Hydration And Oral Care, Elimination.

(Wk # 6: June 8 to June 14 – Main post under Assignment by Wed, June 10 at 11:59 PM EST).

Students are required to post a minimum of three times per week (1 main post answering the question 100% before Wednesday at 11:59 PM EST and 2 peer responses by Sunday at 11:59 PM EST). The three posts in each individual discussion must be on separate days (same day postings / replies will not be accepted).

Chapter 11 – Hydration and Oral Care.

Chapter 12 – Elimination.

Questions:

Choose a condition, disease, disorder affecting the elderly discussed in chapter 11 and 12 of your textbook.

1. Discuss signs and symptoms of the chosen condition, disease, disorder.

2. Explain possible treatments.

Guidelines: The answer should be based on the knowledge obtained from reading the book, no just your opinion.

Grading Criteria: Student mentioned a condition, disease, disorder discussed in chapter 11 or 12 of the textbook (25%). Student mentioned at least 3 signs and symptoms of the chosen condition, disease, disorder (45%). Student explained possible treatment(s) of the chosen condition, disease, disorder (30%).

Chapter 12

Elimination

The body must remove waste products of metabolism to sustain healthy function

Bowel and bladder functions later in life contribute to the independence of older adults

Nurses are in a key position to implement evidence-based assessment and interventions to enhance continence and improve function, independence, and quality of life for older people

Concepts of Elimination

The involuntary loss of urine sufficient to be a problem
Is an underdiagnosed, underreported, and undertreated condition, especially in older adults
Treatment is not sought because of embarrassment, normal aging, or the older adult is uneducated about treatment

Urinary Incontinence

Thought to be related to
Cognitive impairment
Limitations in daily activities
Institutionalization
Stroke, diabetes, obesity, poor general health, certain medications, and comorbidities are associated with urinary incontinence (UI)

Risk Factors for Urinary Incontinence

Increased risk of falls, fractures, hospitalization, and skin breakdown
Loss of dignity and autonomy
Increased feelings of depression, anxiety, shame, and embarrassment
Increased social isolation
Sexual activity is avoided
Loss of independence and self-confidence

Consequences of Urinary Incontinence

Incontinence is classified as
Transient (acute) or

Sudden onset

Present for 6 months or less

Usually caused by treatable factors such as urinary tract infections (UTIs) or delirium

Established (chronic)

Sudden or gradual onset

Includes stress; urge; urge, mixed, or stress UI with high postvoid residual (PVR); functional UI; and mixed UI

Types of Urinary Incontinence

Continence must be routinely addressed in the initial assessment of every older person
Nurses are expected to be able to collect and organize data about urine control, report findings, and implement evidence-based interventions

Implications for Gerontological Nursing and Healthy Aging

Multidimensional
Determine if UI is transient or established, determine type of UI, and identify possible causes
Continence care is a quality of care indicator for nursing homes; residents should be assessed on admission and whenever there is a change in cognition, physical ability, or urinary tract function

Assessment

Behavioral
Scheduled voiding
Bladder training
Prompted voiding
Pelvic floor muscle exercises
Lifestyle modifications
Absorbent products
Nonsurgical devices

Interventions

Pharmacologic treatment
Anticholinergic, antimuscarinic agents may be indicated for urge UI and overactive bladder (OAB)

Have similar efficacy

Choice depends on drug effects, drug–drug and drug–disease interactions, dosing frequency, titration range, and cost

Beta3-agonists (mirabegron) are a new class of medications for urge UI and OAB
Surgical treatment
Colposuspension (Burch operation)
Slings

Interventions (Cont.)

Urinary catheters
Intermittent catheterization
Indwelling catheters

Not appropriate for long-term management (more than 30 days) except in certain clinical conditions

External catheters

Interventions (Cont.)

Most common cause of bacterial sepsis in older adults
10 times more common in women than in men
May be difficult to detect
Older individuals do not report classic symptoms
Cognitively impaired residents may not recall or report symptoms

Urinary Tract Infection

UTIs that occur in a patient with an indwelling catheter or within 48 hours of catheter removal
Most common hospital-acquired infection worldwide
Incidence decreased by implementing evidence-based guidelines, catheter reminders, stop orders, nurse-initiated removal protocols, and a urinary catheter bundle

Catheter-Associated Urinary Tract Infections (CAUTIs)

During a visit to the emergency department, a 92-year-old man discloses that he dribbles when he urinates. Which of the following would be a reason for this incontinence?

Diet

Old age

Laziness when urinating

Underlying cause, such as an infection

Question

D—Dribbling is a symptom of a UTI.

Answer

Can be a source of concern and a potentially serious problem, especially for older persons who are functionally impaired
Normal elimination should be an easy passage of feces, without undue straining or a feeling of incomplete evacuation or defecation

Bowel Elimination

A reduction in the frequency of stool or difficulty in formation or passage of stool
One of the most common gastrointestinal complaints encountered in clinical practice
Associated with impaired quality of life, significant health care costs, fecal impaction, bowel obstruction, cognitive dysfunction, delirium, falls, and increased morbidity and mortality

Constipation

Common in incapacitated and institutionalized older people
Symptoms include malaise, urinary retention, elevated temperature, incontinence of bladder or bowel, alteration in cognitive status, fissures, hemorrhoids, and intestinal blockage
Treat with oil-retention enemas and digital removal

Fecal Impaction

Assess
Precipitants and causes of constipation
Thorough bowel history
Physical assessment rules out systemic causes
Food and fluid intake
Abdomen is examined for masses, distention, tenderness, and bowel sounds
Rectal examination is performed for painful anal disorders

Implications for Gerontological Nursing and Healthy Aging

Examine medications for constipation-producing effects
Increase fluid and fiber intake
Promote exercise
Environmental manipulation
Establish regularity of bowel evacuation
Cautiously use laxatives
Use enemas

Interventions

The involuntary loss of liquid or solid stool that is a social and hygienic problem
Often associated with UI
Can be transient or persistent
Devastating social affects
Contributing factors include damage to the pelvic floor, neurologic disorder, functional impairment, immobility, and dementia

Fecal Incontinence

Assessment
Obtain a complete history of UI; investigate stool incontinence, surgical and obstetric history, and medications
Use of laxatives and enemas
Digital examination is performed to determine the presence of a mass
Effect on quality of life

Implications for Gerontological Nursing and Healthy Aging

Environmental manipulation (access to toilet)
Diet alterations
Habit-training schedules
Improved transfer and ambulation abilities
Sphincter-training exercises
Biofeedback
Medications
Surgery to correct underlying cause

Interventions

Which of the following interventions would the nurse include in a bowel retraining program for a patient in an extended care facility?

Administering a daily oil-retention enema

Limiting fluid intake at breakfast and lunch

Reducing the intake of high residue foods

Toileting the patient at the same time daily

Question

D—A critical part of a bowel retraining program is to establish a regular time for bowel movements.

Answer

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