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Phase 3a Geriatrics > Urine > Flashcards

Urine Flashcards

1
Q

What increases prevalence of incontinence?

A

Middle age
70+ age

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2
Q

what is incontinence?

A

Involuntary enuresis, can be stress, urge, overflow, neurological

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3
Q

RF for incontinence?

A

F (X2)
Multiparity
Increased age
abdo surgery
BPH
Spinal trauma

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4
Q

What is urge incontinence?

A

Overactive
Nocturnal Sx
Key in door

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5
Q

what is stress incontinence?

A

Valsalva is the trigger

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6
Q

What is overflow incontinence?

A

Post retention in BPH + Prostate Ca (cannot empty bladder properly = absent urge = leaks unexpectedly)

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7
Q

what is a cause of neurological incontinence?

A

Cauda equina

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8
Q

How is incontinence Diagnosed?

A

Bladder diary
Urine dip
Urodynamic studies
MRI Spine?
CT Cytogram?

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9
Q

Tx for urge incontinence?

A
  1. Bladder retrain
  2. Oxybutynin
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10
Q

Tx for stress incontinence?

A
  1. Kiegel
  2. Duloxetine
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11
Q

Tx for neurological incontinence?

A

Permanent catheter

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12
Q

What is retention?
what are the 2 categories?

A

Acute (painful >600ml) or
Chronic (less painful, discomfort, ~1000 - 1500ml)

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13
Q

What causes retention?

A

BPH
Prostate Ca
Anticholinergics
fecal impaction

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14
Q

Dx of retention?

A

PR exam (r/o faeces)
Urodynamic studies (CT abdo?)

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15
Q

Tx of retention?

A

Analgesia
acutely catheterise

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16
Q

Complications of retention?

A

Hydronephrosis
Pyelonephritis
AKI

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17
Q

What is palliation?

A

care for Px that has less than 3 months to live

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18
Q

what are the aims of palliation?

A

Max QOL
Set affairs in order (Will, LPA)
Maximise spiritual outcome (imam, priest)
Improve family coping

19
Q

What medications can be given for in palliation:
Pain?
Secretion?

A

Morphine
Hyoscine butyl bromide, Glycopyrronium bromide

20
Q

What medications can be given for in palliation:
N+V?
Dyspnoea?
Agitation?

A

Metoclopramide (also co-danthramer for constipation)

Midazolam, O2

Haloperidol

21
Q

If a palliative Px can’t take meds PO, how would it be given?

A

Consider syringe driver mixed with 0.9% saline

22
Q

What is hypothermia?

A

core body temp <35c with rectal temp

23
Q

Sx of hypothermia?

A

Shivering
Piloerection
Autonomic change (tachy, htn initially then Brady + hypo)

24
Q

Dx of hypothermia?

A

Temperature
ECG (Osborn J wave - extra QRS deflection/VF/tachy)

25
Q

Tx of hypothermia?

A

External rewarming
ABCDE

26
Q

what is hyperthermia?

A

Core body temp >40c with CNS dysfunction
‘heat stroke’

27
Q

what are some causes hyperthermia in older and younger Px?

A

older = increased heat
Young = increased exertion

28
Q

Sx of hyperthermia?

A

Altered mental state
Hot flushed skin
Hypotensive

29
Q

Dx of hyperthermia?

A

temperature
ECG
BP

30
Q

Tx of hyperthermia?

A

ABCDE
IV fluid + cooling

31
Q

Complications of hyperthermia?

A

DIC
Rhabdomyolysis (to AKI)

32
Q

What are nocturnal cramps?
who gets them?
Tx?

A

Exclusively geriatric Px with night leg cramps, abnormal posturing and posterior calf tightening

Quinine (+ more exercise)

33
Q

what are the SE of quinine?

A

ECG
QRS prolongation, hypotension, metabolic acidosis, tinnitus

34
Q

What does advanced care planning allow for?

A

Px to put into place care plans In future should they lack capacity

35
Q

What documents does advanced care planning consider?

A

Lasting power of attorney
Advance statements
Advance directives
RESPECT forms
DNA CPR form

36
Q

is an advance statement legally binding?

A

no

37
Q

what are RESPECT forms used for and are they legally binding?

A

Recommended summary plan for emergency care + Tx

Not legally binding, reviewed + changed regularly

38
Q

What is a DNA CPR used for and is it legally binding?

A

Legally binding
IDEA, will not do CPR if heart stops but will try to save + prolong life (because risks > benefits of resus)

39
Q

in care packages, what 4 things does the NHS provide free?

A

home adaptations
Allowances
Help after discharge from hospital
NHS continuing healthcare

40
Q

what home adaptations can be installed?

A

handrails
walking frame
ramps for wheelchair

41
Q

what allowances can be given in care packages?

A

PIP
Attendance allowance

42
Q

what help can be provided after discharge?

A

Paid carer (dressing, cooking, cleaning, toilet)

43
Q

what care is given in NHS continuing healthcare?

A

fully Pais for disabled/severe illness Px care
palliative cases usually

Phase 3a Geriatrics (5 decks)

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