Exam 3 Urinary Incontinence Flashcards
Incontinence =
Is it a normal part of aging?
Involuntary loss of urine
NO
2 Types of Incontinence
1) Transient or “new onset” =
2) Chronic (5)
1) = aka secondary incontinence - something else can be causing it e.g UTI -> irritation -> incontinence, once trigger is gone, incontinence
2) Stress, Urge, Overflow, Functional, Mixed
Common Causes of Transient Incontinence D I A P P E R S
- Delirium
- Infection
- Atrophic Urethritis (thinning/inflammation of vaginal wall dt decreased estrogen, tx = topical estrogen cream)
- Pharmaceuticals (diuretics)
- Psychologic (new onset of depression may sometimes cause urinary incontinence)
- Excess Urine Output
- Restricted Mobility
- Stool Impaction (from pressure buildup, can do DRE or abdominal x-ray to confirm fecal impaction)
Stress Incontinence =
____ urine loss during (3)
= Weakened external sphincter and pelvic floor muscles, dt increased intra-abdominal pressure
- Small urine loss during sneezing, laughing, exercise
note: so with any pressure build up, the weak sphincter and weak pelvic floor can’t keep in urine
What test do we use to confirm stress incontinence?
A Voiding Cystourethrogram = fills the bladder with dye that can be seen on x-ray, person has to stand and hold their bladder, then cough/laugh on demand to see if urine is released
Stress Incontinence is most common in what populations (4)
- Women < 60 (postmenopausal)
- men after prostate surgery (turp)
- Obese
- Pregnant women
Why are post menopausal women at increased risk for stress incontinence?
Loss of estrogen is associated with urinary incontinence
Prevention Teaching/Tx for Stress Incontinence =
KEGEL exercises* - exercises pelvic floor
Urge Incontinence =
Often called?
- The bladder muscle _____ all the time - “people sometimes say their bladder does it at the worst possible time”
= Detrusor instability, Internal sphincter weakness
= Overactive bladder, losses of LARGE amounts of urine
Urge Incontinence mostly effects what population?
With this they have increased risk for?
Older adults most affected, especially older men (after stroke)
falls
Causes of Urge Incontinence (4)
- Diuretics, Caffeine, Bladder irritants, glucose
Tx for Urge Incontinence =
= Anticholinergics - but lots of contraindications/not good for older adults bc can even cause incontinence
In order for bladder training programs to succeed in a pt w urge incontinence, the pt must be?
____ training will work best for a confused client
These include going to the bathroom (or being assisted to the bathroom) at set times
- Alert, aware, and able to resist the urge urinate
- habit
Overflow Incontinence =
- “_____” or constant losses of ___ amounts of urine
= Bladder muscles OVEREXTENDED and have POOR TONE, overflow or retained urine
- “dribbling”, small
Overflow incontinence occurs in people with (4)
Note: usually those with this will have a _____ schedule
- DM
- BPH
- Ca Channel Blockers
- Anticholinergics -> fight or flight = retain more urine
Toileting
With overflow incontinence, voiding ____ is not intact
So wanna teach what maneuver to help with elimination?
- Reflex
- Valsalva maneuver (holding breath and bearing down as if to deficate can initiate voiding)
Functional Incontinence =
Common in ____ elderly, nursing ___ residents, those with ____
- also patients who lack dexterity (e.g _____)
= Physical or psychological factors impair ability to get to the toilet
- frail, nursing home residents, dementia
What is the most common type of incontinence we see in the hospital?
Functional Incontinence -> may refer to PT/OT
Functional Incontinence
- Older adults unable to ___ from wheelchair to toilet, those with walking ___ that take too long to get to the bathroom (voiding large amounts of urine on ___ while heading to the bathroom)
- transfer, aids, floor
What do we not want to do with pt’s who have functional incontinence?
Patient says they can’t get to the bathroom but needs to void, never say just go in the bed
Collaborative Management: Assessment
History Questions
1) Do you ever ____ urine: when you don’t to; when you cough, laugh, or exercise; on the way to the bathroom?
2) Do you use ___ or ____ in your underwear to catch urine?
Incontinence Assessment Tools (3)
1) leak
2) pads, cloths
1) 24 hour diary - looks at everything
2) sx data collection
3) Urinary incontinence assessment in older adults includes urogenital distress inventory short form, incontinence impact questionnaire
Physical Assessment
- Bladder Distention: how to test for it?
- Bladder s____
- Bowel sounds =
- Pelvic and Rectal Exams by Provider =
- Palpate bladder and ask if they have suprapubic pain
- Scans
- probably decreased maybe from fecal impaction
- insert fingers and squeeze
Laboratory Assessments (2)
1) Urinalysis (to detect infection)
2) Prostate Specific Antigen (BPH has increased PSA)
Imaging (rare)
1) _____ _____ (stress incontinence)
2) Other urodynamic studies = o_____, bladder ____, __metry - are done when pt probably needs?
1) voiding cystourethrogram
2) otoscopy, bladder pressure, flowmetry -> done when pt probably needs surgical correction
Lifestyle Modifications
1) ____ cessation, weight ___, b____ management, avoid other bowel ____, appropriate ___ intake
2) Foods: reduce c____, a____, c____ beverages, d___ products, ____ fruits and juices, highly s___ foods, to____, and ____ sweeteners
1) smoking, reduction, bowel, irritants, fluid
2) caffeine, alcohol, carbonated, dairy, citrus, spicy, tomatoes, artificial sweeteners
Scheduled Voiding Regimens (3)
1) Timed voiding is good for ____ incontinence and men after _____
2) Prompted voiding especially useful for pts with ____ issues or _____
1) Timed voiding
2) Prompted voiding
3) Bladder training
1) stress, prostectomy
2) mobility, dementia
Pelvic Floor Muscle Strengthening (3)
Kegel exercises and electrical stimulation are good for ___* and ___ incontinence
1) Kegel Exercises
2) Biofeedback (tests how well they can do kegel’s)
3) Electrical Stimulation
Stress*, Urge
Kegel Exercises instruct them to do how many? How many times a day?
____ program may help to strengthen core, can be equally as effective as kegels
15 rapid contractions, 1-3 sets/day
Walking
Anti-Incontinence Devices (4)
These devices are effective but a pain t o use because?
1) Pessaries - for prolapsed uterus/bladder
2) Condom Catheters
3) External Clamps
4) Urethral plugs
bc you have to take them out when wanting to void, problem for pts with dexterity issues
Supportive Devices for Incontinence may include (4)
- high toilet seats
- gait training
- modified clothing (velcro)
- absorbent pads or undergarments
Medications (2)*
Others not on PPT
1) anti____ for urge incontinence
2) Alpha ____
3) Beta ____
4) S___’s bc have an ______ effect
1) Anticholinergics such as Oxybutynin (Ditropan)* for urge incontinence (overactive bladder)
2) Topical Estrogen (women with stress incontinence)
1) antispasmotics
2) agonists
3) blockers
4) SSRI’s bc have anti-cholinergic effect
Community- Based Care
1) H_____ environment assessment
2) ___-management education
3) Prevention of Complications (2)
4) P_____ support
5) Continence ______
1) Home
2) Self
3) Skin breakdown, UTI’s
4) Psychosocial
5) Clinics -> can be recommended for pts who have never been medically mamanged (these clinics look at med regime, home environment, exercise devices, individualized lifestyle modifications
