■Spinal cord injuries below S2. ■Diabetic neuropathy■Prostatic hypertrophy■Fecal impaction■Drugs, esp anticholinergic effectFunctionalIncontinence resulting from physical, environmental, or psychosocial causes.Ability to respond to the need to urinate is impaired.■Confusion or dementia■Physical disability or impairedmobility■Therapy or sedation■Depression■Regression○Special Considerations for the Elderly:Older adults have a higher incidence of 2 common urinary tract disorders: UTI and UI. ●Assessing for Home Care: Focuses on risk factors, the extent and manifestations of disorder, and contributing factors. Ask about urine loss, its frequency, and any contributing factors. Inquire about frequency, urgency, and burning upon urination. Identify current meds & time of day that each is taken. Assess patterns of fluid intake and output. Assess ABD for evidence of bladder distention or tenderness. Perform mental status examination if indicated. Assess home environment for possible barriers to urinary elimination:■Inadequate lighting■Narrow doorways that may interfere with access to the toilet■Inadequate toilet facilities■Need for mobility aids such as safety bars, raised toilet seat, or bedside commode.●Teaching for Home Care: discuss following points to help prevent UTI and UI in the older adult:■Maintain generous fluid intake. Reduce or eliminate intake after evening meal to prevent nocturia.■Wear comfortable clothing that is easy to remove for toileting.■Maintain good hygiene, but do not bathe more than necessary. Increased risk of UTI and UI.■Perform Kegel exercises several times a day to increase perineal muscle tone.■Reduce consumption of caffeine containing beverages, citrus juices, and artificially sweetened beverages.■Use behavioral techniques such as scheduled toileting, habit training, and bladder training to reduce the frequency of incontinence. ■See PCP regularly for pelvic or prostate exam.■For women, discuss possible benefits and risks of hormone replacement therapy, physical therapy, or surgery to treat incontinence. ■Report change in urine color, odor, or clarity, or symptoms as burning, frequency, or urgency to PCP.○Nursing Management:UI management is directed at identifying and correcting the cause if possible. Evaluation begins with complete history, including specific questions about lower urinary tract symptoms and duration, frequency, volume, and associated circumstances of urine loss. (Voiding Diary often used). Physical assessment includes abdominal, rectal, and pelvic assessment as well as evaluation of mental and neurological status, mobility, and dexterity. ○Medications:●Duloxetine (Cymbalta): drug that inhibits the uptake of both norepinephrine & serotonin, is drug of choice for treating UI that is not fully controlled with nonpharmacologic treatment.
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Bowel obstruction, urine output, small bowel obstruction