Post on 18-Feb-2016
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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia
Continence: A Matter of Dignity
Care of Chronic and Complex UI
By
Marie Mangino, MSN, CRNP, GNP-BCPresident, Vincent Healthcare, Inc.
Wendy W. Fox, MOT, OTR/LAssistant Professor of Occupational TherapyUniversity of the Sciences, Philadelphia PA
Jennifer A. Reinhold, BA, PharmD, BCPSAssistant Professor of Clinical Pharmacy University of the Sciences in Philadelphia
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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia
Review of First Module
“Causes, Signs and Prevention” The first module covered the following
objectives as learner outcomes: List the common causes of urinary
incontinence (UI) Describe the potentially serious
effects of not treating UI Recognize signs of a UTI Discuss effective ways to prevent
or reduce episodes of UI and enhance dignity
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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia
Learning ObjectivesAt the end of “Care of Chronic and Complex Urinary Incontinence” you will be able to:
List the major types of chronic UI and the common signs and symptoms of each
Explain the importance of preventing constipation in older adults with UI
Discuss creative approaches to more complex cases of older adults with UI
Provide care to prevent or reduce episodes of UI and enhance dignity
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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia
Types of Chronic UI
Stress Urge /Overactive
bladder Overflow Functional Mixed
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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia
Stress UI Small amount of urine leakage Loss of urine with increased
pressure in the abdomen from: Coughing Sneezing Laughing Lifting Standing
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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia
Stress UI : How You Can Help?
Set toileting schedule based on a log and stick to it
Expect small leaks; use a liner to feel more secure
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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia
Stress UI : How You Can Help?
Change more frequently Use skin barrier Encourage to maintain
physical activity levelMrs. Levy
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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia
Urgency UI & Overactive Bladder
• Overactive Bladder – bladder spasms that cause a sudden urge to void, often with increased frequency
• Urge UI – the loss of urine that may result from an overactive bladder
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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia
Urge UI Involuntary loss of urine and a
strong urge to urinate that occurs suddenlyMay be incontinent before
getting up or on the way to the bathroom
May be incontinent of a large amount of urine
Mrs. Powell w/walker
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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia
Urge UI/Overactive Bladder:How You Can Help
Encourage person to avoid bladder irritants
Stick to personalized schedule
Watch for signs of need to toilet
Keep urinal or commode handy
Expect heavier wetting with longer period of dryness
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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia
Play video segment titled, “04 Mrs.
Powell.mpg”
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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia
Case of Mrs. Powell Remind the person to avoid
bladder irritants (including sodas, caffeine, and artificial sweeteners)
Avoid drinking alcohol Help by establishing a toileting
schedule and stick to it as much as possible!
Watch for signs of need to toilet Use proper fitting, appropriate
continence products
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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia
Overflow UI Continuous or periodic leakage of small
amounts of urine Tension in bladder forces muscles to leak
small amounts, either continuously or off and on
Caused by either: Blockage at the exit of the bladder Medications that cause weakened bladder
contractions/ urine retention Bladder, nerve, or
muscle damageMr. Stanley
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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia
Overflow UI: How You Can Help
Allow time to stand or sit and take the time needed
Report complaints of discomfort Report inability to urinate for more than 8
hours or frequent urination (more than every 2hrs)
Watch for signs of mental status change Maintain schedule for toileting Report any changes that occur following
changes in medication
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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia
Functional UIDue to chronic functionalimpairment:
Cognitive impairment Physical disabilities Combination
Mr. Clark
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Functional UI: How You Can Help
Cognitively ImpairedMark bathroom doorsUse a toileting schedule that fits the older adultOffer positive support and encouragement
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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia
Functional UI: How You Can Help
Physically ImpairedEncourage clothing that is easy to removeAssist as needed Keep urinal or commode handyReport pain
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Challenging Situations
Dementia Inappropriate
toileting Denial
Unsafe attempts to toilet
Chronic constipation
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The Challenges of Dementia and UI Inappropriate toileting Denial of incontinence
Mr. Clark
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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia
Dementia and UI: How You Can Help
Never judge or disagree, accept the person’s explanation for wet clothing
Focus on Changing and cleaning Dignity and respect
Prompt (remind and encourage) to use the toilet, assist to get there, then prompt again
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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia
Play video segment titled, “05 Mr.
Clark.mpg”
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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia
Case of Mr. ClarkFocus on:
Dignity and respect Changing and cleaning
if needed Prompt (remind and
encourage) to use the toilet, assist to get there, then prompt again
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UI and Unsafe Attempts to Toilet
Due to: Difficulty Walking Poor vision Poor safety
judgment
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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia
Unsafe Attempts to Toilet: How You Can
Help Use individualized
toileting schedule; be there ahead of time. YOU are the reminder!
Do not rely on call bell Do not wait until the
person tries to get up
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Unsafe Attempts to Toilet: How You Can
Help Use safe footwear
Correctly fitting Closed toe and heel Avoid slippers and “slide in” shoes
Use proper eyeglasses when walking; assist person wearing bifocals
Provide a bedside commode or urinal to reduce the need to walk to the bathroom alone
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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia
Chronic Constipation and UI
Presence of stool in the bowel Takes up room in the pelvis
so bladder cannot fill up completely
Causes need to urinate more often
Increases incontinent episodes
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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia
Chronic Constipation and UI: How You Can
Help Report it! Encourage
Fluid intake Activity Foods rich in fiber
Avoid constipating food Avoid constipating
medications
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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia
Objectives Review
Can you now1.List the major types of chronic
UI and the common signs and symptoms of each?
2.Explain the importance of preventing constipation in older adults with UI?
3.Discuss creative approaches to more complex cases of UI in older adults?
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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia
Play video segment titled, “06
Closing.mpg”
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Special Thanks To:Christine W. Bradway, PhD, CRNP,
FAANAssociate Professor of Gerontologic Nursing
University of PennsylvaniaSchool of Nursing
Mary Ann Forciea, MDClinical Associate Professor of Medicine
Director, Primary Care ServicesUniversity of Pennsylvania Health Systems
Nicole ManginoIllustrator