Flashcards in Bladder Issues Deck (35)
Involuntary leakage of urine in sufficient volumes of frequency so as to cause hygienic or social problems
Clinical Importance of Incontinence
Common especially in women
Common cause of institutionalization, social isolation, & decline in function
Increased risk of fractures
Often not mentioned to providers
Providers ill prepared to deal with it
Screening Question for Incontinence
Do you ever lose your urine & get wet?
How long have you had this problem?
What caused it to begin?
How often does it occur?
How much urine leaks out?
When does the leakage occur?
What precipitates the leakage?
Important History for Incontinence
Leak when you cough, sneeze, or strain?
Feel urge to urinate, urine leaks before you get to the bathroom?
Feel your bladder doesn't empty completely?
Hurt to urinate?
Blood in urine?
Trouble starting urine stream?
Treatment for leakage?
Use pads to catch leakage?
How many pads in a day?
Specific History Outside of Urinary Symptoms
Medical conditions: DM, MS, UTIs
Radiation treatment for GYN/urologic CA
Women Physical Exam for Incontinence
Pelvic: atrophy, prolapse, masses
Rectal: sphincter tone, impaction
Men Physical Exam for Incontinence
Rectal: prostate, sphincter tone, impaction
Transient Causes of Incontinence
Endocrine or excess urine output
Common Pharmaceutical Causes of Incontinence
Sedative hypnotics & any CNS depressants
Required Lab Tests for Incontinence
Urine culture & sensitivities
Useful Lab Tests for Incontinence
How can incontinence affect the elderly?
Decreases self esteem
Behavioral Approaches for Incontinence
Reduce caffeine, liquids
Prompted voiding: positive reinforcement for dryness
Treatment for Incontinence
Anticholinergics Used for Incontinence
Oxybutinin XL (Ditropan XL)
Imipramine or other TCAs
Risk Factors for UTIs
Fecal incontinence or impaction
Vaginal atrophy/estrogen deficiency
Insufficient fluid intake/dehydration
Indwelling foley catheter or instrument procedure
Causative Agents of UTIs in the Elderly
Confirmed UTI Symptoms in Women >65 Years Old
Fever (>38 degrees C)
Frequency, urgency, dysuria, suprapubic tenderness or CVA tenderness
Positive urine culture of at least 10^5 CFUs with no more than 2 species of microorganisms
Therapy for UTI in Older Women Based on
Location of infection
Likely causative agent
UTI in Older Men
Not appropriate: short courses
Signs & Symptoms of UTIs in the Elderly
Fever or hypothermia
Failure to thrive
Diagnostic Tests for UTI in the Elderly
Rapid tests for bacteria in urine
Gram stain of urine
Urine culture & sensitivity
WBC with differential
Things to Look for on UA
Bacterial count >100,000/mL
Things to Look at on Rapid Tests for Bacteria in Urine
Leukocyte esterase test
Gram Stain of Urine Results
Identify shape & characteristics
Obtain clean catch urine
WBC with Differential Results
Increased # of neutrophils
Septicemia refers to the active multiplication of bacteria in the bloodstream that results in an overwhelming infection
Affect of Cytokines in Sepsis
Impaired pulmonary, hepatic, or renal function
Risk Factors for Urosepsis
Alcohol: excessive intake