Urinary

Incontinence

Incontinence of the bladder (loss of

urine) is a common problem among
older adults.
It is a symptom rather than a disease
in itself.
Women are particularly affected by
urinary incontinence, and because
many find it embarrassing to discuss,
the problem often goes untreated.

Case Study
B.K. is a 57-year-old woman (height 65 inches, weight 64 kg)
who has progressive difficulty with bladder control during the
daytime. W hen she feels like she needs to use the toilet, she
is sometimes unable to get to the bathroom on time. She has
experienced a few accidents and is deeply embarrassed. W
hen she exercises or coughs, she loses small amounts of urine.
Her home drugs include alendronate 70 mg weekly for
osteoporosis, loratadine 10 mg daily for allergies, calcium
carbonate 600 mg twice daily, vitamin D 1000 units daily, and
ibuprofen 200 mg once daily for osteoarthritis. She is a lifelong
smoker and does not drink alcohol. She consumes 1 cup of
regular coffee with each meal. She complains of some
osteoarthritis pain and her pain scale rating is 2/10.

Types of Incontinence

Stress Incontinence
Results
from
multiple
pregnancies, obesity, or surgery
triggered by laughing, sneezing,
coughing,
or
straining
of
abdominal muscles to the point
that
the
intra-abdominal
pressure is greater than the
ability of the sphincters to resist
Small amounts of urine are lost

Treatment:
Kegel exercises with or
without biofeedback.

Urge Incontinence
related to birth defects, spine or nerve
damage, immobility, prostate problems,
overactive bladder, or cancer
sudden and unexpected need to void
with moderate to large amounts of
urine lost.

Treatment:
Kegels exercise
Combining
the
pelvic
floor
strengthening exercises with timed
voiding, lengthening the amount of
time between voiding until more
normal voiding patterns are achieved.

Overflow Incontinence
with birth defects, spinal
cord
injury
or
nerve
damage,
multiple
sclerosis,
or
loss
of
bladder muscle tone
Post surgery

Treatment:
If it is a result of a side
effect of the medication,
discontinue or change the
medication
bladder may be scanned
to check postvoid residual

Reflex incontinence
related
to
spinal
cord
injury,
developmental disability, congenital
defect, dementia, or other brain injury,
reflex incontinence gives no warning
prior to the incontinent episode.
large amount of urine is
emptying may be complete

lost

and

Functional incontinence
inability to get to bathroom
facilities due to functional
reasons such as obesity,
clutter that blocks the path
to facilities, or immobility.

Treatment:
a commode may need to be
placed nearer to the bedside
at night to avoid nocturia
incontinence at night
modify lifestyle

An 83-year-old woman with Alzheimer dementia

presented to the emergency department with abdominal
distention. Her husband provided the history. After having
constipation for 1 week, she developed a progressively
distended abdomen in the course of 2 days, with anorexia
but no vomiting, melena, or hematochezia.
She had no history of fever, rigors, dyspnea, or weight
loss. Her medical history was remarkable for hypertension,
coronary artery disease, and impaired fasting blood glucose
levels. Despite the recent symptoms, she had no history of
gastroenterologic symptoms, cancer, abdominal surgeries,
or colon screening studies. She lived with her husband in
the community and was dependent on him for her activities
of daily living except for ambulation with a walker and
feeding herself. She was a nonsmoker and nondrinker.

Case

Her medications were 60 mg/d of isosorbide mononitrate,

325 mg/d of aspirin, 2.5 mg/d of amlodipine, 20 mg/d of
atorvastatin, and a combination of 37.5 mg/d of triamterene
and 25 mg/d of hydrochlorothiazide.
The patient had normal levels of hemoglobin, white blood
cells, platelets, chloride, bicarbonate, creatinine, blood urea
nitrogen, troponin, and lipase, as well as a prothrombin time
within the normal range. She had a serum sodium of 126 mEq/L
(reference ranges provided parenthetically) (135-145 mEq/L), a
potassium level of 2.5 mmol/L (3.6-4.8 mmol/L), and a blood
glucose level of 198 mg/dL (70-100 mg/dL). Urinalysis was
positive for trace occult blood and 1+ protein. Abdominal plain
radiography showed prominent gaseous dilatation of the
transverse colon and redundant sigmoid colon without distinct
signs of obstruction or free air.

Case

BOWEL
ELIMINATION

defecation less than three times a

week or straining on defecation at
least a quarter of the time.

Taking certain medicines may cause

constipation:
Antacids
Aluminum hydroxide
Calcium Carbonate
Anticholinergics
Anti - diarrheal
Anti - Parkinson's
Antidepressants
Tricyclics
Lithium
Anti - hypertensive/Anti arrhythmic

Calcium channel blockers

especially verapamil
Metals
Bismuth
Iron
Heavy metals
Opioids
Laxatives (used chronically)
NSAIDs
Sympathomimetic
Pseudoephedrine

Symptoms:
Difficulty in starting or completing a bowel
movement
Infrequent and difficult passage of stool
Passing hard stool after prolonged straining
If the person has irritable bowel syndrome (IBS),
with crampy abdominal pain, excessive gas, a
sense of bloating, and a change in bowel habits
If the person has an intestinal obstruction,
which results in nausea, vomiting, absence of a
bowl movement, and inability to pass gas
Distended abdomen, headaches, and loss of
appetite
Coated (furred) tongue, bad breath (halitosis),
and bad taste in the mouth

Treatment
Acute Cases
non - stimulant laxative
such as sorbitol (if this doesn't
work, irritant laxatives may
need to be used),
water
Fleets enemas or
polyethylene glycol to clear
the bowels.
If the client do not respond to
this then increased fluid
intake, either by instilling
fluids into the stomach (1-2
liters) or alternatively using a
high tap water enema.

Treatment

Nursing Interventions
1.Encourage a fluid intake of 1.5 to 2 L/day (six to eight glasses of
liquids per day), unless contraindicated because of renal insufficiency.
Cereal fibers such as wheat bran add additional bulk by attracting water
to the fiber, so adequate fluid intake is essential. Increasing fluid intake
to 1.5 to 2 L/day while maintaining a fiber intake of 25 g can significantly
increase the frequency of stools in clients with constipation (Weeks,
Hubbartt & Michaels, 2000; Anti, 1998).
2.Provide laxatives, suppositories, and enemas only as needed if other
more natural interventions are not effective, and as ordered only;
establish a client goal of eliminating their use. Use of stimulant laxatives
should be avoided because they result in laxative dependence and loss
of normal bowel function (Merli & Graham, 2003). Laxatives and enemas
also damage the surface epithelium of the colon (Schmelzer et al, 2004).
3.Encourage client to resume walking and activities of daily living as
soon as possible if their mobility has been restricted. Encourage turning
and changing positions in bed, lifting the hips off the bed, performing
range-of-motion exercises, alternately lifting each knee to the chest,
doing wheelchair lifts, doing waist twists, stretching the arms away from
the body, and pulling in the abdomen while taking deep breaths. Bed
rest and decreased mobility lead to

Diarrhea
Diarrhea is the number of bowel movements with
stools more than normal (normal 100-200 ml per
hour) with the form of liquid or semi-liquid feces, can
also be accompanied by an increased frequency
defecation.
According to WHO diarrhea is watery bowel
movements and more than 3 times a day. Acute
diarrhea is a sudden diarrhea and short duration,
within a few hours to 7 days or until 14 days. Chronic
diarrhea is diarrhea that lasts more than 3 weeks.

Etiology
Parasites
viruses (E.colli, V.
cholerae,
Aeromonas.SP.)
Toxin
Drug
Food
Chemotherapy
fecal impaction and
other conditions

Clinical Manifestations
abdominal pain to stomach
cramps
defecation increases with
increasing fluid content in feces.
spasmodic contraction of the
pain and stretching is not
effective in anal (tenesmus) can
happen every defecation.
lack of fluid causes the patient to
feel thirsty, tongue dry, and
decreased skin elasticity.
Hypovolemic can cause rapid
pulse, decreased blood pressure,
nervous, pale, cyanosis, in
certain circumstances cause
hypokalemia which will lead to
cardiac arrhythmia.

Management
Replace fluid and
electrolyte losses.
Provide good perianal
care. Diarrheal stool is
oftentimes highly acidic.
This causes anal soreness
and irritation in the
perianal area.
Promote rest. To reduce
peristalsis.
Diet : Small amounts of
bland foods

Thank you !! :D