Geri GU Flashcards
urinary incontinence is a syndrome resulting from what 3 things?
Medical conditions, meds, lower urinary tract disease
what are the 4 types of urinary incontinence?
Transient incontinence
Urge incontinence
Stress incontinence
Overflow incontinence
what is Transient urinary incontinence?
caused by factor outside LUT
what is Urge urinary incontinence?
coincident with or follows precipitant urge to void
what is Stress urinary incontinence?
coincident w/maneuvers which incr. intra-abd pressure (coughing, running)
what is Overflow urinary incontinence?
impaired detrusor contractility, bladder outlet obstruction, or both
who gets urinary incontinence more, males or females?
W > M until 80 y/o, when M=W
what occurs in women with urinary incontinence?
anxiety and depression
what aspects of life does urinary incontinence affect? Leading cause for admission to what?
QOL, sexual dysfxn, morbidity (perineal infections from moisture and irritation - e.g. candida or cellulitis)
Leading cause for admission to SNF
what are the age related causes of urinary incontinence for BOTH genders?
- Bladder contractility decreases
- Uninhibited bladder contractions more prevalent
- Diurnal urine output occurs later in the day
- Bladder capacity decreases
cause of MALE urinary incontinence?
BPH
cause of FEMALE urinary incontinence?
Urethral closure pressure decreases
Vaginal mucosal atrophy prevalent
what are 3 causes of urinary incontinence?
Age-related LUT changes
Physiologic causes
Meds
what are age-related LUT changes associated with urinary incontinence?
- Prevalence of involuntary detrusor muscle contractions
- Impaired detrusor contractility
- Increased nocturnal diuresis
- Urethral shortening
- Decreased elasticity in women
- BPH in men
what are physiologic causes associated with urinary incontinence?
- MSK conditions
- Neuro conditions
- Cancer (bladder/prostate)
- Fecal incontinence
- Stool impaction
- Depression
what meds cause urinary incontinence?
anticholinergics
what are the sx’s of urinary incontinence?
- Urgency
- Frequency (>8 in 24hrs is abnormal)
- Nocturia (>2 voids in sleeping hours)
- Incomplete emptying (sense of fullness post-void)
- Hesitancy
- Decreased force or urine stream
what type of PE should be done for urinary incontinence? especially what systems?
a FULL physical exam should be down (esp Cardio, Neuro, Abd)
what nerve should be assessed for urinary incontinence?
perineal innervation (S2-S4) -> eval anal wink and bublbocavernosus reflex
what word should you NOT use when taking hx for pt with urinary incontinence?
don’t use the word “Incontinence”
what are screening questions for urinary incontinence?
Do you have any problems with bladder control?
Do you have problems making it to the bathroom on time?
Do you ever leak urine?
what dx test should be done for women with urinary incontinence?
Stress test
how is the Stress Test for women with urinary incontinence done?
Done with bladder full & in standing position
Relax pt, she gives single, forceful cough
if man has Post-void residual volume, what test do they need?
renal US
what is the tx for urinary incontinence?
- avoid caffeine
- bladder retraining, prompted voiding
- oxybutynin
- surgery to resuspend muscles/ligaments
- pessaries
- catheters (for sacral or LE wounds)
- palliative measures (absorbent garments)
what factors can worsen urinary incontinence?
- Involuntary detrusor contraction
- Increasing comorbidity
- Multiple meds
UTI is most common of infectious illnesses in who?
elderly women (>80)
UTIs have impact on what?
morbidity, exacerbates underlying illnesses, and initiating fxn decline
risk of UTI infection increases with what in elderly?
- Communal residence
- Daycare programs or senior centers
- ***Indwelling devices (high risk)
what correlates more than age to immune fxn compromise for UTIs in elderly?
increasing number of comorbidities
elderly pts immune fxn compromised by what?
alterations in berries of skin, GIT, lungs
comorbidities
what is a major risk factor for abx resistant organisms in the elderly with UTIs?
Institutionalization
- MRSA, VRE
- Fluoroquinolone-resistant Streptococcus pneumoniae
- Multiple-resistant GN bacilli
what bacteria are the MOST COMMON in UTIs?
GN bacilli
- E. coli
- Enterobacter
- Klebsiella
- Proteus
asx bacteriuria common where?
community and SNF
sx’s of UTI in elderly
***Fever ABSENT
Non-specific decline in baseline functional status:
- ***increased confusion (#1 sx)
- falling
- anorexia
- exacerbations of underlying illness (ex: Afib)
why is fever absent in elderly?
d/t changes systems responsible for thermoregulation
- shivering
- vasoconstriction
- hypothalamic regulation
body temp of older adults?
< 37 degrees C
dx of UTI in elderly relies on what?
S/S
what is the criteria for symptomatic UTI in women >65 y/o?
Symptomatic UTI in women >65 y/o defined by at least 2 of these criteria:
- Fever (>38 degrees C)
- Frequency, urgency, dysuria, suprapubic tenderness, or costovertebral angle pain
- Pyuria (> 10 WBCs/mm3 of unspun urine)
-Pos. Ucx of at least 105 colony-forming units/mL w/no more than 2 species of microorganisms
(infected elderly may have lower colony counts, 102-103, compared to young pt)
what test is done to r/o UTI for pts w/ low pre-test probability?
dipstick
are UA and Ucx ordered for asx pts?
NO!!! don’t order UA and UCx in asx pts
Dx testing for UTI in elderly should be for ___
fever, dysuria, gross hematuria, worsening incontinence
what is the MOST IMPORTANT PK change in elderly?
decrease in GFR
when do fluoroquinolone work best?
when levels of drug exceed MIC
what is the abx of choice for UTIs in elderly and young people? how long is the course of uncomplicated Lower UTI and Upper UTI?
Cipro
-3-6 day courses of abx for uncomplicated symptomatic lower UTI
-Upper UTI requires longer therapy course
use of overly broad abx tx increases risk of what?
abx resistance and C. diff disease
when is IV therapy NOT essential for UTI tx in elderly?
IV therapy NOT essential if patient:
- Can tolerate PO meds
- Not septic
- Infecting organisms sensitive to oral agents
UTIs in men are considered what? what tx is inappropriate in elderly men?
complicated UTIs
short-course therapy in elderly men is inappropriate
