Week 9: Elimination And Sleep Flashcards
Age related changes in he Reinaldo and urological system
- Age-related loss of nephrons, kidney mass, and ability to concentrate urine generally lead to little change in the body’s ability to maintain adequate fluid homeostasis
- Renal disease or urinary tract obstruction can amplify age-related decline in function
Is urinary incontinence and frequency considered a normal part of aging?
Should never be considered a normal part of aging
Urinary Incontinence: Risk Factors
- Dementia (b/c person may not be able to find the bathroom or recognize the urge to void)
- Drugs that increase UO, sedatives, tranquilizers, hypnotics that produce drowsiness, confusion or limited mobility promote incontinence by dulling the transmission or desire to urinate.
Consequences of Urinary Incontinence
- Affects quality of life and has physical, psychosocial and economic consequences.
- Associated with increased risk for falls, fractures, and hospitalization.
- Affects self-esteem and increases risk for depression, anxiety, dignity, autonomy, social isolation, skin breakdown, and sexual activity
- Increases the risk for admission to the nursing home in those over 65 years of age
- Psychosocial impact affects the person and his or her family caregivers
Types of Urinary Incontinence
-Classified as either transient (acute) or established chronic)
Transient Urinary Incontinence
- Sudden onset
- Present for 6 months or less
- Usually caused by treatable factors such as UTI, delirium, constipation, stool impaction or increased urine production.
Establish Urinary Incontinence
- May have sudden or gradual onset
- Categoriezed as: 1) stress 2) urge 3) urge, mixed, stress 3) functional 5) mixed
Urinary Incontinence Interventions
- Behavioral (Box 16-7)
- Scheduled (timed) voiding (Figure 16-1)
- Bladder training
- Pelvis floor muscle exercises (Box 16-8)
- Vaginal weight training
- Lifestyle modifications (Box 16-9)
Intermittent Catheterization
Usually used for weak destructor muscle, black age of the urethra, BPH or reflux incontinence.
Long term use of indwelling catheter
-Increases the risk for recurrent UTIs Leading to urosepsis, urethral damage in men, urethritis or fistula formation.
External catheter
“Condom catheters” used for male patients
Catheter Associated Urinary Tract Infections
-Persons who develop UTI with an indwelling catheter in place or within 48 hours of removal.
What can decrease catheter associated UTI’s?
- Implementation of evidence based guidelines
- Catheter reminders
- Stop orders
- Nurse-initiated removal
- Urinary catheter bundle
Urinary Incontinence Management include
- Absorbent products: Protective undergarments or briefs
- Pharmacological interventions: Not considered first-line Treatment; Anticholinergics and anitmuscarinics
- Surgical Interventions: for stress incontinence; procedures include colposuspension and “slings”
- Nonsurgical devices: Intravaginal or intraurethral devices to relieve stress.
Bowel Elimination: Constipation
Defined as the reduction in the frequency of stool or difficulty in formation or passage of stool.
Fecal Impaction: Management
Requires digital removal of the hard impacted stool from the rectum with lubrication containing lidocaine jelly.
Bowel Elimination Assessments
- It is important to obtain a bowel history including usual patterns, frequency, size, consistency, any changes, and occurrence of straining and hard stools
- The precipitants and causes of constipation must be included in the evaluation
Bowel Elimination Interventions
- Nonpharmacological interventions
- Physical activity
- Positioning
- Toileting regimen
- Pharmacological interventions
- Enemas
- Alternative treatments
Fecal Incontinence
-Involuntary loss of liquid or solid stool that is a social and hygienic problem
Assessment for Fecal Incontinence
Assessment should include complete client history as in UI and investigation into stool consistency and frequency, use of laxatives or enemas, surgical and obstetric history, medications, effects of incontinence on quality of life, focused physical examination with attention to the gastrointestinal system, and a bowel record
Interventions for Fecal Incontinence
- Environmental manipulations (accessible toilet)
- Diet alterations
- Habit-training schedule
- Pelvic floor muscle exercises
- Improving transfer and ambulation ability
- Sphincter training exercises
- Biofeedback
- Medications
- Surgical intervention
What is the most important biorhythm?
-Circadian sleep-wake rhythm
What happens to the natural circadian rhythm as one ages?
the natural circadian rhythm may become less responsive to external stimuli, such as changes in light during the course of the day
What can cause less sleep efficacy in older adults?
Endogenous changes in the production of melatonin become diminished, resulting in less sleep efficacy
The body progresses through five stages of normal sleep pattern consisting of
- Rapid eye movement
- Sleep
- Non-rapid eye movement
Sleep and Aging
- REM sleep declines with aging and is a “critical state for sleeping elders” when the brain replenishes neurotransmitters.
- Increase in the number of nighttime awakenings and lower sleep efficiency
Insomnia
Interferes with sleep quality and quantity and is associated with subjective complaints of sleep.
Insomnia is characterized by subjective complains of sleep including
- Difficulty initiating sleep
- Difficulty maintaining sleep
- Premature morning awakening
- Nonrestorative sleep
Insomnia and Alzheimers Disease
About half of individuals with dementia experience sleep dysregulation, which may be associated with agitation, wandering, comorbid illness, primary sleep disorders, or medications used to treat the dementia
Behavior techniques that enhance sleep for those with AD
- Sleep hygiene education
- Daily walking
- Increased light exposure
Sleep Assessment
- Assessment for sleep disorders and contributing factors to poor sleep (pain, chronic illness, medications, alcohol use, depression, anxiety) are important
- Complete assessment data (Box 17-7)
- Sleep diary
Sleep Interventions: Nonpharmacological Treatment
- Directed at identifiable cause
- Considered first line treatment for insomnia
- Sleep hygiene
- Relaxation techniques
- Sleep restriction measures
- Stimulus control
- Circadian interventions
Pharmacological Treatment for Insomnia
-Benzodiazepines (one of the most abused drugs, along with opiates, in the older population) and other sedative hypnotics should not be used in older adults as a first choice of treatment for insomnia
Untreated obstructive sleep apnea is related to
- Right HF
- Cardiac dysrhythmias
- Stroke
- Type 2 Diabetes
- Death
What predisposes older adults to obstructive sleep apnea?
Age-related decline in the activity of the upper airway muscles, resulting in compromised pharyngeal patency, predisposes older adults to OSA
Assessment for Obstructive Sleep Apnea
- The individual may present with complaints of insomnia or daytime sleepiness, and assessment should include assessment of insomnia complaints
- If OSA is suspected, a referral for a sleep study should be made
- Recognition of OSA in older adults may be more difficult because they may not have a sleeping partner
Interventions for Obstructive Sleep Apnea
- Therapy depends on the severity and type of sleep apnea, as well as the presence of comorbid illness
- Continuous positive airway pressure is recommended as initial therapy
- Teaching should include the effects of untreated OSA and emphasize the need for treatment
