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Geriatrics/Neuro > Geri GU > Flashcards

Geri GU Flashcards

1
Q

urinary incontinence is a syndrome resulting from what 3 things?

A

Medical conditions, meds, lower urinary tract disease

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2
Q

what are the 4 types of urinary incontinence?

A

Transient incontinence

Urge incontinence

Stress incontinence

Overflow incontinence

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3
Q

what is Transient urinary incontinence?

A

caused by factor outside LUT

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4
Q

what is Urge urinary incontinence?

A

coincident with or follows precipitant urge to void

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5
Q

what is Stress urinary incontinence?

A

coincident w/maneuvers which incr. intra-abd pressure (coughing, running)

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6
Q

what is Overflow urinary incontinence?

A

impaired detrusor contractility, bladder outlet obstruction, or both

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7
Q

who gets urinary incontinence more, males or females?

A

W > M until 80 y/o, when M=W

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8
Q

what occurs in women with urinary incontinence?

A

anxiety and depression

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9
Q

what aspects of life does urinary incontinence affect? Leading cause for admission to what?

A

QOL, sexual dysfxn, morbidity (perineal infections from moisture and irritation - e.g. candida or cellulitis)

Leading cause for admission to SNF

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10
Q

what are the age related causes of urinary incontinence for BOTH genders?

A
  • Bladder contractility decreases
  • Uninhibited bladder contractions more prevalent
  • Diurnal urine output occurs later in the day
  • Bladder capacity decreases
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11
Q

cause of MALE urinary incontinence?

A

BPH

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12
Q

cause of FEMALE urinary incontinence?

A

Urethral closure pressure decreases

Vaginal mucosal atrophy prevalent

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13
Q

what are 3 causes of urinary incontinence?

A

Age-related LUT changes

Physiologic causes

Meds

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14
Q

what are age-related LUT changes associated with urinary incontinence?

A
  • Prevalence of involuntary detrusor muscle contractions
  • Impaired detrusor contractility
  • Increased nocturnal diuresis
  • Urethral shortening
  • Decreased elasticity in women
  • BPH in men
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15
Q

what are physiologic causes associated with urinary incontinence?

A
  • MSK conditions
  • Neuro conditions
  • Cancer (bladder/prostate)
  • Fecal incontinence
  • Stool impaction
  • Depression
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16
Q

what meds cause urinary incontinence?

A

anticholinergics

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17
Q

what are the sx’s of urinary incontinence?

A
  • 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
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18
Q

what type of PE should be done for urinary incontinence? especially what systems?

A

a FULL physical exam should be down (esp Cardio, Neuro, Abd)

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19
Q

what nerve should be assessed for urinary incontinence?

A

perineal innervation (S2-S4) -> eval anal wink and bublbocavernosus reflex

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20
Q

what word should you NOT use when taking hx for pt with urinary incontinence?

A

don’t use the word “Incontinence”

21
Q

what are screening questions for urinary incontinence?

A

Do you have any problems with bladder control?

Do you have problems making it to the bathroom on time?

Do you ever leak urine?

22
Q

what dx test should be done for women with urinary incontinence?

A

Stress test

23
Q

how is the Stress Test for women with urinary incontinence done?

A

Done with bladder full & in standing position

Relax pt, she gives single, forceful cough

24
Q

if man has Post-void residual volume, what test do they need?

A

renal US

25
Q

what is the tx for urinary incontinence?

A
  • avoid caffeine
  • bladder retraining, prompted voiding
  • oxybutynin
  • surgery to resuspend muscles/ligaments
  • pessaries
  • catheters (for sacral or LE wounds)
  • palliative measures (absorbent garments)
26
Q

what factors can worsen urinary incontinence?

A
  • Involuntary detrusor contraction
  • Increasing comorbidity
  • Multiple meds
27
Q

UTI is most common of infectious illnesses in who?

A

elderly women (>80)

28
Q

UTIs have impact on what?

A

morbidity, exacerbates underlying illnesses, and initiating fxn decline

29
Q

risk of UTI infection increases with what in elderly?

A
  • Communal residence
  • Daycare programs or senior centers
  • ***Indwelling devices (high risk)
30
Q

what correlates more than age to immune fxn compromise for UTIs in elderly?

A

increasing number of comorbidities

31
Q

elderly pts immune fxn compromised by what?

A

alterations in berries of skin, GIT, lungs

comorbidities

32
Q

what is a major risk factor for abx resistant organisms in the elderly with UTIs?

A

Institutionalization

  • MRSA, VRE
  • Fluoroquinolone-resistant Streptococcus pneumoniae
  • Multiple-resistant GN bacilli
33
Q

what bacteria are the MOST COMMON in UTIs?

A

GN bacilli

  • E. coli
  • Enterobacter
  • Klebsiella
  • Proteus
34
Q

asx bacteriuria common where?

A

community and SNF

35
Q

sx’s of UTI in elderly

A

***Fever ABSENT

Non-specific decline in baseline functional status:

  • ***increased confusion (#1 sx)
  • falling
  • anorexia
  • exacerbations of underlying illness (ex: Afib)
36
Q

why is fever absent in elderly?

A

d/t changes systems responsible for thermoregulation

  • shivering
  • vasoconstriction
  • hypothalamic regulation
37
Q

body temp of older adults?

A

< 37 degrees C

38
Q

dx of UTI in elderly relies on what?

A

S/S

39
Q

what is the criteria for symptomatic UTI in women >65 y/o?

A

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)

40
Q

what test is done to r/o UTI for pts w/ low pre-test probability?

A

dipstick

41
Q

are UA and Ucx ordered for asx pts?

A

NO!!! don’t order UA and UCx in asx pts

42
Q

Dx testing for UTI in elderly should be for ___

A

fever, dysuria, gross hematuria, worsening incontinence

43
Q

what is the MOST IMPORTANT PK change in elderly?

A

decrease in GFR

44
Q

when do fluoroquinolone work best?

A

when levels of drug exceed MIC

45
Q

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?

A

Cipro
-3-6 day courses of abx for uncomplicated symptomatic lower UTI

-Upper UTI requires longer therapy course

46
Q

use of overly broad abx tx increases risk of what?

A

abx resistance and C. diff disease

47
Q

when is IV therapy NOT essential for UTI tx in elderly?

A

IV therapy NOT essential if patient:

  • Can tolerate PO meds
  • Not septic
  • Infecting organisms sensitive to oral agents
48
Q

UTIs in men are considered what? what tx is inappropriate in elderly men?

A

complicated UTIs

short-course therapy in elderly men is inappropriate

Geriatrics/Neuro (11 decks)

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