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36 Cards in this Set
- Front
- Back
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Incontinence affects how may people in the US?
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13 million, 80% are women
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Is incontinence a normal part of aging?
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NO WAYYYYYYY
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What are the 5 types of incontinence?
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Urge incontinence (over active bladder)
Stress incontinence Overflow incontinence Functional Mixed |
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What is urge incontinence?
Population? Cause? |
sudden need to void that can't be suppressed
most common type over age 75 usually idiopathic, but can be caused by infection, stones, tumor, stroke |
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What is the most common type of incontinence in people over the age of 75?
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Urge incontinence
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What are some bladder irritants?
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caffeine, alcohol, chocolate
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What is stress incontinence?
Population? What is the cause of the problems in this population? |
Loss of urine with increased intra-abdominal pressure
Most common cause in women 85% have hypermobility of the bladder neck and urethra as a complication of childbirth 15% have intrinsic sphincter deficiency |
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What is the most common type of incontinence in women?
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stress incontinence
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What is overflow incontinence?
Most common population? What are the most common causes? |
Over distension of the bladder causing frequent urinationa nd dribbling
most common in men Causes: 1. bladder outlet obstruction due to prostate enlargement, urethral structure, cystocele, fecal impaction 2. atonic/acontractile bladder due to diabetes, MS, spinal cord injury, lumbar stenosis |
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What is the most common type of incontinence in men?
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Overflow incontinence
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What is the worst outcome of overflow incontinence?
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chronic over distention of the bladder can lead to hydronephrosis, which can lead to renal failure
SO YOU MUST WORK THIS UP IF YOU SUSPECT IT |
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What is functional incontinence?
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NOT a problem of the lower urinary tract, caused by cognition, physical impairment or mobility restriction
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What is mixed incontinence?
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overlap of 2 or more types of incontinence
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What are the causes of transient incontinence?
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delirium, infection (UTI), atrophic urethritis, pharmaceutical, psychological, excessive urine output, restricted mobility, stool impaction
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What are the causes of established incontinence?
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detrusor over activity (urge)
detrusor under activity (neurogenic) urethral obstruction (overflow) urethral incontinence (stress) |
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What drugs can affect urinary function?
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sedative, hypnotics, alcohol, anticholinergics, antipsychotics, tricyclic antidepressants, antiparkinsons drugs (EXCEPT L dopa), narcotics, alpha blockers, diuretics
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Antiparkinsons drugs affect urinary function... which one DOES NOT?
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L dopa
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What do you do to work up a potential incontinence case?
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Physical- mental status, mobility, prostate, impaction, cystocele
Lab- UA, BUN, Cr, glucose, calcium Imaging- Bladder Scan, Renal Ultrasound Post void residual scan |
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How do you do a post void residual scan?
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must do within 5 minutes of voiding, use a bladder scan or catheter
if there is less than 100cc that is ok 100-200cc is borderline more than 200cc is abnormal and need furthur evaluation |
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What is urge incontinence and how do you treat it?
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remember- it is the sudden urge to void that can't be suppressed
behavioral tx- decreased fluid intake, void on schedule, avoid bladder stimulants (caffeine, OH, chocolate), no fluids 2-3 hours before bed, toilet should be readily available drugs- anticholinergics including oxybutynin (ditropan) and tolerodine (detrol) oxyBUTynin, T(its)olerodine |
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What are the side effects of anticholinergic use?
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dizziness, sleepiness, confusion, dry eyes, dry mouth, tachycardia, palpitations, dyspepsia, constipation, URINARY RETENTION
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What is stress incontinence and what is the treatment?
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remember, stress incontinence is the loss of urine associated with increased intra-abdominal pressure
behavioral tx- voiding schedule, KEGAL drug tx- pseudoephedrine (sudafed), estrogen (topical) surgery tx- 80-90% success rate but falls to 50% after 10 years Injection- periuretheral bulking agents Pessary- elevates the bladder necka nd corrects the vesico-uretheral angle.... look this up on wiki. ew. |
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What is overflow incontinence and what is the treatment?
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remember, overflow incontinence is over distention of the bladder
if the problem is an obstruction- sugery, alpha blockers if the problem is atonic/acontractile bladder- insert a catheter |
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What is functional incontinence and how is it treated?
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remember, functional incontinence is not a problem of the urinary tract, but a problem with cognition, physical impairment or mobility restriction
tx- treat the underlying problem!! |
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What are the indications for a temporary catheter?
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long surgical procedure, monitoring urine during severe illness, decompress bladder following prolonged retention, obtain urine specimen, protect surgical wound during initial post op period
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What are the indicaitons for a permanent catheter?
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neurogenic bladder, skin protection for immobile patient, comfort measure for terminal illness, non repairable bladder obstruction
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What are some predisposing factors for UTI in the elderly?
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post void residual greater than 100cc, structural abnormalities, prostate enlargement, bladder/renal stones, catheters and surgery, underlying illness, antibiotics
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How does a UTI present in the elderly?
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fever, dysuria, frequency, CONFUSION, lethargy, weakness
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What are the symptoms of uncomplicated UTI?
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mild fever, dysuria, frequencia, bacturia
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How does urosepsis present?
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temperature over 38C, hypotension, bacturia, bacteriemia, change in mental status
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What are the emperic treatments for UTI?
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oral quinalone, trimethoprim sulfa, amoxicillin/clavulanate, cephalexin
when they are in the hospital, they are really sick, so you have to give these via IV |
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What percent of LTC residents will have pyruia/bacturia?
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90%
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How does age affect renal blood flow?
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Renal blood flow decreases by 1% per year after age 50
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Mantra for drug administration?
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START LOW
GO SLOW |
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Do we have to adjust the dose based on GFR?
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YES
Normal GFR is 60 or above... if it is below 50 drug doses may need to be adjusted |
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How do creatinine clearance and GFR relate?
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note: Creatine clearance often overestimates GFR
increase in serum creatinine is reflected in a decreased GFR |
