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Geriatric > Urinary Incontinence & Pressure Ulcers > Flashcards

Urinary Incontinence & Pressure Ulcers Flashcards

1
Q

What nervous system is in charge of the detrusor muscle contraction?

A

Parasympathetic

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2
Q

What nervous system is in charge of the internal urethral sphincter?

A

Sympathetic

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3
Q

What muscles is the external urethral sphincter made of?

A

Striated

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4
Q

Where is urination controlled in the brain? What is is called?

A

Pons; Micturition Center

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5
Q

What nervous system is in charge of the stopping detrusor muscle contraction?

A

Sympathetic

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6
Q

Common aging changes in the bladder

A
  • Decreased Bladder Capacity
  • Decreased Ability to Inhibit Reflex Contractions
  • Decreased Closing Pressure
  • Increased Residual Urine
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7
Q

What can cause incontinence that is “readily” treatable? In other words, these are “short term incontinence issues.”

Hint: DIAPPERS

A 
Delirium
Infection
Atrophic Vaginitis/Urethritis
Pharmaceutical (diuretics, sedatives)
Psychosocial
Endocrine (Inc. Glucose/Calcium)
Restricted Mobility
Stool Impaction
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8
Q

What are the 4 types of Incontinence?

A
  • Detrusor Instability (Urge)
  • Overflow
  • Stress Incontinence
  • Functional
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9
Q

This type of incontinence is most common in men. It is caused by defects in CNS regulation, hyperexcitability, or sometimes deconditioning. Essentially, the detrusor contractions are not inhibited as they should be.

A

Urge/Detrusor Instability Incontinence

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10
Q

This type of incontinence is caused by an outlet obstruction or destrusor inadequacy. Commonly, diabetic neuropathy can cause this. The Intravesicular pressure cannot exceed intraurethral pressure.

A

Overflow Incontinence

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11
Q

This type of incontinence is caused by a weakness of pelvic muscles, estrogen deficiency, or urologic surgery. Physiologically caused by sphincter insufficiency.

A

Stress Incontinence

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12
Q

In real life, can different types of incontinences overlap? Or are they exclusive?

A

They can overlap. There are cases of obstruction or stress incontinence that often have assc. destrusor instability

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13
Q

In what patients should you inquire about urinary incontinence?

A

All middle-aged and older women

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14
Q

When inquiring about urinary continence, what should you ask in regard to pattern?

A
  • Incontinence Chart

- Stress Related Behavioral or Functional Problem

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15
Q

When inquiring about urinary continence, what should you ask in regard to local factors?

A
  • UTI
  • Outlet Obstruction
  • Hx Pelvic Surgery
  • Local Neurologic Symptoms
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16
Q

When inquiring about urinary continence, what should you ask in regard to systemic factors?

A
  • Hx Neoplasia
  • Hx DM
  • CNS Dysfunction
  • Medications
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17
Q

Upon physical exam, what things are you looking for that can cause or indicate urinary incontinence

A
  • Estrogen Deficiency
  • Fecal Impaction
  • Prostatic Hypertrophy
  • Sacral Neurologic Function
  • Enlarged Bladder After Voiding
  • Incontinence with Coughing (Supine vs. Upright)
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18
Q

What labs would you order in someone with potential urinary incontinence?

A
  • Serum Glucose/Calcium
  • UA
  • Post-void residual volume measurement (normal < 100 mL)
  • Urodynamics
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19
Q

T/F: Due to the small urethra, females tend to have an obstruction as a cause of incontinence at a greater degree than men.

A

False, men have a higher likelihood for incontinence.

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20
Q

What tests do you order to check Urodynamics

A
  • Post-void residual
  • Urine Flow
  • Cystometry
  • Cystoscopy
  • Electromyography
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21
Q

When do you refer for a Urodynamic Study

A
  • Hx of Pelvic Sx or Irridiation
  • Marked Pelvic Prolapse
  • Evidence of Prostatic Obstruction
  • Post-void Residual > 100 mL
  • Uncertain Dx
  • Unresponsive to Tx
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22
Q

What effect do diuretics have that can affect continence?

A

Polyuria

23
Q

What effect does caffeine have that can affect continence?

A

Detrusor Irritation

24
Q

What effect do beta agonists have that can affect continence?

A

Urinary Retention

25
Q

What effect do anticholinergics have that can affect continence?

A

Urinary Retention

26
Q

What effect do hypnotics have that can affect continence?

A

Sedation

27
Q

What effect do alpha agonists have that can affect continence?

A

Urinary Retention

28
Q

What effect do alpha blockers have that can affect continence?

A

Sphincter Relaxation

29
Q

What effect do narcotics have that can affect continence?

A

Urinary Retention

30
Q

What is the treatment goal for functional urinary incontinence?

A

Re-establish normal pattern

31
Q

What is the treatment goal for stress incontinence?

A

Inc. Intraurethral Pressure

32
Q

What is the treatment goal for overflow incontinence?

A

Remove Obstructions

33
Q

What is the treatment goal for detrusor instability?

A

Dec. Detrusor Contractions

34
Q

What is a class of drug you would use for detrusor instability?

A

Anticholinergic Agents/Bladder Relaxants because they block detrusor contractions

i.e. Oxybutynin, Tolterodine, Solifenacin

35
Q

What are some problems with anticholinergics?

A

Dry Mouth
Constipation
CNS issues

36
Q

What is another class of drug you would use for detrusor instability?

A

Imipramine. Used because it has anticholinergic and alpha sympathetic agonist activity.

37
Q

What non-pharmacologic treatments could you use in conjunction with medication for detrusor instability?

A
  • Bladder training/scheduled voiding
  • Eliminate Caffeine
  • Formal training using biofeedback in pelvic floor (Kegel) contraction prn urge sensation
38
Q

How do you treat an obstructive cause of overflow incontinence?

A
  • Sx: May have detrusor instability for period post-op

- Drug: alpha blockers, anti-androgens (finasteride)

39
Q

How do you treat a detrusor weakness cause of overflow incontinence?

A
  • Intermittent Catherization

- Inswelling (Foley) catheter

40
Q

How do you treat stress incontinence?

A
  • Estrogen
  • Kegel Exercises
  • Bladder Training
  • Sympathomimetics
  • Surgery
41
Q

How do you treat functional incontinence?

A
  • Incontinence Chart
  • Tx Psych issues
  • Use prompted voiding
42
Q

This is defined as an area of soft-tissue breakdown, usually occurring over a bony prominence.

A

Pressure Sore/Ulcer

43
Q

This type of pressure ulcer has erythema present for at least 24 hours, it is indurated and the epidermis is intact.

A

Grade I

44
Q

This type of pressure ulcer extends into the dermis with surrounding erythema and is indurated.

A

Grade III

45
Q

This type of pressure ulcer involves deep fascia and/or muscle with surrounding erythema and is indurated

A

Grade IV

46
Q

This type of pressure ulcer involves a break in the epidermis or a blistering with surrounding erythema and induration.

A

Grade II

47
Q

Rule of Thumb with people at risk for ulcers

A

Small opening at the surface may underlie a large undermining defect.

48
Q

What is the most common location for a pressure ulcer?

A

Ischial

49
Q

What percent of patients develop a pressure ulcer during hospitalization?

A

3-4.5%

50
Q

If interstitial pressure is elevated, what can happen that can cause pressure ulcers to occur (>12 mm)

A
  • Filtration of Capillary Fluid
  • Occlusion of Lymphatics
  • Accumulation of Metabolic Wastes
51
Q

Contributing Factors ot Pressure Ulcers

A
  • Pressure
  • Shearing Force
  • Fricition
  • Moisture
  • Malnutrition
52
Q

How do you treat a pressure ulcer?

A
  1. Relieve Pressure (turn Q2hours)
  2. Debride Necrotic areas
  3. Wound Dressing (kept wet)
    - - Superficial: Paraffin Gauze
    - - Deep Ulcer: wet-to-wet
  4. Improve General Health (Nutrition)
  5. Inspect Skin (measure)!
53
Q

Objectives of Sx

A
  • Excision Ulcerate Areas
  • Resection Bony Prominences
  • Formation of large Flaps
  • Obtainment of Additional Padding (Muscle)
54
Q

Complications of Ulcers

A
  1. Sepsis (Polymicrobial, anaerobes)

2. Osteomyelitis

Geriatric (9 decks)

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