Exam 3 Urinary Incontinence

Question 1

Incontinence =

Is it a normal part of aging?

Answer 1

Involuntary loss of urine

NO

Question 2

2 Types of Incontinence

1) Transient or “new onset” =
2) Chronic (5)

Answer 2

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

Question 3

Common Causes of Transient Incontinence 
D
I
A
P
P
E
R
S

Answer 3

• 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)

Question 4

Stress Incontinence =

____ urine loss during (3)

Answer 4

= 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

Question 5

What test do we use to confirm stress incontinence?

Answer 5

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

Question 6

Stress Incontinence is most common in what populations (4)

Answer 6

• Women < 60 (postmenopausal)
• men after prostate surgery (turp)
• Obese
• Pregnant women

Question 7

Why are post menopausal women at increased risk for stress incontinence?

Answer 7

Loss of estrogen is associated with urinary incontinence

Question 8

Prevention Teaching/Tx for Stress Incontinence =

Answer 8

KEGEL exercises* - exercises pelvic floor

Question 9

Urge Incontinence =

Often called?

• The bladder muscle _____ all the time - “people sometimes say their bladder does it at the worst possible time”

Answer 9

= Detrusor instability, Internal sphincter weakness

= Overactive bladder, losses of LARGE amounts of urine

Question 10

Urge Incontinence mostly effects what population?

With this they have increased risk for?

Answer 10

Older adults most affected, especially older men (after stroke)

falls

Question 11

Causes of Urge Incontinence (4)

Answer 11

• Diuretics, Caffeine, Bladder irritants, glucose

Question 12

Tx for Urge Incontinence =

Answer 12

= Anticholinergics - but lots of contraindications/not good for older adults bc can even cause incontinence

Question 13

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

Answer 13

• Alert, aware, and able to resist the urge urinate

- habit

Question 14

Overflow Incontinence =

• “_____” or constant losses of ___ amounts of urine

Answer 14

= Bladder muscles OVEREXTENDED and have POOR TONE, overflow or retained urine

• “dribbling”, small

Question 15

Overflow incontinence occurs in people with (4)

Note: usually those with this will have a _____ schedule

Answer 15

• DM
• BPH
• Ca Channel Blockers
• Anticholinergics -> fight or flight = retain more urine

Toileting

Question 16

With overflow incontinence, voiding ____ is not intact

So wanna teach what maneuver to help with elimination?

Answer 16

• Reflex

- Valsalva maneuver (holding breath and bearing down as if to deficate can initiate voiding)

Question 17

Functional Incontinence =

Common in ____ elderly, nursing ___ residents, those with ____

• also patients who lack dexterity (e.g _____)

Answer 17

= Physical or psychological factors impair ability to get to the toilet

• frail, nursing home residents, dementia

Question 18

What is the most common type of incontinence we see in the hospital?

Answer 18

Functional Incontinence -> may refer to PT/OT

Question 19

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)

Answer 19

• transfer, aids, floor

Question 20

What do we not want to do with pt’s who have functional incontinence?

Answer 20

Patient says they can’t get to the bathroom but needs to void, never say just go in the bed

Question 21

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)

Answer 21

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

Question 22

Physical Assessment

• Bladder Distention: how to test for it?
• Bladder s____
• Bowel sounds =
• Pelvic and Rectal Exams by Provider =

Answer 22

• Palpate bladder and ask if they have suprapubic pain
• Scans
• probably decreased maybe from fecal impaction
• insert fingers and squeeze

Question 23

Laboratory Assessments (2)

Answer 23

1) Urinalysis (to detect infection)

2) Prostate Specific Antigen (BPH has increased PSA)

Question 24

Imaging (rare)

1) _____ _____ (stress incontinence)
2) Other urodynamic studies = o_____, bladder ____, __metry - are done when pt probably needs?

Answer 24

1) voiding cystourethrogram

2) otoscopy, bladder pressure, flowmetry -> done when pt probably needs surgical correction

Question 25

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

Answer 25

1) smoking, reduction, bowel, irritants, fluid

2) caffeine, alcohol, carbonated, dairy, citrus, spicy, tomatoes, artificial sweeteners

Question 26

Scheduled Voiding Regimens (3)

1) Timed voiding is good for ____ incontinence and men after _____
2) Prompted voiding especially useful for pts with ____ issues or _____

Answer 26

1) Timed voiding
2) Prompted voiding
3) Bladder training

1) stress, prostectomy
2) mobility, dementia

Question 27

Pelvic Floor Muscle Strengthening (3)

Kegel exercises and electrical stimulation are good for ___* and ___ incontinence

Answer 27

1) Kegel Exercises
2) Biofeedback (tests how well they can do kegel’s)
3) Electrical Stimulation

Stress*, Urge

Question 28

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

Answer 28

15 rapid contractions, 1-3 sets/day

Walking

Question 29

Anti-Incontinence Devices (4)

These devices are effective but a pain t o use because?

Answer 29

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

Question 30

Supportive Devices for Incontinence may include (4)

Answer 30

• high toilet seats
• gait training
• modified clothing (velcro)
• absorbent pads or undergarments

Question 31

Medications (2)*

Others not on PPT

1) anti____ for urge incontinence
2) Alpha ____
3) Beta ____
4) S___’s bc have an ______ effect

Answer 31

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

Question 32

Community- Based Care

1) H_____ environment assessment
2) ___-management education
3) Prevention of Complications (2)
4) P_____ support
5) Continence ______

Answer 32

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