Description
Please respond to your peer’s posts, from an FNP perspective. To ensure that your responses are substantive, use at least two of these prompts:
- Do you agree with your peers’ assessment?
- Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
- Share your thoughts on how you support their opinion and explain why.
- Present new references that support your opinions.
Please be sure to validate your opinions and ideas with citations and references in APA format. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.Be sure to review your APA errors in your reference list, specifically you have capitalization errors in some words of the titles.Include the DOI. Also, be sure you are italicizing titles of online sources.No more than 200 words maximum.
Please respond to at least 2 of your peer’s posts. To ensure that your responses are substantive, use at least two of these prompts:
- Do you agree with your peers’ assessment?
- Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
- Share your thoughts on how you support their opinion and explain why.
- Present new references that support your opinions.
Please be sure to validate your opinions and ideas with citations and references in APA format.
Nora’s Response
According to the American Academy of Family Physicians (AAFP), millions of Americans suffer from urinary incontinence.
What strategies can the FNP use to prevent or manage urinary incontinent and urinary tract infections in geriatric clients who are bed bound in their homes or in nursing homes (include medications, non-pharmacologies, client teaching, etc)?
When reflecting on the “normal” parts of aging, urinary incontinence is common, but not considered “normal”. Treatment of urinary incontinence (UI) should begin with the least invasive approach, such as behavior modification, medications, and surgical intervention if warranted (Ham, Sloane, Warshaw, Potter, & Flaherty, 2014). The APRN should try to assess what type of incontinence the patient is suffering from by questioning the patient regarding pattern of incontinence. Is it stress, urge, overflow, functional, or mixed incontinence, as this would affect what type of interventions were part of the plan of care. It would also be important to further assess the patient for other potential causes of incontinence, such as urinary tract infection or new medications that may have been prescribed.
For patients who are bed bound at home and incontinent, providing education on how to prevent skin breakdown will be important to prevent further healthcare issues. “A typical presentation is an inflammation of the skin surface, redness, swelling, and possible blister formation. Urinary incontinent dermatitis typically affects the female labial area and male scrotal areas, with thighs and buttock damage in both sexes” Holroyd & Graham, 2014). “Nursing home residents with UI are more likely than continent residents to have impaired mobility, dementia, delirium, and receive psychoactive medications” (Ham, Sloane, Warshaw, Potter, & Flaherty, 2014). Because of this, caregivers should be instructed to apply barrier cream to prevent breakdown before it starts. Breakdown in the skin, the body’s natural barrier to fight infection could be detrimental to the health of our elderly clients in many ways. Untreated symptoms can lead to further skin breakdown, bed sores, and potentially septic scenarios.
Patients who are in a good cognitive state may also be taught Kegel exercises for bladder training. Patients should be encouraged to drink fluids early in the day to remain hydrated and reduce their risk for urinary tract infections. They should be encouraged to empty their bladder on a schedule or even if they do not feel as though their bladder is full to reduce the volume and lower the risk for incontinence. They should also be educated on choosing fluids that they like to drink that are not diuretics. Avoid coffee, alcohol, and teas, as well as drinking large amounts of fluid late in the evening.
If medications are needed to assist in the treatment of incontinence, Oxybutynin (Ditropan) 2.5 to 5 mg PO TID would be an available pharmacologic choice. However, it should be used with caution, as it is an anticholinergic and may be contraindicated depending on the patient’s other co-morbidities. Other pharmacologic options would include a tricyclic antidepressant or an oral decongestant, all of which should be used with caution in the elderly (Leik, 2018).
Reference:
Ham, R., Sloane, P., Warshaw, G., Potter, J., & Flaherty, E. (2014). Ham’s primary care geriatrics: A case-based
approach (6th ed.). PA: Elsevier. ISBN: 9780323089364
Holroyd, S., & Graham, K. (2014). Prevention and management of incontinence-associated dermatitis using a
barrier cream. British Journal of Community Nursing, 19(Sup12), S32-8. Retrieved from
https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=103923702&site=ehost-live (Links to an external site.)
T., C. L. M. (2018). Family nurse practitioner certification intensive review: fast facts and practice questions. New
York, NY: Springer Publishing Company, LLC.
Sura, S., Carnahan, R., Chen, H., & Aparasu, R. (2013). Prevalence and Determinants of Anticholinergic
Medication Use in Elderly Dementia Patients. Drugs & Aging, 30(10), 837–844.
https://doi.org/10.1007/s40266-013-0104-x
Latara’s Response
According to the American Academy of Family Physicians (AAFP), millions of Americans suffer from urinary incontinence.
What strategies can the FNP use to prevent or manage urinary incontinent and urinary tract infections in geriatric clients who are bed bound in their homes or in nursing homes (include medications, non-pharmacologies, client teaching, etc)?
Although incontinence can happen at any age, it’s more common in older adults. According to the National Association for Continence, one in five individuals over the age of 40 suffer from overactive bladder or urgency or frequency symptoms, some of whom leak urine before reaching a restroom. In the nursing home population, at least 50 percent of residents have elderly urinary incontinence (Bradway, & Hernly, 2017). Usually the first line of treatment is behavioral therapy, which will often cure the incontinence. Treatments can include bladder training, scheduled bathroom trips, pelvic floor muscles exercises, and fluid and diet management. Medications are frequently used in combination with behavioral therapies: anticholinergic or antispasmodic drugs, hormone replacement or antibiotics.
The most common problem facing nursing homes is urinary tract infections and the prevalence continues to increase. This increase can be prevented by performing frequent diaper changes for immobile or incontinent residents. Limiting the use of urinary catheters, increasing assisted trips to the toilet and adequate care can all help to reduce the chances of getting a urinary tract infection (Rowe, & Juthani-Mehta, 2017). Tips we can use as healthcare providers in nursing homes and we can provide to our long-term care facility workers to help prevent UTIs are:
• Wash hands frequently and adhere to standard infection control practices.
• Support patients in being as mobile as possible.
• Maintain patient hydration. Provide access to fluids and assistance with drinking as appropriate (unless the patient is on a fluid restriction for a medical reason.)
• Provide regular trips to/access to the toilet, commode, or bedpan.
• Keep patients clean and dry. Wash patients frequently with soap and water.
• Use catheters only when “clinically needed,” assess them daily, and discontinue their use when no longer needed.
• Use portable bladder ultrasound scanners to confirm that certain patients have emptied their bladders.
• If a catheter is necessary, attach urine collection bags to the patient’s leg to limit bag movement and tugging.
• Keep urine collection bags below the bladder to facilitate drainage.
• Avoid any kinking or twisting of tubes.
• Clean urine collection bags regularly.
• Employ and utilize trained “infection control specialists (Bardsley, 2015).
Identify the evidence-based pharmacologic protocol for urinary incontinence.
Treatment for urinary incontinence depends on the type of incontinence, its severity and the underlying cause. A combination of treatments may be needed. Behavioral techniques such as bladder training (to delay urination after the patient gets the urge to go), double voiding (to help with learning to empty the bladder more completely to avoid overflow incontinence), scheduled toilet trips (to urinate every two to four hours rather than waiting for the need to go), and fluid and diet management (to regain control of the bladder). Additionally, pelvic floor exercises may be suggested to strengthen the muscles that help control urination. These are also known as Kegel exercises, these exercises are especially effective for stress incontinence but may also help urge incontinence. There are several medications that can be used to treat incontinence. Anticholinergics can calm an overactive bladder and may be helpful for urge incontinence. Examples include oxybutynin (Ditropan XL), tolterodine (Detrol), darifenacin (Enablex), fesoterodine (Toviaz), solifenacin (Vesicare) and trospium (Sanctura) (Smith & Ouslander, 2018). For women, applying low-dose, topical estrogen in the form of a vaginal cream, ring or patch may help tone and rejuvenate tissues in the urethra and vaginal areas. In men with urge or overflow incontinence, these medications relax bladder neck muscles and muscle fibers in the prostate and make it easier to empty the bladder. Examples include tamsulosin (Flomax), alfuzosin (Uroxatral), silodosin (Rapaflo), doxazosin (Cardura) and terazosin (Smith & Ouslander, 2018).
Bardsley, A. (2015). Treating urinary tract infection in older adults. Nursing & Residential Care, 17(11), 610–615.
https://doi.org/10.12968/nrec.2015.17.11.610
Bradway C, & Hernly S. (2017). NGNA. Urinary incontinence in older adults admitted to acute care. Geriatric Nursing, 19(2), 98–102. Retrieved from https://search.ebscohost.com/login.aspx?direct=tru…
Rowe, T. A., & Juthani-Mehta, M. (2017). Diagnosis and management of urinary tract infection in older adults. Infectious Disease Clinics, 28(1), 75–89. https://doi.org/10.1016/j.idc.2013.10.004
Smith,D., & Ouslander J. (2018). Pharmacologic management of urinary incontinence in older adults. Topics in Geriatric Rehabilitation, 16(1), 54–60. Retrieved from https://search.ebscohost.com/login.aspx?direct=tru…
