Geriatric: Incontinence, Weight Loss Flashcards
What is incontinence?
- Involuntary loss of urine or stool
- Ranges from occasional episodes to continous incontinence
- Many patients fail to tell provider
What are some adverse physical health effects from incontinence?
- Contact dermatitis
- Recurrent UTIs and skin infection
- Skin irritation
What are the requirements for continence?
- Stretch receptors within the destrusor muscle send signal to brain
- Brain decides if it is socially acceptable to void
- Destrusor muscle contracts
- External urethral sphincter relaxes under voluntary control
What are the classification of urinary incontinence?
- Transient or potentially reversible
- Established
What are the mnemonic for reversible causes of incontinence?
DRIP
DIAPPERS
What does DRIP stand for?
D: delirium
R: restricted mobility
I: Infection, inflammation, impaction
P: Polyuria, pharmaceuticals
What does DIAPPERS stand for?
D: Delirim
I: infection
A: atrophic urethritis and vaginitis
P: Pharmaceuticals
P: Psychological disorders
E: Excessive urine output
R: Restricted mobility
S: stool impaction
What is the most common cause of incontinence in hospitalized patients??
Delirium
*Clouded sensorium impedes the recognition of both the need to void and the location of the nearest toilet
What infection most commonly contributes to incontinence?
UTI
*asymptomatic bacteriuria does not cause incontinence
What is the most common causes of transient incontinence?
Pharmaceuticals
*diuretics
How can psychological factors lead to incontinence?
There is severe depression with psychomotor retardation
-May impede the ability or motivation to reach a toilet
How can excess urinary output lead to incontinence?
Can overwhelm the ability of an older person to reach the toilet in time
-Diuretics
-Excess fluid intake
-Metabolic abnormalities
How will a clinician know that there is stool impaction?
There will be both urinary and fecal incontinence
What are some established causes of urinary incontinence?
Addressed after the transient causes are ruled out risk factors
1. Older age
2. Female sex
3. Increase BMI
4 limited physical activity
What are the different types of incontinence?
- Stress (urethral incompetence)
- Urge (destrusor over activity)
- Overflow (destrusor under activity)
- Functional
What is stress incontinence/urethral incompetence?
- Urethral sphincter and pelvic musculature is weakened
- Transient increases in intra-abdominal pressure, raise the bladder pressure to levels that exceed urethral resistance
What is the clinical presentation of stress incontinence
- Small amounts with increased abdominal pressure
*cough
*sneeze
*exercise - Leakage is worse in the day
What is urge incontinence/ destrusor over activity?
- The detrusor wants to immediately empty as soon as it stretches
- Most common cause f established geriatric incontinence
What are causes or urge incontinence?
- Usually idiopathic
- Detrusor overactivity (detrusor muscle is contracting before bladder is full)
What is an overactive bladder?
Urinating more than 8 times in a 24 hours period
What is Overflow incontinence/Detrusor underactivity
- Least common cause
- Leakage of urine from mechanical forces on an over distended bladder
*overflow due to urinary retention
What are some causes of overflow incontinence?
- Anatomical obstruction
- Acontractile bladder
*weakness in the detrusor muscle from peripheral nerve disease - Neurogenic
What is functional incontinence?
- Inability to reach the toilet
*Psychological unwillingness
*Environmental barriers
*Impairment of cognitive
What are some causes of functional incontinence?
- Mobility problems
- Environmental factors
- Severe dementia
- Psychological factors
