4 Body Systems and Related Conditions: Urinary Incontinence

4 Body Systems and Related Conditions
Define the following terms:
Urinary incontinence the inability to control the bladder, which leads to an involuntary loss of urine.
Transparency 4-20: The Urinary System

6. Describe the urinary system and related conditions Remember the following points about the urinary system: Composed of two kidneys, two ureters, one urinary bladder, and a single urethra Two functions are Eliminate waste products created by the cells Maintain water balance in the body

6. Describe the urinary system and related conditions Normal changes of aging to the urinary system include the following: Ability of kidneys to filter blood decreases Bladder muscle tone weakens Bladder holds less urine, which causes more frequent urination Bladder may not empty completely, causing greater chance of infection

6. Describe the urinary system and related conditions Think about this question: How can you help residents with the normal changes of aging to the urinary system?

6. Describe the urinary system and related conditions Observe and report the following regarding the urinary system: Weight loss or gain Swelling in upper or lower extremities Pain or burning during urination Changes in urine (cloudiness, odor, color) Changes in frequency and amount of urination Swelling in abdominal/bladder area Complaints that bladder feels full or painful Urinary incontinence/dribbling Pain in kidney or back/flank region Inadequate fluid intake

6. Describe the urinary system and related conditions Common disorders of the urinary system include the following: Urinary incontinence Urinary tract infection (UTI)

6. Describe the urinary system and related conditions Remember these facts about urinary incontinence: Can occur in people who are confined to bed, ill, elderly, paralyzed, or who have circulatory or nervous system diseases or injuries Stress that incontinence is not a normal part of aging and may signal an illness. It is a major risk factor for pressure sores.
Transparency 4-21: Care Guidelines for Urinary Incontinence Offer to assist with toileting often. Follow toileting schedules. Answer call lights and requests for help promptly. Document carefully and accurately any time a residents skin or anything touching residents skin is wet from urine, even if it is a small amount. Wash urine off immediately and completely. Incontinent residents who are bedbound should have plastic, latex or disposable sheets under them to protect the bed. Place a draw sheet over it to absorb moisture and protect skin. Use disposable incontinence pads or briefs as needed to keep body wastes away from skin. Change wet briefs promptly. Do not refer to them as diapers. Be reassuring and understanding.

6. Describe the urinary system and related conditions Remember these facts about urinary tract infection (UTI): Being bedbound is a risk factor for increased incidence of UTIs. Women are more likely than men to contract a UTI due to shorter Urethra. Women should wipe the perineal area from front to back after elimination.
Transparency 4-22: Preventing Urinary Tract Infections Encourage residents to wipe front to back and do the same when providing perineal care. Give careful perineal care when changing incontinent briefs. Encourage plenty of fluids. Offer to assist with toileting often. Answer call lights promptly. Taking showers, rather than baths, helps prevent UTIs. Report cloudy, dark, or foul-smelling urine, or if resident urinates often and in small amounts.

Digestion the process of preparing food physically and chemically so that it can be absorbed into the cells. Elimination the process of expelling solid wastes made up of the waste produts of food that are not absorbed into the cells. Fecal/anal incontinence the inability to control the bowels, leading to involuntary passage of stool.
Transparency 4-23: The Gastrointestinal System

7. Describe the gastrointestinal system and related conditions Remember the following points about the gastrointestinal system: Digestion prepares food for absorption into cells. Elimination is expelling solid wastes.

7. Describe the gastrointestinal system and related conditions Normal changes of aging to the gastrointestinal system are as follows: Decreased saliva production affects chewing/swallowing Absorption of vitamins/minerals decreases Digestion takes longer, is less efficient Body waste moves more slowly through intestines; constipation more frequent

7. Describe the gastrointestinal system and related conditions Observe and report the following regarding the gastrointestinal system: Difficulty swallowing or chewing Fecal/anal incontinence Weight gain or loss Loss of appetite (anorexia) Abdominal pain or cramping Diarrhea Nausea and vomiting (especially coffee grounds type)

7. Describe the gastrointestinal system and related conditions Observe and report (contd.): Constipation Flatulence Hiccups, belching Bloody, black, or hard stools Heartburn Poor nutritional intake

7. Describe the gastrointestinal system and related conditions Common disorders/conditions of the gastrointestinal system include the following: Constipation Fecal impaction Hemorrhoids Diarrhea Gastroesophageal reflux disease (GERD) Ostomies

Constipation the inability to eliminate stool, or the difficult and painful elimination of a hard, dry stool. Enema a specific amount of water, with or without an additive, that is introduced into the colon to eliminate stool. Suppository a medication given rectally to cause a bowel movement.

7. Describe the gastrointestinal system and related conditions Remember these facts about constipation: Causes: Decreased fluid intake Poor diet Inactivity Medications Aging Disease Ignoring the urge to eliminate

7. Describe the gastrointestinal system and related conditions Facts about constipation (contd.): Symptoms: Abdominal swelling Gas Irritability No recent record of bowel movement Treatment: Increasing fiber and fluid intake Increasing activity level Possibly enema or suppository

7. Describe the gastrointestinal system and related conditions Remember these facts about fecal impaction: Cause: hard stool that is stuck in the rectum and cannot be expelled; results from unrelieved constipation Symptoms: No stool for several days Oozing of liquid stool Cramping Abdominal swelling Rectal pain

7. Describe the gastrointestinal system and related conditions Facts about fecal impaction (cont.d): Treatment: Nurse or doctor inserts one or two gloved fingers into the rectum to break the mass into fragments so that it can be passed Prevention: High-fiber diet Plenty of fluids Increase in activity level Possibly medication

7. Describe the gastrointestinal system and related conditions Remember these facts about hemorrhoids: Cause: enlarged veins in the rectum and/or outside the anus resulting from an increase in pressure in the lower rectum due to Straining during bowel movements Chronic constipation Obesity Pregnancy Sitting for long periods of time on the toilet

7. Describe the gastrointestinal system and related conditions Facts about hemorrhoids (contd.): Symptoms: rectal itching, burning, pain, and bleeding Treatment: Medications Compresses Sitz baths Surgery may be necessary

7. Describe the gastrointestinal system and related conditions REMEMBER: When cleaning the anal area, be careful to avoid causing pain and bleeding from hemorrhoids.

7. Describe the gastrointestinal system and related conditions Remember these facts about diarrhea: Cause: frequent elimination of liquid or semi-liquid feces resulting from Infections Microorganisms Irritating foods Medications

7. Describe the gastrointestinal system and related conditions Facts about diarrhea (contd.): Symptoms: Abdominal cramps Urgency Nausea and vomiting can accompany diarrhea Treatment: Medication Change of diet - bananas, rice, apples, and tea/toast (BRAT diet)

7. Describe the gastrointestinal system and related conditions Remember these facts about gastroesophageal reflux disease (GERD): Chronic condition in which the liquid contents of the stomach back up into the esophagus Liquid can inflame and damage the lining of the esophagus, causing bleeding or ulcers Scars from tissue damage can narrow the esophagus and make swallowing difficult Heartburn is the most common symptom of GERD Treatment is usually medications.

7. Describe the gastrointestinal system and related conditions Remember these care guidelines for GERD: Serve evening meal three to four hours before bedtime. Keep resident upright at least two to three hours after eating. Give residents an extra pillow so the body is more upright during sleep. Serve the largest meal of the day at lunchtime and serve several small meals throughout the day. Reduce fast foods, fatty foods, and spicy foods. Stopping smoking, not drinking alcohol, and wearing loosefitting clothes may also help.

Ostomy a surgically-created opening from an area inside the body to the outside. Stoma an artificial opening in the body.

7. Describe the gastrointestinal system and related conditions Remember these facts about ostomies: May be necessary due to bowel disease, cancer, or trauma The terms colostomy and ileostomy tell what part of the intestine was removed and the type of stool that will be eliminated. In a colostomy, stool will generally be semi-solid. With an ileostomy, stool may be liquid. Disposable bag fits over the stoma to collect the feces and is attached to the skin by adhesive. A belt may also be used to secure it.

7. Describe the gastrointestinal system and related conditions Remember these guidelines for ostomy care: Make sure resident receives good skin care and hygiene. Ostomy bag should be emptied and cleaned or replaced whenever stool is eliminated. Always wear gloves and wash hands carefully. Teach proper handwashing techniques to residents with ostomies. Be sensitive and supportive when working with residents with ostomies. Always provide privacy for ostomy care.

Glands structures that produce substances in the body. Hormones chemical substances created by the body that control numerous body functions.
Transparency 4-24: The Endocrine System

8. Describe the endocrine system and related conditions Remember the following points about the endocrine system: Glands are structures that produce substances. Hormones are chemical substances created by the body that regulate essential body processes. Hormones are carried by the blood to organs in order to Maintain homeostasis Influence growth and development Regulate blood sugar levels Regulate calcium levels in bones Regulate the bodys ability to reproduce Determine how fast cells burn food for energy

8. Describe the endocrine system and related conditions Normal changes of aging to the endocrine system include the following: Decrease in levels of hormones, such as estrogen and progesterone Less production of insulin Less able to handle stress

8. Describe the endocrine system and related conditions Observe and report the following regarding the endocrine system: Headache* Weakness* Blurred vision* Dizziness* Hunger* Irritability* Sweating* Change in behavior* Change in mobility*

8. Describe the endocrine system and related conditions Observe and report (contd.): Change in sensation* Numbness or tingling in arms or legs* Weight gain/loss Loss of appetite/increase in appetite Increased thirst Frequent urination Dry skin Skin breakdown Sweet or fruity breath Sluggishness or fatigue Hyperactivity *Report these immediately

8. Describe the endocrine system and related conditions Common disorders of the endocrine system include: Thyroid disorders include hyperthyroidism (too much thyroid hormone) and hypothyroidism (too little). Diabetes occurs when the body does not produce enough or properly use insulin. Two major types are: Type I (juvenile, appears in childhood) Type II (most common, develops slowly after age 35)

Diabetes a condition in which the pancreas does not produce enough or does not properly use insulin. Insulin a hormone that converts glucose into energy for the body. Glucose natural sugar.

Pre-diabetes a condition in which a persons blood glucose levels are above normal but not high enough for a diagnosis of type 2 diabetes. Gestational diabetes type of diabetes that appears in pregnant women who have never had diabetes before but who have high glucose levels during pregnancy.

8. Describe the endocrine system and related conditions Remember these facts about diabetes: Pancreas does not produce enough insulin. Glucose collects in blood causing circulatory problems. Two types are type 1 (diagnosed in children and young adults, will continue throughout a persons life) and type 2 (adultonset and milder). Pre-diabetes describes blood glucose levels above normal but not high enough for a diagnosis of type 2 diabetes.

8. Describe the endocrine system and related conditions These are possible signs of diabetes: Excessive thirst Extreme hunger Frequent urination Weight loss High levels of blood sugar Sugar in urine Sudden vision changes Tingling or numbness in hands or feet Feeling very tired Very dry skin Sores that are slow to heal More infections than usual

8. Describe the endocrine system and related conditions Complications of diabetes include the following: Changes in the circulatory system can cause heart attack, stroke, poor extremity circulation, poor wound healing, and kidney and nerve damage. Damage to eyes can cause vision loss and blindness. Diabetes can lead to leg and foot ulcers, infected wounds, and gangrene due to poor circulation and impaired wound healing. Insulin reaction and diabetic ketoacidosis are serious complications (see Chapter 2).
Transparency 4-25: Care Guidelines for Diabetes Follow diet instructions exactly. Encourage exercise. Observe residents management of insulin doses. Perform urine and blood tests as directed. Give foot care as directed. Encourage comfortable, leather footwear and cotton socks.

Reproduce to create new life. Gonads sex glands.
Transparency 4-26: The Reproductive System

9. Describe the reproductive system and related conditions Note the following about the reproductive system: Reproductive organs are different in males (testes, scrotum, testosterone) and females (ovaries, fallopian tubes, estrogen).

9. Describe the reproductive system and related conditions Normal changes of aging to the reproductive system include the following: Female: Menstruation ends. Decrease in estrogen leads to loss of calcium, causing brittle bones. Drying and thinning of vaginal walls occurs. Male: Sperm production decreases. Enlargement of the prostate gland occurs.

9. Describe the reproductive system and related conditions Observe and report the following regarding the reproductive system: Discomfort or difficulty with urination Discharge Swelling of genitals Blood in urine or stool Breast changes, lumps, or discharge Sores on genitals Reports of impotence Reports of painful intercourse

9. Describe the reproductive system and related conditions Common disorders of the reproductive system include Vaginitis Benign prostatic hypertrophy

9. Describe the reproductive system and related conditions Remember these facts about vaginitis: Causes: Bacteria Protozoa Fungus Hormonal changes after menopause Symptoms: White vaginal discharge Itching and/or burning Treatment Oral medication Vaginal gels or creams

9. Describe the reproductive system and related conditions Remember these facts about benign prostatic hypertrophy: Occurs in men as they age Causes: Enlarged prostate causes pressure on the urethra, which leads to problems urinating and emptying the bladder Treatment Medications Surgery

9. Describe the reproductive system and related conditions REMEMBER: Men are also at increased risk for prostate cancer as they age. Prostate cancer is usually slow-growing and responsive to treatment, so early detection is important.
Handout 4-1: Sexually Transmitted Diseases and Infections Sexually transmitted diseases (STDs), also called venereal diseases, are diseases passed through sexual contact with an infected person. This contact includes sexual intercourse, contact of the mouth with the genitals or anus, and contact of the hands to the genitals. A person may be infected, and may potentially infect others, without showing signs of the disease. This is called a sexually transmitted infection (STI). Using latex condoms during sexual contact can reduce the chances of being infected with or passing on some STDs and STIs. The human immunodeficiency virus (HIV), acquired immune deficiency syndrome (AIDS), and some kinds of hepatitis can be sexually transmitted. STDs are very common. They can cause serious health problems. Residents may be unaware of or embarrassed by symptoms of an STD. Be professional when dealing with STDs and STIs. This can help put residents at ease.
Handout 4-1: Sexually Transmitted Diseases and Infections (contd.) Chlamydia infection is caused by organisms in the mucous membranes of the reproductive tract. Chlamydia can cause serious infection, including pelvic inflammatory disease (PID) in women. PID can cause sterility. Signs of chlamydia infection are yellow or white discharge from the penis or vagina and burning with urination. It is treated with antibiotics. Syphilis can be treated effectively in the early stages, but if left untreated, it can cause brain damage, mental illness, and even death. Babies born to mothers with syphilis may be born blind or with other serious birth defects. Syphilis is easier to detect in men than in women. This is due to open sores called chancres that form on the penis soon after infection.
Handout 4-1: Sexually Transmitted Diseases and Infections (contd.) The chancres are painless and can go unnoticed. If untreated, the infection spreads to the heart, brain, and other vital organs. Common symptoms at this stage include rash, sore throat, or fever. When detected, syphilis can be treated with penicillin or other antibiotics. The sooner it is treated, the better the chances of preventing long-term damage and avoiding infection of others. Gonorrhea, like syphilis, can be treated with antibiotics and is easier to detect in men than in women. If untreated, gonorrhea can cause sterility in both men and women. Most women with gonorrhea show no early symptoms. This makes it easy for women to spread the disease. Men with gonorrhea will often show a greenish or yellowish discharge from the penis within a week after infection. Burning with urination is another common symptom in men.
Handout 4-1: Sexually Transmitted Diseases and Infections (contd.) Herpes simplex 2, unlike the other STDs discussed here, is caused by a virus. It cannot be treated with antibiotics. Once infected with the herpes virus, a person cannot be cured. The person may have repeated outbreaks of the disease for the rest of his or her life. A herpes outbreak includes burning, painful, red sores on the genitals. These heal in about two weeks. The sores are infectious, but a person with herpes virus can also spread the infection when sores are not present. Some people infected with herpes never have repeated outbreaks. The later episodes may not be as painful as the first outbreak. Antiviral drugs can help people stay symptom-free longer. Babies born to women infected with herpes simplex 2 can be infected during birth. Pregnant women experiencing a herpes outbreak are usually delivered by cesarean section, or C-section.

Define the following term:
Lymph
A clear yellowish fluid that carries disease-fighting cells called lymphocytes.
Transparency 4-27: The Lymphatic System

10. Describe the immune and lymphatic systems and related conditions Remember the following points about the lymphatic system: Function of system is to remove excess fluids and waste products as well as to help the immune system to fight infections. It is closely related to the circulatory system because lymph fluid, after being purified in the lymph nodes, flows into the bloodstream. It has no pump, but is circulated by muscle activity, massage, and breathing. Nonspecific immunity protects the body from disease in general. Specific immunity protects against a particular disease that is invading the body at a given time.

10. Describe the immune and lymphatic systems and related conditions Normal changes of aging to the immune and lymphatic systems include the following: Increased risk of infections due to weaker immune system Decreased response to vaccines

10. Describe the immune and lymphatic systems and related conditions Observe and report the following regarding the immune and lymphatic systems: Recurrent infections Swelling of lymph nodes Increased fatigue

10. Describe the immune and lymphatic systems and related conditions HIV/AIDS affects the immune and lymphatic systems: Acquired immunodeficiency syndrome (AIDS) is caused by HIV (human immunodeficiency virus). HIV attacks the immune system and disables it. HIV is transmitted by sexual contact, blood, infected needles, or from mother to fetus. Symptoms at transmission are like flu. Later symptoms include infections, tumors, and central nervous system symptoms. Late stage is AIDS dementia complex.

10. Describe the immune and lymphatic systems and related conditions Signs and symptoms of HIV/AIDS include the following: Appetite loss Involuntary weight loss Flu-like symptoms Night sweats Swollen lymph nodes Severe diarrhea Dry cough Skin rashes

10. Describe the immune and lymphatic systems and related conditions Signs and symptoms of HIV/AIDS (contd.): Painful white spots in mouth Cold sores Warts on the skin and in mouth Inflamed and bleeding gums Low resistance to infection Bruising that does not go away Kaposis sarcoma AIDS dementia complex

10. Describe the immune and lymphatic systems and related conditions REMEMBER: Opportunistic infections invade the weakened body of a resident with AIDS. Treatment is medication. Drugs slow the progress but there is no cure for the disease.
Handout 4-2: Myths About HIV and AIDS Myth: If I am HIV positive, that means I have AIDS. Fact: HIV positive means that your body was exposed to the virus. Since your body was exposed, there is a good chance that you are infected with the virus. But it does not mean that you have AIDS. AIDS develops over time. Myth: HIV is the same as AIDS. Fact: HIV is the virus that causes AIDS. AIDS is a group of symptoms that develop during the last stage of HIV infection.
Handout 4-2: Myths About HIV and AIDS Myth: I can get HIV from an infected person by shaking hands, hugging, or kissing. Fact: HIV is not spread through casual contact. There is a slight possibility that you could become HIV infected through kissing if you and the infected person both have open bleeding sores in your mouths and the infected persons blood gets into yours. If you are really worried about this, do an oral exam on your partner before kissing him or her. Myth: I can get HIV from telephones. Fact: The HIV virus can't live outside of the body. You cannot become infected through saliva. Myth: I can get HIV from doorknobs, tables, chairs, or push buttons. Fact: The HIV virus can't live outside of the body.
Handout 4-2: Myths About HIV and AIDS (contd.) Myth: I can get HIV from eating food that was prepared by an infected person. Fact: Once again, HIV dies very quickly outside the body. Even if the food prep person cut his finger and then attractively arranged your food on your plate, you would not become infected from eating this food. Once any body fluid is dry, you can be absolutely sure that the virus is dead. Just about the only way you could become infected this way is if the food prep person cuts off a finger, and as he is bleeding in your food, you are eating it at that exact moment. This scenario is rather extreme.
Handout 4-2: Myths About HIV and AIDS (contd.) Myth: I can get HIV from toilets. Fact: Toilets have been blamed for just about everything, from getting you pregnant to giving you sexually transmitted diseases (STD). The only way you might possibly become HIV infected from a toilet seat is to have unprotected sex while sitting on it! Myth: I can get HIV from mosquitoes. Fact: Although it sounds very possible, you cannot become HIV infected through mosquitoes, fleas, ticks, or lice. For this to happen, the HIV would have to survive in the insect saliva and salivary glands. HIV is a human virus and cannot survive outside of the human body. As a result, HIV will not and does not survive in mosquitoes, fleas, ticks, or lice. If this were a route of transmission, we would all have been infected a very long time ago.
Handout 4-2: Myths About HIV and AIDS (contd.) Myth: I can get HIV from breathing the same air as an infected person. Fact: HIV does not spread through the air. You cannot get HIV by being in the same room with someone who is infected with the virus.
Transparency 4-28: Care Guidelines for HIV/AIDS Wash hands often. Follow Standard Precautions, and keep everything clean. High-protein, high-calorie, high-nutrient meals can help maintain healthy weight. Help make mealtimes pleasant and relaxing. Know residents favorite foods. Notify nurse of appetite loss/ difficulty eating. If residents have infections in the mouth they may need food that is low in acid/spice and neither cold nor hot. Good mouth care is vital. Small, frequent meals can help with nausea. Help ensure adequate fluid intake.
Transparency 4-28: Care Guidelines for HIV/AIDS (contd.) If diarrhea is severe, doctor may order BRAT diet (bananas, rice, apples, toast). This is helpful short-term. Good rehydration fluids include water, juice, soda and broth. Avoid caffeinated beverages. Numbness, tingling, and pain in the feet and legs is usually treated with medications. Going barefoot or wearing loose, soft slippers may help. Bed cradle may be used. Treat residents with respect and provide emotional support. Provide safe environment and close supervision in ADLs.

10. Describe the immune and lymphatic systems and related conditions Think about these questions: Why might a resident with AIDS be under extra emotional stress? Why might be some of the special challenges of caring for residents with AIDS?

10. Describe the immune and lymphatic systems and related conditions REMEMBER: Results of HIV testing (whether of residents or staff) are confidential and cannot be discussed with anyone. Serious violations apply under HIPAA if confidentiality is breached.

Define the following term:
Tumor a group of abnormally growing cells.

10. Describe the immune and lymphatic systems and related conditions Cancer is a disorder of the immune and lymphatic systems: General term meaning many types of malignant tumors. Tumors can be benign (non-cancerous, usually grow slowly) or malignant (cancerous, grow rapidly). There is no cure. It may spread to other areas of the body, affecting other body systems. Cancer often first appears in breast, colon, rectum, uterus, prostate, lungs or skin

10. Describe the immune and lymphatic systems and related conditions The following are risk factors for cancer: Tobacco use Exposure to sunlight Excessive alcohol use Some food additives Exposure to some chemicals and industrial agents Radiation Poor nutrition Lack of physical activity

10. Describe the immune and lymphatic systems and related conditions The American Cancer Society has identified warning signs of cancer: Unexplained weight loss Fever Fatigue Pain Skin changes Change in bowel or bladder habits

10. Describe the immune and lymphatic systems and related conditions Warning signs of cancer (contd.): Sores that do not heal Unusual bleeding or discharge Thickening or lump in breast or other part of body Indigestion or difficulty swallowing Recent change in wart or mole Nagging cough or hoarseness

10. Describe the immune and lymphatic systems and related conditions Treatments for cancer include Surgery Chemotherapy Radiation
Transparency 4-29: Care Guidelines Cancer Each case is different. Do not make assumptions. Respect residents needs and be sensitive. Have a positive attitude. Try plastic utensils for residents receiving chemotherapy. Encourage a variety of food. Watch for signs of pain and report them to the nurse. Give back rubs for comfort. Reposition residents. Use lotion on dry skin. Do not remove markings. Give back rubs. Assist with oral care often. Use a soft-bristled toothbrush and baking soda rinse. Provide help with grooming. Encourage visitors. Suggest good times of the day for visits. Get to know residents interests. Be alert to needs not being met or stresses.

10. Describe the immune and lymphatic systems and related conditions Report the following signs and symptoms and cancer: Increased weakness or fatigue Weight loss Nausea, vomiting, diarrhea Changes in appetite Fainting Signs of depression

10. Describe the immune and lymphatic systems and related conditions Signs and symptoms of cancer to report (contd.): Confusion Blood in stool or urine Change in mental status Changes in skin New lumps, sores, rashes Increase in pain or unrelieved pain

4 Body Systems and Related Conditions: Urinary Incontinence

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4 Body Systems and Related Conditions: Urinary Incontinence

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4 Body Systems and Related Conditions

Define the following terms: