Exam 2 - Chapter 16 Flashcards
what are the types of urinary incontinence?
- urge
- stress
- functional
urge incontinence definition
inability to suppress need to urinate
characteristics of urge incontinence
- urinary frequency (8 voids in 24 hrs)
- urgency
- nocturia
stress incontinence definition
loss of small amounts of urine when coughing, sneezing, exercising, lifting, or bending (increased abdominal pressure)
leakage of ≥ 50mL
stress incontinence is more common in women
true
stress incontinence can occur in men under which conditions?
post-op prostate surgery
functional incontinence definition
individual is unable to reach the toilet due to limitations in environment
lower urinary tract intact
what are the interventions to address incontinence?
- assessment of incontinence
- scheduled/ prompted voiding
- Kegels
- lifestyle modifications
- medications
- urinary catheters
what are some lifestyle modifications that older adults with incontinence can adapt?
- limit intake of bladder irritants (caffeine and alcohol)
- drink eight glasses of 8oz. water daily
- smoking cessation
- adopt physical activity
urinary catheters are the last resort to address incontinence
true
UTIs are the most common causes of sepsis in older adults
true
what are the elements of screening questions when assessing for urinary incontinence?
- onset
- duration
- frequency
- timing (day/ night)
- dribbling
- padding (do they use it to catch incontinence?)
- pain
what are unconventional symptoms of older adults with UTI?
- mental status change
- decreased appetite
- incontinence (due to asymptomatic bacteriuria)
what are the medications that treat incontinence?
- tolterodine
- tropsium chloride
- darifenacin
- fesoterodine
- solifenacin
anticholinergic and antimuscarinic medications
why is oxybutynin (medication for incontinence) avoided for older adults?
may lead to increased cognitive impairment
it is normal for older adults to have asymptomatic bacteria in urine
true
age related changes in the small intestine
- less functional
- decreased blood flow
- decreased absorption
age related changes in the large intestine
- slowed peristalsis
- reduced response to rectal filling
- dysmotility (due to increased collagen deposits)
- thicker anal sphincter
constipation is more common in older women
true
what are the complications of constipation?
- impaction
- obstruction
- cognitive dysfunction
- delirium
- falls
- increased morbidity and mortality
- increased risk for bowel cancer
what are the interventions for constipation?
- increase physical activity
- squatting on the toilet
- attempt BM after meals
- fluid intake 1500 mL
- increase fiber intake
- lay on left side after 30 mins of sitting up after meals
what does it mean when an older adult shows no sign of incontinence or UTI but goes to the bathroom often?
they have no urinary problems
going to the bathroom often is a result of decreased bladder capacity (normal in older adults)
what are foods high in dietary fiber?
- fruits
- vegetables
- beans
- wheat products
types of laxatives
- bulk-forming
- emollients
- osmotic
- stimulants
examples of bulk-forming laxatives
- pysillium fiber
- methylcellulose
what are some side effects of bulk-forming laxatives?
- abdominal distention
- flatulence
why are bulk-forming laxatives the first-line agents for constipation?
- low-cost
- fewer adverse effects
which individuals should be cautious in taking bulk-forming laxatives?
- frail older adults
- bedbound patients
- those with swallowing difficulties
what is MOA of emollients?
increase moisture content of stool
examples of emollients
- docusate
- mineral oil
why should mineral oil be avoided?
there is a risk for lipoid aspiration pneumonia
what is the main benefit of emollients?
alleviates straining
what are the types of osmotic laxatives?
- milk of magnesemia (MoM)
- lactulose
- sorbitol
- polyethylene glycol (miralax)
why should patients with renal insufficiency avoid MoM?
can lead to hypermagnesemia or hypophosphatemia
what are the side effects of lactulose and sorbitol?
- diarrhea
- abdominal cramping
- flatulence
why is miralax more likely to be prescribed than other osmotic laxatives?
- less bloating
- less flatulence
what is the MOA of osmotic laxatives?
causes water retention in the colon
what is the MOA of stimulant laxatives?
stimulate colorectal motor activity
what are some possible side effects of stimulant laxatives?
- cramping
- fluid or electrolyte imbalance
when are enemas most appropriate to use?
- other methods yielded no results
- fecal impaction
what is a side effect of enemas?
alteration of fluid and electrolyte status
why are phosphate enemas contraindicated in older adults?
it irritates the rectal mucosa
fecal impaction is most common among older adults in LTC (due to infrequent mobilization)
true
what is a major complication of constipation?
fecal impaction
what are the manifestations of fecal impaction?
- malaise
- urinary retention
- increased temperature
- incontinence
- cognitive decline
- hemorrhoids
- intestinal obstruction
how does a nurse perform fecal disimpaction?
- use lots of lube (containing lidocaine)
- let the patient know it will take several days & it is painful
- use oil-retention enema beforehand (softens the stool first)
beware of large impaction & its effects on the vagal nerve
define paradoxical diarrhea
leakage of fecal material around the impaction
occurs with fecal impaction
lab work (CBC) is better in indicating dehydration than skin turgor
true
