Chapter 16 Elimination Flashcards
Elimination
- Can be severe enough to interfere with ability to continue independent living and threaten body’s capacity to function and survive
- Can threaten a person’s independence and well-being
- Nurses are in a key position to implement evidence-based assessment and interventions to enhance continence and improve function, independence, and quality of life
Age-Related Changes in the Renal and Urological System
Age-related loss of nephrons, kidney mass, and ability to concentrate urine generally lead to little change in the body’s ability to maintain adequate fluid homeostasis
Renal disease or urinary tract obstruction can amplify age-related decline in function
Urinary incontinence (UI) and frequency should never be considered a normal part of aging – However, It is often found r/t other issues.
Urinary Incontinence
UI is a stigmatized, underreported, underdiagnosed, and undertreated condition that is not a normal part of aging
Individuals may not seek treatment because they may be embarrassed or think it is normal
UI is an important but yet neglected geriatric syndrome
Viewed as an inconvenience instead of a treatable condition
Nurses must take the lead in implementing approaches to continence promotion and public health education
UI facts and figures
More common in women and peaks at menopause, and steady increase in aging men
More prevalent than diabetes and Alzheimer’s disease
More expensive than diabetes
Risk factors
Dementia is a high-risk factor for UI because a person may not be able to find the bathroom or recognize the urge to void
Drugs that increase urine output, sedatives, tranquilizers, hypnotics that produce drowsiness, confusion, or limited mobility promote incontinence by dulling the transmission or desire to urinate
Consequences of UI
Affects quality of life and has physical, psychosocial, and economic consequences
Associated with increased risk for falls, fractures, and hospitalization
Affects self-esteem and increases risk for depression, anxiety, dignity, autonomy, social isolation, skin breakdown, and sexual activity
Increases the risk for admission to the nursing home in those over 65 years of age
Types of UI
Classified as either transient (acute) or established (chronic)
Transient has a sudden onset, present 6 months or less, and is usually caused by treatable factors, like urinary tract infection (UTI), delirium, constipation, stool impaction, or increased urine production
Established UI may have sudden or gradual onset and is categorized as: (1) stress, (2) urge, (3) overflow, (4) functional, (5) mixed
Assessment
UI should routinely be addressed on the initial assessment
80% of incontinence can be cured or treated to minimize detrimental affects
Nurses play a key role in identification of UI
Assessment is multidimensional and includes continence patterns, alterations, and contributing factors
Interventions
Treatment choices (Box 16-8)
- Lifestyle
- Environmental
Behavioral
- Scheduled voiding
- Pelvic floor muscle exercises
- Habit/bladder retraining
- Prompted voiding
Barriers to implementation and continuation of toileting programs include
include inadequate staffing, lack of knowledge about UI and existing evidence-based protocols, and insufficient professional staff
Urinary Catheters
Intermittent catheterization
Usually used for weak detrusor muscle, blockage of urethra, reflux incontinence
Indwelling catheter*
Long-term use increases risk of recurrent UTIs
Those with more care needs, cognitive impairment, and pressure injuries are at higher risk of catheter placement
External catheter
“Condom catheters” used for male patients
Urinary Incontinence Management
Absorbent products
Protective undergarments or briefs
Pharmacological interventions
Not considered first-line treatment
Anticholinergics and antimuscarinics
Surgical interventions
Indicated for stress incontinence
Most common procedures colposuspension and “slings”
Nonsurgical devices
Intravaginal or intraurethral devices to relieve stress
Urinary Tract Infections
Most common cause of bacterial sepsis in older adults and 10 times more common in women
Assessment and appropriate treatment of UTIs in older people, particularly in the nursing home, is complex
Persons may be cognitively impaired or do not present with classic symptoms
The diagnosis of symptomatic UTI is based on clinical features and laboratory evidence
Bowel Elimination
*Bowel function is only slightly altered by physiological changes of aging, but can be a source of concern and potentially serious
Normal elimination should be easy passage of feces, without undue straining or a feeling of incomplete evacuation or defecation
Constipation
Defined as the reduction in the frequency of stool or difficulty in formation or passage of stool
The Rome Criteria outlines operational definitions of constipation and guide to diagnosis
Associated with impaired quality of life, significant health care costs, large economic burden, and can lead to serious consequences
It is a symptom, not a disease
Fecal impaction
More commonly seen in institutionalized older adults who require narcotic medications for chronic pain
Unrecognized, unattended, or neglected constipation eventually leads to fecal impaction
Removal of fecal impaction is at times worse than the misery of the condition
Management requires digital removal of the hard, compacted stool from the rectum with lubrication containing lidocaine jelly
Assessment
It is important to obtain a bowel history including usual patterns, frequency, size, consistency, any changes, and occurrence of straining and hard stools
The precipitants and causes of constipation must be included in the evaluation
Interventions
Nonpharmacological interventions Physical activity Positioning Toileting regimen Pharmacological interventions Enemas Alternative treatments
Fecal incontinence
Involuntary loss of liquid or solid stool that is a social and hygienic problem
Higher prevalence rates are found in persons with diabetes, irritable bowel syndrome, stroke, multiple sclerosis, spinal cord injury
Also associated with UI
Devastating social ramifications for persons and families
Skin breakdown
Assessment
The term accidental bowel leakage is preferred over fecal incontinence
Assessment should include complete client history as in UI and investigation into stool consistency and frequency, use of laxatives or enemas, surgical and obstetric history, medications, effects of incontinence on quality of life, focused physical examination with attention to the gastrointestinal system, and a bowel record
Interventions
Environmental manipulations (accessible toilet) Dietary alterations Habit-training schedule Pelvic floor muscle exercises Improving transfer and ambulation ability Sphincter training exercises Biofeedback Medications Surgical intervention
Which is a risk factor for UI? A. High caffeine intake B. Smoking C. Estrogen deficiency D. All of the above
D. All of the above
Which persons have the highest risk for fecal incontinence? A. Persons living in the community B. Persons residing in nursing homes C. Persons in the hospital D. Persons that are younger in age
B. Persons residing in nursing homes
