GERI mod 6 Flashcards
Why is incontinence more common in women?
Childbirth/repetitive trauma, urine travel is shorter, menopause and hormones, lack of estrogen will cause vaginal changes to sphincters.
What is a common profound complaint of incontinent patients?
Social isolation* and embarrassment. Also very costly, Falls are common because of the urgency to get to the bathroom. Infections are common in pads or diapers. Can cause rashes or skin breakdown.
What are the most common types of incontinence?
Stress and urge
Epesiotomies put you at high risk for what?
Incontinence and pelvic prolapse
An inappropriate sense of incontinence that is neurogenic. These patients are frantic to get to the bathroom.
Urge
Mixed is which two incontinence?
Most commonly Stress and urge. but can be a mix of any.
MC of acute incontinence is what? They won’t have burning or pain.
Infection
A blockage of flow. Can be caused by meds. Will have urgency but can’t get it out.
Overflow (retention) usually in men from prostate problems.
Patient just can’t make it to the bathroom because they can’t move or get up fast enough. No sphincter issue. Can be from dementia.
Functional incontinence
What are the reversible forms of incontinence?
Delirium, Intake of fluid poor or incorrect, stool impaction, Atrophic vaginitis/urethritis, psychological, pharmaceuticals, Excess urine output, abn labs, restrictive mobility
What are the most common reversible causes of incontinence?
Atrophic vaginitis/urethritis, Meds that would cause urge - diuretics, Meds like benadryl and Ca channel blockers, opiods can cause overflow incontinence.
What are the causes of fixed incontinence?
Dementia, stroke, cauda equina, MS, Parkinson, age related changes or trauma to pelvic floor.
sympathetic/somatic diminish and parasympathetic contracts
bladder.
Bladder emptying
How much vol does the bladder hold?
300-600L
Closes bladder neck and inhibits parasympathetic (relaxes
bladder dome
Sympathetic tone
Hx /description of symptoms:
UTI, duration, pain, nocturia*,
Urge vs stress - Child birth hx and C-section, Pregnancy in general is a RF even without vaginal delivery, Urge - they have to go right now!
Functional - can’t ambulate fast enough.
Med review
Meds - Anticholinergics, Diuretics, opiods, Ca channel blockers
PE
Sores, Atrophy vaginitis, thin skin or any break down, pelvic prolapse.
Testing
Get up and go test –> Physical therapy, UA test, Post void residual ultrasound –> >150ml is elevated retention.
Testing pelvic floor strength with valsalva –> can see and grade how much pelvic organs come out.
Urge - inappropriate impulse to bladder –> EMG test.
Weak pelvic floor.
Stress incontinence, treat with physical therapy. Can use lasers to tighten the tissues. Pessary helps hold up uterus and bladder.
Bladder control remedy
Injection stimulation usually for urge.
Catheters can get what?
Biofilms and cause infections.
Males usually get what two incontinence?
Overflow and may or may not get stress from prostectomy.
Gross hematuria
Visible
How does hematuria present?
painless
Hematuria is what until proven otherwise?
Bladder or renal cancer.
Can be from stones.
Menstruation, sexual activity, beats, blackberries, can also cause hematuria.
Criteria for hematuria.
Atleast 2 dips 2-6 weeks apart.
An endurance athlete with rabdomylosis will have what?
Hematuria - Myoglobin based
Cystoscopy
Visual exam ordered by urologist. Need CT scan with Cystoscopy because you can visualize everything above the bladder while the urology apointment is materializing.
With hematuria, If no infection what do you look for?
Kidney or glomerular causes.
What should you be cautious about with treating UTI in women?
Antibiotic resistance, and not doing an impirical treatment. Let the patient wait until you find out what is causing the UTI.
Are urine dips reliable?
Not really, can get false positives. In UTI the dip will have leukocytes, nitrates, RBCs, protein. Really what you need is a bacteria culture*
What number of bacturia do you need to diagnose UTI?
100,000, MC is E.Coli, kelbsella
What do you give patients for pain?
Pyridium
How to you treat UTI empirically?
1st line: nitrofurantoin - not for kidney dz, bacterium - not for anticoag, Cipro - not for C-diff, cephlex.
Do you treat asymptomatic chronic bacteriuria?
No, Will need to fix if they need procedures like hip replacements.
How do you diagnose asymptomatic bacteriuria?
Do a second culture.
Causes of Isolated proteinuria
DM, HTN
Microalbuminuria early stages of kidney disease.
UTI in severe cases.
Spot check
How much protein in how much time. protein to creatine ratio.
What meds should you consider in patients with proteinuria?
ACE and ARBS.
