Question

Case Scenario A:

Mrs. P is an 80-year-old retired school teacher who receives visits from a nursing agency for congestive heart failure. Mrs. P was diagnosed with dementia 4 years ago. She lives with her daughter, who is also her caregiver. In addition to dementia. Mrs. P has macular degeneration. She is blind at her left eye and has significantly impaired vision in her right, she fell and fractured her left hip 1 year ago. She walks with the assistance of a walker. She has a moderate amount of ankle and foot edema bilaterally. She always suffered from frequent constipation. Her current medication include; hydrochlorothiazide, a calcium channel blocker and a stool softener, Mrs. P is able to get in and out bed by herself but requires assistance with all other ADLs. She has been incontinent of urine for 2 years. Mrs. P voids but leaks urine before she gets to the bathroom. Mrs. P wears incontinence undergarments. She also has enuresis and usually wet in the morning

1. Enumerate and describe each different types of urinary incontinence.

2. Make a drug study of hydrochlorothiazide and stool softener

3. What is the common cause of urinary incontinence of Mrs. P?

4. How can you stop incontinence in older adult?

5. Is incontinence a normal part of aging, explain?

B.

1. What are the components of a basic evaluation for urinary incontinence?

2. Factors that may lead to urinary incontinence.

3. Explain different forms of urinary incontinence.

4. What are the different strategies/ interventions of care with urinary incontinence?

Answer 1

1. Types of incontinence :-

urge incontinence

involuntary loss of larger amount of urine accompanied by a strong urge to void - aka overactive bladder

stress incontinence

involuntary loss of small amounts of urine with increased intra-abdominal pressure. "loss of less than 50 mL of urine" in the absence of an overactive bladder. pregnancy, childbirth, obesity, chronic constipation, straining at stool. exercise, laughing, sneezing, coughing and lifting all are activities that produce leakage of urine

mixed incontinence

combination of urge and stress incontinence

overflow incontinence

the loss of urine in combination with a distended bladder. causes include fecal impaction, neurological disorders and enlarged prostate

functional incontinence

untimely loss of urine when no urinary or neurological cause is involved. occurs because of physical disability, immobility, pain, external obstacles or problems in thinking or communicating that prevent a person from reaching a toilet. confusion, disorientation, or mobility problems

transient incontinence

short-term incontinence that is expected to resolve spontaneously. UTI and meds esp diuretics

unconscious (reflex) incontinence

loss of urine when the person does not realize the bladder is full and has no urge to void. CNS disorders and multisystem problem are common causes. tissue damage from radiation, cystitis, bladder inflammation or radical pelvic surgery can trigger

enuresis

familial. involuntary urination after about 5-6 years of age when control of bladder is established. stress, UTI, allergies, abnormal EEG patterns, sleep disorders, hearty laughing, and small bladder

nocturnal enuresis

bedwetting. can persist until age 10 or later. familial. UTI, urinary obstruction, diabetes, pressure on the bladder from extreme constipation, or neurological disorders of the spinal cord

2. Hydrochlorothiazide :

Drug Class :-

Antihypertensive, diuretic

Pregnancy Category :-

Category B

Usage :-

To manage hypertension

Dosage: Adults

12.5 mg daily

Dosage: Oral Solution

25 to 100 mg daily as a single dose or in divided doses b.i.d.

Dosage: Children over 6 Months

1 to 2 mg/kg daily as a single dose or in divided doses b.i.d.

Dosage: Children under 6 Months

Up to 3 mg/kg daily

Mechanism of Action :-

A thiazide diuretic, hydrochlorothiazide promotes the movement of sodium (Na+), chloride (Cl-), and water (H2O) from blood in the peritubular capillaries into the nephron's distal convoluted tubule, as shown at right. Initially, hydrochlorothiazide may decrease extracellular fluid volume, plasma volume, and cardiac output, which helps explain blood pressure reduction. It also may reduce blood pressure by causing direct dilation of arteries. After several weeks, extracellular fluid volume, plasma volume, and cardiac output return to normal, and peripheral vascular resistance remains decreased.

Contraindications :-

Anuria; hypersensitivity to hydrochlorothiazide, other thiazides, sulfonamide derivatives, or their components; renal failure

Adverse Reactions :-

CNS:

Dizziness, fever, headache, insomnia, paresthesia, vertigo, weakness

CV:

Hypotension, orthostatic hypotension, vasculitis

EENT:

Blurred vision, dry mouth

ENDO:

Hyperglycemia

GI:

Abdominal cramps, anorexia, constipation, diarrhea, indigestion, jaundice, nausea, pancreatitis, vomiting

GU:

Decreased libido, impotence, interstitial nephritis, nocturia, polyuria, renal failure

HEME:

Agranulocytosis, aplastic anemia, hemolytic anemia, leukopenia, neutropenia, thrombocytopenia

MS:

Muscle spasms and weakness

SKIN:

Alopecia, cutaneous vasculitis, erythema multiforme, exfoliative dermatitis, photosensitivity, purpura, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria

Other:

Anaphylaxis, dehydration, hypercalcemia, hyperuricemia, hypochloremia, hypokalemia, hyponatremia, hypovolemia, metabolic alkalosis, weight loss

Nursing Considerations :-

Give hydrochlorothiazide in the morning and early in the evening to avoid nocturia.

Monitor fluid intake and output, daily weight, blood pressure, and serum levels of electrolytes, especially potassium.

Assess for signs of hypokalemia, such as muscle spasms and weakness.

Monitor BUN and serum creatinine levels.

Frequently monitor blood glucose level as ordered in diabetic patients, and expect to increase antidiabetic drug dosage, as needed.

If patient has gouty arthritis, expect an increased risk of gout attacks during therapy.

#. Stool softeners: description

help form soft stool

Stool softeners: action

promote peristalsis

Stool softeners: therapeutic uses

Psyllium: decrease diarrhea.

Docustate: relieves constipation.

Bisacodyl: preprocedure for colon evactuation, it sttimulates.

Magnesium hydroxide or milk of magnesia (MOM): rapid stool evacuation

Stool softeners: drugs

psyllium, docustate, bisacodyl, magnesium hydroxide or milk of magnesia or M.O.M.

Stool softeners: adverse effects

bronchospasm, cramps, nausea

Stool softeners: contraindications

fecal impaction, obstructions. hypersensitivity, abdominal pain, dysphagia.

Stool softeners:med/ food interactions

decreased absoprtion of warfarin. caution with diet restricted clients.

Stool softeners: nursing interventions

monitor bowel finctions

Stool softeners: med administration

administer with water or juice. Shake solution well.

Stool softeners: evaluation of med effectiveness

soft forms stool and bowel functino

Stool softeners: client education

educate regarding activities and moving. promote bowel elimination. Increased fluid and fiber intake.

3. Common cause :-

Weak bladder muscles

Weak pelvic floor muscles

Damage to nerves that control the bladder

4. Pelvic muscle exercises (also known as Kegel exercises) work the muscles that is used to stop urinating.

Biofeedback uses sensors to make us aware of signals from your body.

Timed voiding may help control your bladder.

Lifestyle changes may help with incontinence.