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109 Cards in this Set
- Front
- Back
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What is the unplanned loss of urine that is sufficient enough to be considered a problem by the person family or caregiver
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Urinary incontinence
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When can urinary incontinence develop?
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It can be a acute. It can developed during an illness. Or it can develop over a period of time.
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Is urinary incontinence a normal part of aging
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No. However there are age-related changes in the urinary tract that predisposes the Elder to urinary infections
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Name the seven types of urinary incontinence
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Stress, urge, overflow, reflex, functional, total and mixed.
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Name the type of incontinence where there is a sudden increase in interabdominal pressure such as from sneezing coughing or lifting something heavy
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Stress incontinence
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Who is most at risk for stress incontinence
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Women and it is very common during pregnancy.
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Which type of incontinence occurs when there is a sudden urge to void and the client doesn't get to the restroom in time
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Urge incontinence
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Which type of incontinence When there is a frequent loss of urine due to an over distended bladder?
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Overflow incontinence. This patient never completely empties their bladder.
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Which type of incontinence occurs where there is nothing wrong with the urinary tract itself but there are other issues interfering with the ability to get to the bathroom to void
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Functional incontinence. Examples would be patients with Alzheimer's, dementia, or perhaps they have a broken leg in a cast and can't get to the bathroom.
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Which type of incontinence is when urine never accumulates in the bladder.
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Total incontinence. Think of an infant makes urine releases urine makes urine releases urine. urine is never stored.
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Define mixed incontinence
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This is any combination of incontinences. The most common combination is urge and stress. It is most common in older women because of the number of vaginal births and poor interabdominal muscle strength.
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Transient or acute cases of incontinence may be attributed to DIAPPERS. What is DIAPPERS.
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Delirium
Infection Atrophic vaginitis Pharmacologic agents Psychological factors Excessive urinary production Restricted activity Stool impaction |
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Name some of the risk factors for urinary incontinence
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Pregnancy, menopause, genitourinary surgery, pelvic muscle weakness, incompetent urethra, immobility, diabetes, stroke, morbid obesity, cognitive disturbance, medication, urinary track infections.
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How is menopause a risk factor for incontinence
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There is an increase in estrogen and increased estrogen causes a higher incidence of stress and urge incontinence.
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What are some consequences of incontinence?
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Rash, pressure ulcers, skin infections, increase in UTIs, and social ramifications.
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How is the diagnosis of urinary incontinence made
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By obtaining a good health history, getting lab work (probably a UA), and determining residual urine.
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How do you performing bladder scan?
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Have a patient void completely and scan the bladder to determine how many milliliters are left remaining in the bladder. Normal is anything less than 50.
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What are some pharmacologic means of treating urinary incontinence?
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Ditropan, detrol LA, and vesicare.
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What are the negative side effects related to pharmacological treatment for urinary incontinence
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Dry mouth, slow G.I. tract, and confusion. Confusion may be a problem for elders who are already experiencing confusion.
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What are surgical interventions for urinary incontinence?
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Collagen injections to the urethra is a temporary fix that last 12 to 24 months. Transvaginal transections using mesh are not performed often anymore due to lawsuits.
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What are some behavioral treatments for urinary incontinence?
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Fluid management, standardized voiding frequency, pelvic muscle exercises (kegal).
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What are some additional items that can help urinary incontinence?
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Awareness of amount and timing of fluid intake. Avoid diuretics after 1600 hrs. Avoid bladder irritants such as caffeine, artificial sweeteners, smoking, and alcohol. Avoid constipation. Void 5 to 8 times daily. Smoking cessation. Take vitamin C. Avoid catheterization. Acidic juices or vitamin C will acidifying urine preventing bacteria growth.
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Define benign prosthetic hyperplasia.
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It is an enlargement or hypertrophy of the prostate.
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Is benign prostatic hyperplasia a normal aging process
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Yes. The prostate naturally enlarges with age usually at the age of 50 or older
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How is benign prosthetic hyperplasia determined
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Usually through a digital rectal exam which reveals a prostate that is large, rubbery and nontender.
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What are some Nonsurgical treatment options for benign prostatic hyperplasia
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Watchful waiting, catheterization, balloon dilation, or medication.
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What are some medications used to treat benign prostatic hyperplasia
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Flomax and Hytrin relax muscles of the bladder and prostate. Proscar is in androgen inhibitor that causes suppression of prostate cells and decreases prostate size.
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What is gynecomastia
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Man boobs
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What are some of the negative side effects associated with the medication Proscar used to treat benign prostatic hyperplasia
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Gynecomastia, erectile dysfunction, and hot flashes or flushing.
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What are some surgical options to treat benign prostatic hyperplasia
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TURP, TUIP or Suprapubic prostatectomy, perineal prostatectomy, or retropubic prostatectomy.
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What is the most common surgical treatment for benign prostatic hyperplasia
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TURP or transurethral resection of the prostate
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Water of the positive and negative side effects of a TURP procedure
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It rarely leads to a erectile dysfunction but it can cause retrograde ejaculation
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What is the difference between a TURP and a TUIP procedure
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In a TURP procedure the prostate is removed in small chips through the urethra. in a TUIP procedure a scope is passed through the urethra and a small incision is made at the base of the penis in which small pieces of the prostate are removed.
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What is the most common complication after any type of prostate surgery
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Hemorrhage
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Which prostatectomy is used most commonly
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The suprapubic prostatectomy. Perineal or Retropubic prostatectomy's are not done very often anymore because of the risk of impotence, incontinence and infection related to where the incision is.
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What is continuous bladder irrigation
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It is a large IV bag of fluid that is flowing through a urinary catheter into the bladder flushing the contents.
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What is the second most common cancer in men after nonmelanoma skin cancer
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Cancer of the prostate
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Who is thought to be most at risk for death from cancer of the prostate
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African-American men thought to be due to the lack of access to healthcare and a strong genetic link at an early age
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What are some ways to assess and diagnose cancer of the prostate
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Digital rectal exam, serum PSA, bone scans, renal function tests, and a CT scan.
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What would be the finding of a digital rectal exam when assessing and diagnosing cancer of the prostate
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The prostate will feel stony hard and fixed when cancer of the prostate exist.
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What are some common clinical manifestations reported by patients who may have cancer of the prostate?
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Unfortunately there maybe none at first. eventually urinary obstruction is the first indicator but it is usually late in the disease process. blood and semen is found in the urine and the man will have painful ejaculation.
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What hormone is often prescribed for cancer of the prostate
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Men are often given estrogen supplements because this cancer is androgen specific.
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What are some medical managements for cancer of the prostate
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Surgical - either radical or laparoscopic prostatectomy. Radiation treatment, hormonal treatment, or chemotherapy, and potentially other therapies
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How is radiation treatment performed for cancer of the prostate
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It is called Brachytherapy. It is internal radiation 80 - 100 radioactive seeds are in planted in the prostate area. For the first two months the man should avoid being around pregnant women or babies. He will be asked to strain his urine for the radioactive seeds which will be sloughed off. He should wear a condom during sex.
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What are the positive and negative side effects of radiation treatment for cancer of the prostate
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On the negative side the patient will have inflammation of the rectum, bowel and bladder and he can have painful urination and ejaculation. On the positive side there is a greater chance for preserving sexual function.
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What is the greatest complication of treatment for cancer of the prostate
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Sexual dysfunction
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What are some aging changes related to sexuality in the male
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Decreased sperm production, atrophy, testosterone remains the same but estrogen increases, it takes longer to achieve erection, orgasm is unchanged for less forceful, there maybe occasional periods of erectile dysfunction, the refractory period may take longer, and in very very old males erection may not be firm enough for vaginal penetration.
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What are some aging changes related to sexuality in the female
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Menopause, estrogen decreases other hormones decrease,atrophy, breast tissue becomes involuted, decreased response of the labia, decreased vaginal lubrication, orgasm is usually shorter and not as intense, and there are urinary changes after intercourse.
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What are some medications that might be prescribed to treat urinary incontinence
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Tricyclic antidepressants such as nortriptyline which have anticholinergic effects. Urinary anti-spasmodics or anticholinergic agents such as Ditropan and or Bentyl. Bladder analgesics such as pyridium. Also if infection is present Garamycin or Keflex.
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What parts of the urinary system are included in upper urinary infections?
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The kidneys and ureters
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What parts of the urinary system are included in lower urinary infections
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The bladder and urethra
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What are some risk factors for a lower UTI
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Female gender, indwelling catheters, stool incontinence, bladder distention, urinary conditions, genetic links, diseases such as diabetes mellitus, older adult clients, and renal complications.
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Why are females more at risk for lower UTIs
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Shorter urethra, close proximity to the rectum, decreased estrogen in aging women, sexual intercourse, frequent use the feminine products, pregnancy, poorly fitted diaphragms, hormonal influences within the vaginal flora, synthetic underwear and pantyhose or slacks and tighy clothing, wet bathing suits, frequent submersion into Baths or hot tubs.
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What clinical symptoms will a patient report that may have a Lower UTI
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Older patients may have , otherwise dysuria frequency, incontinence, pelvic or flank pain, nausea, perineal itching, hematuria, fever, vomiting, voiding in small amounts, urethral discharge, cloudy or foul-smelling urine, nocturia.
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In the elderly who is more at risk of developing a UTI men or women
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Neither. In men the prosthetic secretions decrease with age these would usually protect a man from UTI.
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What assessments and diagnostic tools will be used to diagnose a lower UTI
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A urinalysis will be used to determine specific gravity and pH which would be elevated. A urine culture and sensitivity would be performed on a midstream clean catch urine specimen to identify the organism. Cellular studies might be performed to determine if white blood cells are in the urine indicating pyuria. Cystoscopy is used for complicated UTIs.
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What are important patient teachings when a patient is prescribed Pyridium
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It causes the urine to turn fluorescent orange and it can stain clothes.
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What medications might be prescribed for a lower urinary tract infection
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The sulfonamides Bactrim or Septra. Macrodantin. Cipro if the patient has a sulfa allergy. Levaquin. Pyridium for pain.
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What are some common NANDA diagnoses for a lower urinary tract infection
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Pain hydration fall risks and fatigue
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What are some common nursing interventions associated with a lower urinary tract infection
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Encourage fluids up to 3000 mL per day. Administer meds as prescribed. Encourage urination every 3 to 4 hours. Maintain an acid urine pH of 5.5 to prevent bacterial growth. Encourage daily bathing to promote good body hygiene. Advise client to urinate before and after intercourse. Advice female clients to wipe from front to back
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What are some complications of the lower UTI.
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Urethral obstruction, pyelonephritis, chronic renal failure, urosepsis, septic shock, and death.
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What is the most common and first sign of urosepsis
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Fever. Catheterized patients must be monitored for urosepsis especially older adults which can be very serious. You should obtain a urine specimen for culture and sensitivity before administering antibiotics.
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What is another name for an upper urinary tract infection
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Pyelonephritis
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What is the definition of pyelonephritis
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A bacterial infection of the. Renal pelvis, tubules, and interstitial space of one or both kidneys
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What is the definition of a lower UTI
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An inflammation of the bladder, obstruction of the urethra, or other irritants,
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What is the most common organisms associated with a lower or upper UTI
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E. coli
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What are the clinical manifestations associated with an acute upper UTI
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These patients are acutely ill. They may have chills, fever, colicky type abdominal pain, Malaise, fatigue, lower back pain, flank pain, nausea and vomiting, painful urgent or frequent urination, costovertebral tenderness, nocturia, Tachypnea, hypertension, tachycardia, inability to concentrate urine and conserve sodium, leukocytosis, bacteriuria.
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What assessment and diagnostic findings would you find with acute pyelonephritis
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Bacteremia, ultrasound, ct scan, IV pyelogram, Urinalysis, urine culture and sensitivity, white blood cell count and differential, serum creatinine and bun.
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What patient teachings should occur if they are going to have an IV pyelogram.
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They should be notified that it will feel like they are on fire for about 10 seconds and they will also feel as if they have Peed on themselves but they haven't.
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What are the clinical manifestations of chronic pyelonephritis
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Fatigue, headache, polyuria, thirst and weight loss. This can lead to renal failure due to scarring of the kidneys
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What is a normal bun level?
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Normal is 8 - 25 mg/dL
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What is a normal serum creatinine level
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0.6 - 1.3 mg/dL
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What does creatinine clearance tell you. What is normal Gfr?
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It provides the best estimate of the glomerular filtration rate. Normal GFR is 125 mL per minute
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What is nitrogenous urea
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A byproduct of protein metabolism in the liver
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When serum bun and serum creatinine levels increase at the same rate what does that tell you?
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It is an indicator of renal dysfunction.
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What are the assessment and diagnostic findings related to chronic pyelonephritis
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IV urogram to visualize abnormalities in the urinary system. Creatinine clearance. Serum bun and serum creatinine levels.
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What are some complications of chronic pyelonephritis
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End-stage renal disease, hypertension, kidney stones, And septic shock.
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What are the identifying signs of septic shock
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Hypotension tachycardia and fever
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What are the three parts of cognition
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Registration - Captures the person's attention
Storing - They record the information in their memory Retrieval - They find the information when they need it |
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Which memory is most affected in the elderly
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Short-term memory is most affected meaning they can't remember what they had for lunch but they can remember 1960
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How does the scoring work on the clock face exam
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A score from 0 to 4 can be obtained. One point for drawing and enclosed circle. One point for including only the numbers one through 12 no more no less. One point for having the numbers one through 12 in the right position. One point for being able to draw the hands on the face depending on what time you give them.
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What does folstein's mini mental status exam tell you
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It tests the mental status of the elder
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If you don't have the time to perform Folstein's Mini mental status exam. what other assessment tool might you use?
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A short portable mental status questionnaire which is faster to perform than folstein's. It gives you a quick clue as to the Elders mental status.
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Define dementia
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It is an irreversible deterioration of mental function.
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What are the 10 possible signs of dementia
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Loss of initiative, rapid mood swings, misplacing items, disoriented to place and time, problems with language, difficulty with familiar tasks, changes in personality, poor or decreased judgment, abstract thinking problems, memory loss that affects life.
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Define aphasia
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The inability to verbally communicate
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Define apraxia
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The inability to execute movement
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Define agnosia
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The inability to recognize familiar objects people or sounds.
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How does the DSM-IV define dementia
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Memory impairment, impairment in functioning, it can't be secondary to delirium or psychiatric problems, and at least one or more of the following: aphasia, apraxia, Agnosia, or disturbance of executive functions.
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What are some characteristics of Lewy body dementia
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Hallucinations, delusions, and the patient may fall frequently related to syncope.
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What are some characteristics of multi-infarct dementia
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It accounts for 20 to 25% of dementias. It is more common in men especially those with hypertension or cardiovascular disease. There is a rapid decline of intellectual abilities. Poor impulse control and judgment. Gait abnormalities.
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What are some characteristics of Wernecke's encephalopathy
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Double vision, nystagmus, lack of muscle coordination, decreased mental function. This can be related to malnutrition thiamine deficiency gastrointestinal tract disease, Or chronic alcoholism.
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What are some characteristics of picks or frontotemporal dementia
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It has a younger onset between the age of 40 and 50. Personality changes. Sexual or criminal disinhibition. Executive function declines severely. The person will develop behavioral issues or apathy.
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Explain Creutzfeldt Jacob dementia
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The human form of mad cow disease. Always fatal usually within one year. It is usually acquired from exposure to needles or instruments that were previously used on an undiagnosed patient or by eating undercooked meat especially brain tissue.
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What are the characteristics of Parkinson's
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It is a slow progressive neurological disorder. Usually greater than 60 years of age. Younger if patient had acute encephalitis or carbon monoxide poisoning. Patient will exhibit resting tremor, pill rolling, mask like expression, drooling, intolerance to heat, emotional instability, poor judgment which worsens with fatigue. Meds are prescribed to correct the decreased dopamine level.
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What are the characteristics of Huntington's dementia
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It is rare. The first signs and symptoms are usually seen in the age of the 40s. Death occurs in about 15 years. There is no treatment that signs and symptoms can be helped with medications.
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What is the most common form of dementia
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Alzheimer's
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What are some characteristics of Alzheimer's
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It is a slow steady decline with death occurring within 8 to 15 years. It is considered early-onset if it begins before the age of 65. It does not affect intelligence in the early stages.
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What are some diagnostic studies done to identify Alzheimer's
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An EEG, or a CT or MRI of the head (which will show atrophy).
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What are the three classes of Alzheimer's
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Mild moderate or severe
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What might you notice in the patient with mild Alzheimer's
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A lack of energy. Often it is noticed by family member who has been away for a long period of time.
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What might you notice in the patient with moderate Alzheimer's
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They can still perform many things independently however they may need help with complicated tasks.
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What might you notice in the patient with severe Alzheimer's
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There is an obvious disability. the patient would require assistance with even simple tasks. they need 24 hour supervision
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What is sundowners
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A cognitive impairment that worsens with the setting of the sun
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What are the most likely causes of death in the patient with dementia?
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Pneumonia, malnutrition, fluid and electrolyte imbalance, or dehydration.
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What are some medications to treat dementia
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Cognex, aricept, namenda, excelon, geodon, Aricept has been shown to delay long-term care about 21.4 months. Behaviors are improved and most have few side effects.
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What is the max score on mini mental status exam
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30
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Define delirium
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It is an acute confused state that is temporary and reversible. Delusions and hallucinations may be present
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When a person has lost the sensation for the need to avoid this is what type of incontinence
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Reflex incontinence
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