Continence: A Matter of Dignity Causes, Signs and Prevention
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Transcript of Continence: A Matter of Dignity Causes, Signs and Prevention
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Continence: A Matter of Dignity
Causes, Signs and Prevention
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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AcknowledgementsAppearing in Video:
Name Appearing as
Bob Swensen……….Mr. BanksRuth Alpert…………Mrs. BanksSusaye Lawson…… SusayeNate Lazowick…….Mr. WilliamsKevin Brown……… Carl, DCSW Dinnie Childs………Piano PlayerClarese Herbert……Mr. William’s
friendMan at Piano………Arjun BhojwaniNancy Web…………Mrs. PowellEric Stewart……….Mike, grandsonRuth Livikoff………Ruth, DCSW
Name Appearing as
Dick Brown………………Mr. ClarkDeanna Penn…………….SupervisorSangeeta Bhojwani…….TraineeRoby Jacobs……………..Daughter Charlene Duff……………Shopper, Gift ShopSheila Mitchell-Ayers…Shopper, Gift Shop Marie Mangino………….Trainer, as herselfTanisha Jones……………TestimonialJulie Cohlmer…………….Testimonial
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Special thanks to:
• Henrietta Roberts and Sandy Bailey, of Stapeley in Germantown for coordination of video shoot
• All the residents and staff of Stapeley in Germantown, for their participation and for permitting video production.
• Raybourn Rusk Productions
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Play video segment titled, “01
Introduction.mpg”
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Urinary Incontinence (UI) Defined
UI is simply defined as the involuntary or inappropriate loss of urine. In other words, incontinence is urine loss which happens when the person doesn’t want it to or doesn’t know it’s happening.
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Learning ObjectivesAt the end of this program you will be able
to: List the common causes of urinary
incontinence (UI) Describe the potentially serious effects of
not treating UI Recognize signs of a urinary tract
infection Discuss effective ways to prevent or
reduce episodes of UI Enhance the dignity of those in your care
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Prevalence of UI
More thank 13 million Americans have UI
85% of them are women 37% of persons over 65 and
living in the community have UI 53% of homebound have UI 30-77% of NH residents have UI
In 8 of 10 cases symptoms can be improved and in some cases function restored.
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The Facts about UI Continence is normal;
Incontinence is not Normal aging does not cause
incontinence When continence is impaired,
many simple things can be done to restore or improve functionMrs. Mendoza
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Caring for UI is Important Because:
Untreated or under-treated UI can cause: Skin breakdown and infection Falls and injuries Sleep disturbance
Mr. Phillips
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Caring for UI is Important Because: Untreated or under treated
UI can cause: Depression/social withdrawal Loss of dignity/lower quality
of life UTIs (urinary tract
infections) hospitalization death
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by Nicole Mangino
Left KidneyRight
Kidney
BladderStructure of the
Urinary Tract System
Left Kidney
Ureters
Urethra
Bladder wall muscle
Nicole Mangino 2004
Bladder
Right Kidney
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Contributors to UI: Age-Related
Changes Overactive bladder muscle Enlarged prostate (BPH) Atrophic vaginitis and
urethritis (occurs after menopause)
Reduced bladder capacity Increased post-void residual
(PVR)
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Contributors to UI:Injury and Disease
Diabetes Damage to the:
BrainSpinal Cord Bladder
Short term use of an indwelling catheter during acute illnessMrs. Banks
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Contributors to UI: Limitations in
Function Ambulation Dressing Fear of falling Choice
Mr. Williams
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Contributors to UI: Dietary Factors
Artificial sweeteners
Caffeine Alcohol Acidic Foods
Mrs. Powell
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Contributors to UI: Medications
Anticholinergics : Can affect the bladder’s ability to empty
Diuretics (water pills): Cause extra urine production
Cold medicines: Can affect the bladder’s ability to empty
Pain medicines: Can cause constipation and fecal impaction
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Contributors to UI Hydration & Physical
Conditions Not enough fluid Too much fluid Fecal impaction Acute confusion Too much alcohol or caffeine Infections/Medical illness
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UTI Symptoms in the Older Adult
Increased frequency Increased urgency New or increased UI Urine odor or cloudiness Blood in the urine Fever or chills Change in mental status
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Acute Changes in Mental Status that may
indicate UTI Sleepiness Irritability or agitation Lethargy New or increased
confusion
Mr. Green
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Things You Can Do for Older Adults with UI
Keep a log of UI events
Monitor toileting
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Things You Can Do for Older Adults with UI
Determine frequency of need
Develop a schedule and assist to toilet
Consider recent medication change
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Play video segment titled, “02 Mrs.
Banks.mpg”
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Things You can Do: Scheduling
Log actual number of “accidents” or “urinations”
Based on log results - develop schedule
Establishing and following a schedule can give a person confidence to do other things
Prompt and assist Praise the effort
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Things You Can Do Encourage change in diet
(gradually reducing and then eliminating caffeine, alcohol, sweeteners and acidic foods)
Avoid over the counter medications that can cause constipation or make continence more difficult
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Things You Can Do Assist as needed to:
Get to the bathroom or commode safely
Remove clothing Make urinals (male and female)
available as well as bed pans Position urinal or bedpan Assist w/ pericare and appropriate
products and redressing
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Play video segment titled, “03 Mr. Williams.mpg”
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Mr. Williams’ Challenge
Arthritis Personal
embarrassment Effect on family Clothing with
elastic or Velcro closures
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Things You Can Do • Establish safe bathroom setup
– Use of grab bars and/or a raised toilet seat, 3-in-1 commode
– Observe for good hygiene– Assist if needed with hygiene
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Things You Can Do Make urinals available Prompt (suggest,
encourage and remind) to toilet
Compliment effort and success
Change if incontinent
Mr. Samson
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Things You Can Do “JIC”• For outings….Be prepared!
– Take a “JIC” bag – Just In Case• Extra set of clothes• Incontinence products (briefs, liners, underwear)
• Gloves, moist wipes, hand sanitizer• Absorbent pads to protect furniture• Air deodorizer• Plastic bag
• Being prepared reduces anxiety for both the client and the caregiver!
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Skin CareTo prevent skin breakdown:
Work towards improved continence
Promptly change absorbent undergarments and clean perineum and buttocks
Use a skin barrier Promptly report any
change in skin
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Product Use for UI Least restrictive Most dignified
Individual product preference Proper fit Regular underwear w/ liner Pull-up Brief (adult absorbent product) Proper fit ensures best protection
and is most cost effective!
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Things You Can Do• Simple clothing changes
make toileting a lot easier!– Velcro closures on
shirts/pants/shoes makes on/off less effortful
– Elastic waistbands and roomier fit ease up/down of pants
– Add rings onto zippers
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Final Case Scenario• Ms. Hill has rheumatoid
arthritis with severe deformities of her hands
• She has difficulty with such things as door knobs and buttons on her clothes
Mrs. Hill
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Learning Objectives Review
Can you now: List the common causes of urinary
incontinence (UI) Describe the potentially serious effects of
not treating UI Recognize signs of a urinary tract
infection Discuss effective ways to prevent or
reduce episodes of UI List ways to enhance the dignity of those
in your care
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Special Thanks To:Christine Bradway, PhD, CRNP, FAAN
Associate 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
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References and Resources• American Medical Directors Association. (2012). Urinary Incontinence in the Long Term Care Setting Clinical Practice Guideline. Columbia, MD: AMDA.
• DuBeau, C.E., Kuchel, G.A., Johnson.T., Palmer, M.H., Wagg, A. Incontinence in the frail elderly. In Abrams, P, Cardozo, L, Khoury, S, Wein, A. (2009). 4th International Consultation on Incontinence. Health Publication Ltd. 963-1024.
•DuBeau CE, Simon SE, Morris JN. The effect of urinary incontinence on quality of life in older nursing home residents. J Am Geriatr Soc 2006;54:1325-33.
•Fink HA, Taylor BC, Tacklind JW, Rutks IR, Wilt TJ. Treatment interventions in nursing home residents with urinary incontinence: a systematic review of randomized trials. Mayo Clin Proc 2008;83:1332-43
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References and Resources
• Genao, L. & Buhr, G.T. Urinary tract infections in older adults residing in long-term care facilities. Annals of Long-Term Care: Clinical Care and Aging. 2012;20(4):33-38.
• Hagglund, D. (2010). A systematic literature review of incontinence care for persons with dementia: the research evidence. Journal of Clinical Nursing. 2010;19,303-312.
• Kraus SR. Bavendam T. Brake T. Griebling TL. Vulnerable elderly patients and overactive bladder syndrome. Drugs & Aging. 2010; 27(9):697-713.
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References and Resources• Landefeld CS, Bowers BJ, Feld AD, et al. National Institutes
of Health state-of-the-science conference statement: prevention of fecal and urinary incontinence in adults. Ann Intern Med 2008;148:449-58.
• Lee, S.Y., Phanumus D. & Fields S.D. Urinary incontinence: a primary care guide to managing acute and chronic symptoms in older adults. Geriatrics 2000; 55(11): 65-72.
• Matthews, S.J. & Lancaster, J.W. Urinary tract infections in the elderly population. The American Journal of Geriatric Pharmacotherapy 2011; 9: 286-309.
• Newman, D.K., & Wein, A.J. Managing and treating urinary incontinence. 2nd ed. 2009; Baltimore, MD: Health Professions Press.
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References and Resources
• Offermans, MP, Du Moulin MF, Hamers JP, Dassen T, Halfens RJ. Prevalence of urinary incontinence and associated risk factors in nursing home residents: a systematic review. Neurourol Urodyn 2009;28:288-94.
• Saliba D, Solomon D. Rubenstein L. Young R. Schnelle J. Roth C. Wenger N. Feasibility of quality indicators for the management of geriatric syndromes in nursing home residents. Journal of the American Medical Directors Association 2005; 6(3 Suppl):S50-9, 2005.
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References and Resources
Web sites:Collaborative to Support Urinary Incontinence and
Women’s Health www.stressUI.org
National Association for Continence: www.nafc.org
Australian Government Department of Health and Aging http://www.bladderbowel.gov.au/all/bladderproblems.htm
National Kidney and Urologic Diseases Information Clearing House http://kidney.niddk.nih.gov/index.aspx