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Community And Wellness > Geriatric: Incontinence, Weight Loss > Flashcards

Geriatric: Incontinence, Weight Loss Flashcards

1
Q

What is incontinence?

A
  1. Involuntary loss of urine or stool
  2. Ranges from occasional episodes to continous incontinence
  3. Many patients fail to tell provider
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2
Q

What are some adverse physical health effects from incontinence?

A
  1. Contact dermatitis
  2. Recurrent UTIs and skin infection
  3. Skin irritation
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3
Q

What are the requirements for continence?

A
  1. Stretch receptors within the destrusor muscle send signal to brain
  2. Brain decides if it is socially acceptable to void
  3. Destrusor muscle contracts
  4. External urethral sphincter relaxes under voluntary control
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4
Q

What are the classification of urinary incontinence?

A
  1. Transient or potentially reversible
  2. Established
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5
Q

What are the mnemonic for reversible causes of incontinence?

A

DRIP
DIAPPERS

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6
Q

What does DRIP stand for?

A

D: delirium
R: restricted mobility
I: Infection, inflammation, impaction
P: Polyuria, pharmaceuticals

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7
Q

What does DIAPPERS stand for?

A

D: Delirim
I: infection
A: atrophic urethritis and vaginitis
P: Pharmaceuticals
P: Psychological disorders
E: Excessive urine output
R: Restricted mobility
S: stool impaction

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8
Q

What is the most common cause of incontinence in hospitalized patients??

A

Delirium
*Clouded sensorium impedes the recognition of both the need to void and the location of the nearest toilet

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9
Q

What infection most commonly contributes to incontinence?

A

UTI
*asymptomatic bacteriuria does not cause incontinence

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10
Q

What is the most common causes of transient incontinence?

A

Pharmaceuticals
*diuretics

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11
Q

How can psychological factors lead to incontinence?

A

There is severe depression with psychomotor retardation
-May impede the ability or motivation to reach a toilet

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12
Q

How can excess urinary output lead to incontinence?

A

Can overwhelm the ability of an older person to reach the toilet in time
-Diuretics
-Excess fluid intake
-Metabolic abnormalities

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13
Q

How will a clinician know that there is stool impaction?

A

There will be both urinary and fecal incontinence

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14
Q

What are some established causes of urinary incontinence?

A

Addressed after the transient causes are ruled out risk factors
1. Older age
2. Female sex
3. Increase BMI
4 limited physical activity

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15
Q

What are the different types of incontinence?

A
  1. Stress (urethral incompetence)
  2. Urge (destrusor over activity)
  3. Overflow (destrusor under activity)
  4. Functional
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16
Q

What is stress incontinence/urethral incompetence?

A
  1. Urethral sphincter and pelvic musculature is weakened
  2. Transient increases in intra-abdominal pressure, raise the bladder pressure to levels that exceed urethral resistance
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17
Q

What is the clinical presentation of stress incontinence

A
  1. Small amounts with increased abdominal pressure
    *cough
    *sneeze
    *exercise
  2. Leakage is worse in the day
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18
Q

What is urge incontinence/ destrusor over activity?

A
  1. The detrusor wants to immediately empty as soon as it stretches
  2. Most common cause f established geriatric incontinence
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19
Q

What are causes or urge incontinence?

A
  1. Usually idiopathic
  2. Detrusor overactivity (detrusor muscle is contracting before bladder is full)
20
Q

What is an overactive bladder?

A

Urinating more than 8 times in a 24 hours period

21
Q

What is Overflow incontinence/Detrusor underactivity

A
  1. Least common cause
  2. Leakage of urine from mechanical forces on an over distended bladder
    *overflow due to urinary retention
22
Q

What are some causes of overflow incontinence?

A
  1. Anatomical obstruction
  2. Acontractile bladder
    *weakness in the detrusor muscle from peripheral nerve disease
  3. Neurogenic
23
Q

What is functional incontinence?

A
  1. Inability to reach the toilet
    *Psychological unwillingness
    *Environmental barriers
    *Impairment of cognitive
24
Q

What are some causes of functional incontinence?

A
  1. Mobility problems
  2. Environmental factors
  3. Severe dementia
  4. Psychological factors
25
Q

How to treat stress incontinence/urethral incompetence?

A
  1. Lifestyle modification
    *limit caffeine, timed voiding
  2. Pelvic floor exercise
  3. Surgery
26
Q

How to treat urge incontinence/Detrusor overactivity

A
  1. bladder training
    *Voiding schedule
    *gradually increase the time
  2. Pelvic floor exercises
  3. Lifestyle modification
27
Q

What are some drug therapies that can be used for urge incontinence/Detrusor overactivity

A
  1. Antimuscarinic agents
    *Tolterodine (detrol)
    *Oxybutin (Ditropan)
    MOA: Increase bladder capacity
28
Q

What are the B3 agonist used for urge incontinence/ Detrusor overactivity?

A
  1. Mirabegron (myrbetrig)
  2. Vibegron (Gemtesa)
29
Q

What is the MOA of B3 agonist

A

Stimulates the receptors in the bladder responsible for smooth muscle relaxation

30
Q

How to treat urethral obstruction that is causing overflow incontinence

A
  1. A-blocking agents (male)
    *Terazosin (Cardura)
    *Tamsulosin (Flomax)
    *Prazosin
  2. Finasteride (proscar)
31
Q

How to treat overflow incontinence?

A
  1. Double voiding
  2. Suprapubic pressure
32
Q

When should you refer the elderly with incontinence to urology?

A

Men: with urinary obstruction who do not respond with medical therapy
women: who do not respond to medical therapy and behavioral therapy

33
Q

What is stress incontinence due to?

A

Increased abdominal pressure under stress (weak pelvic floor muscles)

34
Q

What is urge incontinence due to?

A

Involuntary contraction of the bladder muscles

35
Q

What is overflow incontinence due to?

A

Blockage of the urethra

36
Q

What can lead to fecal incontinence?

A

Constipation
* <3 BM per week

37
Q

What are some treatment options for constipation?

A
  1. Stool softener (Docusate sodium)
  2. Bulk forming agents (Metamucil)
  3. Osmotic cathartics
  4. Stimulants (bisacodyl)
38
Q

What is a reasonable threshold for weight loss for 1 month and 6 months?

A

1 month: 5%
6 months: 10%

39
Q

What does upper arm circumference asses?

A

Lean body mass

40
Q

What does waist to hip ratio asses?

A

Determine fat distribution or central adiposity

41
Q

What are some treatments for weight loss?

A

Megestrol acetate (Megace)
*used as a appetite stimulant
*has significant side effects

42
Q

What are some high risk drugs?

A

Drugs with anticholinergic activity

43
Q

What is a sensitivity age related change?

A

High pitches lost initially

44
Q

What is a speech age related change?

A

Difficulty understanding if background noise

45
Q

What is a loudness age related change?

A

Hypersensitivity to high pitch

46
Q

What is localization age related change?

A

Hard to figure out where noise is coming from

Community And Wellness (39 decks)

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