
Loss of self-esteem

Question 5

Urinary incontinence Risk Factors

Answer 5

Diabetes (altered sensation)
Chronic conditions
Alzheimer's disease
Other cognitive impairment
Limitations in ADL's
Institutionalization

Question 6

Urge incontinence

Answer 6

Involuntary loss of urine soon after urge to void
Overactive bladder contributes to this
Post void residuals are low

Question 7

Stress incontinence

Answer 7

• Involuntary loss of less than 50cc of urine associated with activities that increase intra-abdominal pressure
• Post void residual is low

Question 8

Urge, mixed stress with high post-void residuals

Answer 8

Bladder becomes over extended
Frequent nearly constant urine loss
Hesitancy in starting stream
Slow stream
Feelings of incomplete bladder emptying

Question 9

Functional incontinence

Answer 9

• Lower urinary tract is intact

- Unable to reach bathroom (environmental barriers, physical barriers, cognitive impairment)

Question 10

Mixed incontinence

Answer 10

Usually a mix of stress and urge

Most prevalent form of incontinence in women

Question 11

Behavioral interventions for urinary incontinence

Answer 11

Scheduled voiding
Prompted voiding
Bladder training
Biofeedback
Pelvic floor muscle exercised (kegel)

Question 12

Lifestyle modification Intervention for urinary incontinence

Answer 12

Diet: increased fluid and avoidance of caffeine
Weight reduction
Smoking cessation
Bowel management
Physical activity

Question 13

Intermittent catheterization for specific physiological and neurological disorders

Answer 13

Weak detrusor muscle
Blockage of urethra
Reflux incontinence with spinal cord injury

Question 14

Anticholinergic agents

Answer 14

• Treats urinary incontinence
• Antimuscinaric
• Blocks the effects of Ach (going for the antispasmotic effect and the urine retention effect)
• Do not use with BPH (Benign Prostatic Hypertrophy)

Question 15

Oxybutynin (Ditropan)

Answer 15

• Decreased muscle spasms and irritability of bladder

- Used: Frequent urination and Urge incontinence

Question 16

Tolterodine (Detrol)

Answer 16

• Antimuscarinic

- Urinary incontinence and Overactive bladder

Question 17

Toviaz

Answer 17

• Treats urinary incontinence

- Antimuscarinic

Question 18

BPH Treatment (alpha blockers)

Answer 18

• BPH = Benign Prostatic Hypertrophy (enlarged prostate)
• Relax the smooth muscle in the prostate at the opening to the bladder
• 5-Alpha Reductase Inhibitors (interfere with androgen effects on the prostate)–slow the growth and reduce size
• Treats urinary incontinence

Question 19

Ach

Answer 19

acetylcholine

Question 20

androgen

Answer 20

primary sex hormone

Question 21

Surgical interventions for urinary incontinence

Answer 21

Suspension or Slinging of the bladder neck
Prostatectomy
Sphincter implantation
Collagen injection

Question 22

Non-surgical devices (intervention for urinary incontinence)

Answer 22

Pessarie (used to prevent uterine prolapse)
Urethral plugs
Watch for: vaginal infection, low back pain, vaginal mucosa erosion

Question 23

Urinary Tract Infection (UTI)

Answer 23

• One of the leading causes of death in frail older adults
• Cognitively impaired adults may not display or report classic symptoms
• Further assessment is warranted in any change in baseline function or behavior

Question 24

What is the most common symptom related to healthcare providers?

Answer 24

Constipation

Question 25

Fecal Impaction Treatment

Answer 25

Oil enemas followed by digital removal | Watch for Vaso-Vagal reflex

Question 26

Risk factors for altered bowel function

Answer 26

``` Hypotonic colon function Immobility and debilitation Central nervous system lesions Inadequate diet and fluid intake Medications that impair bowel function ```

Question 27

Interventions for altered bowel function

Answer 27

``` Medication review Fluid and fiber review Exercise Positioning Establishing regularity Evaluate need for pharmacologic intervention (laxatives/enemas) ```

Question 28

Fecal incontinence Risk factors

Answer 28

``` Diabetes Stroke Spinal cord injury Immobility Dementia Pelvic floor trauma Delayed obstetric injury ```

Question 29

Interventions for fecal incontinence

Answer 29

``` Complete assessment of precipitating factors Review of bowel records Environmental manipulation Diet alterations Habit training Sphincter training exercises Biofeedback Medications Surgery to correct underlying defects ```

Question 30

Frequency and defecation is not an indicator of constipation. Must have more, such as:

Answer 30

``` Alterations in cognitive status Incontinence Increased temperature Poor appetite Unexplained falls ```

Question 31

When is the Gastrocolic reflex the strongest?

Answer 31

after breakfast and supper | warm drinks help

Question 32

Psychosocial impact

Answer 32

- Deviations in normal bowel and bladder can lead to social withdrawal - Think about meal time: assess each client for incontinence and change them as necessary

Question 33

Bulking agents

Answer 33

Psyllium, methylcellulose

Question 34

Stool softeners

Answer 34

Docusate

Question 35

Osmotic laxitives

Answer 35

Lactulose, Sorbitol

Question 36

Stimulant laxitives

Answer 36

Senna, Bisacodyl | -These are habit forming

Question 37

Saline laxitives

Answer 37

Milk of Magnesia (MOM)

Question 38

Enemas

Answer 38

- Normal saline or tap water (500-1000ml at 105 degrees) - Oil retention enemas: fecal impaction - Do not use: Soap-sud and phosphate. Irritate rectal mucosa.