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Geriatrics > Urinary Incontinence, UTI’s and Urosepsis in the Elderly > Flashcards

Urinary Incontinence, UTI’s and Urosepsis in the Elderly Flashcards

1
Q

Definition of Incontinence

A

Involuntary leakage of urine in sufficient volumes or frequency so as to cause hygienic or social problems

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2
Q

UI can cause?

4

A

Common cause of

  1. institutionalization,
  2. social isolation, and
  3. decline in function
  4. Increased risk of fractures
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3
Q

What factors do you want to look for in the history that may be causing this? 5

A
  1. Fluid Intake
  2. Medications
  3. Gynecologic / Urologic Surgeries
  4. Medical Conditions – DM, MS, UTIs
  5. Radiation Treatment for Gynecologic / Urologic Cancer
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4
Q
  1. For women with UI: What are you looking for on the pelvic exam? 3
  2. Rectal exam? 2
  3. Other tests to perform? 2
  4. Genitalia and Rectal exam for men? 3
A
    • atrophy,
    • prolapse,
    • masses
    • sphincter tone,
    • impaction
    • Stress test
    • Q-tip Test
    • prostate,
    • sphincter tone,
    • impaction
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5
Q

Rule out Transient Causes

DIAPPERS?

A 
D elirium
I nfection
A trophy
P harmeceuticals
P sychologic
E ndocrine or excess urine output
R estricted mobility
S tool impaction
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6
Q

Common Drug Causes of Incontinence

7

A
  1. Anticholinergics
  2. Alpha agonists
  3. Alpha antagonists
  4. Diuretics (including caffeine)
  5. Calcium channel blockers
  6. Sedative hypnotics and any 7. CNS depressants, including ETOH
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7
Q
  1. Required Lab tests? 2

2. Useful? 4

A
  1. REQUIRED:
    - U/A
    - Urine C&S
  2. USEFUL:
    - BUN, Creatinine
    - Glucose
    - Calcium
    - Electrolytes
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8
Q

Behavioral Approaches to UI?

4

A
  1. Reduce caffeine, liquids
  2. Timed voiding - go often enough to avoid accidents
  3. Bladder training - lengthen time between voids gradually
  4. Prompted voiding - caregiver positively reinforces dryness, neutral response to wetness
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9
Q

Treatments options for UI? 3

A
  1. Timed voiding, bladder training, prompted voiding
  2. Biofeedback & electrical stimulation
  3. Anticholinergics
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10
Q

Anticholinergics options? 5

A
  1. Oxybutinin XL (Ditropan XL) 5-30 mg QD
  2. Oxybutinin 2.5mg QD - 5mg TID
  3. Tolterodine 1-2mg PO BID
  4. Imipramine 25-50mg QD or other TCAs
  5. Dicyclomine, propantheline
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11
Q

What will establish pattern in most chronic cases of UI? 3

A
  1. Bladder diary,
  2. simple H&P,
  3. PVR
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12
Q

UTI in the elderly: Risk factors?

9

A
  1. Advanced age
  2. Fecal incontinence/impaction
  3. Neurogenic bladder
  4. Vaginal atrophy/estrogen deficiency
  5. Pelvic prolapse/cystocele
  6. Insufficient fluid intake/dehydration
  7. Indwelling foley catheter or instrument procedure
  8. BPH
  9. Diabetes
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13
Q

UTI in elderly: Causitive aganets:

  1. Top 2?
  2. Other 4?
A
    • E. coli ~30%
    • Proteus species (GI tract) ~30%
    • Staph. Aureus,
    • Klebsiella,
    • psuedomonas (gram neg), &
    • Enterococcus (gram pos) ~40%
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14
Q

UTI in women > 65YO be defined by at least 2 of the following? 4

A
  1. Fever (>38 degrees C)
  2. Frequency, urgency, dysuria, suprapubic tenderness or CVA tenderness
  3. Positive urine culture of at least 10 to the 5th colony-forming units/mL with no more than 2 species of microorganisms
  4. Pyuria (>/= 10 WBCs/mm3 of unspun urine)
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15
Q

Urine cultures in infected elderly patients may have lower colony counts: Such as?

A

10 to 2nd or 10 to the 3rd**

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16
Q

Therapeutic antibiotic “trials” are not recommended, to avoid drug toxicity and antimicrobial resistance

  1. When the diagnosis of UTI is in doubt manage how?
  2. _____% or older women with UTI sx will improve in this time frame without therapy
A
  1. withold antibiotics for 1 week and follow-up (outpatients)
  2. 25-50
17
Q
  1. When a true UTI is documented in an older woman, therapy is based on: what?
  2. UTI in older men is frequently caused by what?
A
    • The location of the infection
    • Likely causative agent
  2. by concomitant prostate disease or functional bladder impairment
    - UTIs in these populations are considered high risk
18
Q

What should be obtained when patients develop fever or otherwise unexplained systemic manifestations compatible with infection (eg, altered mental status, fall in blood pressure, metabolic acidosis, and respiratory alkalosis)?

A

Blood and urine cultures

19
Q

UTI in the elderly: Signs and Symptoms?

8

A
  1. Nocturia, incontinence
  2. Confusion
  3. Lethargy
  4. Anorexia
  5. Fever or hypothermia
  6. FTT [failure to thrive]
  7. Pain/dysuria
  8. Behavioral changes
20
Q

Dx of UTI in Elderly?

4

A
  1. UA
  2. Rapid tests for bacteria in urine
  3. Gram stain of urine
  4. Urine culture and sensitivity
  5. CBC with diff
21
Q

What would the following show for UTI:

  1. UA? 3
  2. Rapid tests for bacteria in urine? 2
  3. Gram stain of urine? 2
  4. Urine culture and sensitivity: Culture requires how long for results?
  5. CBC with diff? 2
A
  1. Urinalysis:
    - assess pyuria,
    - bacteria (Bacterial count >100,000 /ml indicative of infection)
    - blood cells in urine;
  2. Rapid tests for bacteria in urine***
    - Nitrite dipstick (turning pink = presence of bacteria)
    - Leukocyte esterase test (identifies WBC in urine)
  3. Gram stain of urine: identify by
    -shape
    -characteristic (gram positive or negative);
    (obtain by clean catch urine or catheterization)
  4. Urine culture and sensitivity: identify infecting organism and most effective antibiotic; culture requires 24 – 72 hours for results; obtain by clean catch urine or catheterization
  5. WBC with differential:
    - leukocytosis and
    - increased number of neutrophils
22
Q

Definition of sepsis?

A

Septicemia refers to the active multiplication of bacteria in the bloodstream that results in an overwhelming infection

23
Q
  1. Excess cytokines indicate? 3
  2. Prognosis depends on what?
  3. Death by?
A
  1. Impaired
    - pulmonary,
    - hepatic, or
    - renal function
  2. Prognosis depends on underlying health status and host defenses
  3. Death by multi-system organ failure
24
Q

Urosepsis risk factors? 5

A
  1. BPH
  2. DM
  3. SLE
  4. Alcohol—excessive intake
  5. Taking steroids
25
Q

Urosepsis: Pathogenesis?

3

A
  1. UTI
  2. BPH
  3. Pyelonephritis
26
Q

Urosepsis
Signs and Symtpoms?
6

A
  1. Hypotension
  2. Tachycardia
  3. Tachypnea
  4. Rales
  5. Respiratory distress
  6. Anorexia, nausea, vomiting
27
Q

Urosepsis Workup

4

A
  1. Blood tests
  2. UA & Culture
  3. CT/MRI/US
  4. Catheterization
28
Q

What blood tests would you do for urosepsis? 3

A
  1. Kidney functions
  2. CBC
  3. Chem 8
29
Q

Urosepsis
Tx?
4

A
  1. Immediate hospitalization
  2. Treat for shock
  3. Fluids
  4. Broad-spectrum antibiotics IV
30
Q

Which Broad-spectrum antibiotics IV? 4

A
  1. Imipenem
  2. Meropenem
  3. Piperacillin-tazobactam
  4. Sulbactam-ampicillin

Geriatrics (16 decks)

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