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Care of Older Adults > Chapter 11 Elimination > Flashcards

Chapter 11 Elimination Flashcards

0
Q

Age-related changes in bladder function

A
  • Decreased capacity
  • Increased irritability
  • Contractions during filling
  • Incomplete emptying
  • May lead to frequency, nocturia, urgency, and vulnerability to infection.
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1
Q

Bowel and bladder function

A

are only slightly altered by normal physiological changes in aging

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2
Q

Urinary Incontinence

A
  • 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)
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3
Q

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

A

2

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4
Q

Urinary incontinence is associated with

A 
Falls
Skin irritations/breakdowns/infection
UTI
Pressure ulcers
Sleep disturbances
Loss of dignity
Loss of self-esteem
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5
Q

Urinary incontinence Risk Factors

A 
Diabetes (altered sensation)
Chronic conditions
Alzheimer's disease
Other cognitive impairment
Limitations in ADL's
Institutionalization
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6
Q

Urge incontinence

A

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

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7
Q

Stress incontinence

A
  • Involuntary loss of less than 50cc of urine associated with activities that increase intra-abdominal pressure
  • Post void residual is low
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8
Q

Urge, mixed stress with high post-void residuals

A 
Bladder becomes over extended
Frequent nearly constant urine loss
Hesitancy in starting stream
Slow stream
Feelings of incomplete bladder emptying
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9
Q

Functional incontinence

A
  • Lower urinary tract is intact

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

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10
Q

Mixed incontinence

A

Usually a mix of stress and urge

Most prevalent form of incontinence in women

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11
Q

Behavioral interventions for urinary incontinence

A 
Scheduled voiding
Prompted voiding
Bladder training
Biofeedback
Pelvic floor muscle exercised (kegel)
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12
Q

Lifestyle modification Intervention for urinary incontinence

A 
Diet: increased fluid and avoidance of caffeine
Weight reduction
Smoking cessation
Bowel management
Physical activity
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13
Q

Intermittent catheterization for specific physiological and neurological disorders

A

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

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14
Q

Anticholinergic agents

A
  • 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)
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15
Q

Oxybutynin (Ditropan)

A
  • Decreased muscle spasms and irritability of bladder

- Used: Frequent urination and Urge incontinence

16
Q

Tolterodine (Detrol)

A
  • Antimuscarinic

- Urinary incontinence and Overactive bladder

17
Q

Toviaz

A
  • Treats urinary incontinence

- Antimuscarinic

18
Q

BPH Treatment (alpha blockers)

A
  • 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
19
Q

Ach

A

acetylcholine

20
Q

androgen

A

primary sex hormone

21
Q

Surgical interventions for urinary incontinence

A

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

22
Q

Non-surgical devices (intervention for urinary incontinence)

A

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

23
Q

Urinary Tract Infection (UTI)

A
  • 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
24
Q

What is the most common symptom related to healthcare providers?

A

Constipation

25
Q

Fecal Impaction Treatment

A

Oil enemas followed by digital removal

Watch for Vaso-Vagal reflex

26
Q

Risk factors for altered bowel function

A 
Hypotonic colon function
Immobility and debilitation
Central nervous system lesions
Inadequate diet and fluid intake
Medications that impair bowel function
27
Q

Interventions for altered bowel function

A 
Medication review
Fluid and fiber review
Exercise
Positioning
Establishing regularity
Evaluate need for pharmacologic intervention (laxatives/enemas)
28
Q

Fecal incontinence Risk factors

A 
Diabetes
Stroke
Spinal cord injury
Immobility
Dementia
Pelvic floor trauma
Delayed obstetric injury
29
Q

Interventions for fecal incontinence

A 
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
30
Q

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

A 
Alterations in cognitive status
Incontinence
Increased temperature
Poor appetite
Unexplained falls
31
Q

When is the Gastrocolic reflex the strongest?

A

after breakfast and supper

warm drinks help

32
Q

Psychosocial impact

A
  • 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
33
Q

Bulking agents

A

Psyllium, methylcellulose

34
Q

Stool softeners

A

Docusate

35
Q

Osmotic laxitives

A

Lactulose, Sorbitol

36
Q

Stimulant laxitives

A

Senna, Bisacodyl

-These are habit forming

37
Q

Saline laxitives

A

Milk of Magnesia (MOM)

38
Q

Enemas

A
  • 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.

Care of Older Adults (8 decks)

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