Archive for the ‘Bowel and Bladder’ Category
Posted on January 21, 2013 - by Nurse Virginia
URINARY INFECTIONS MAY LEAD TO INCREASED CONFUSION IN THE ELDERLY
(Part II)
In the past when an elderly person experienced changes in behavior or increased confusion, the health care community collectively thought that this was normal; after all you’re getting old. How many times has a doctor said to a family member “What do you expect at his age, he’s getting old.”
Addressing the behavior or the increased confusion was the focus, not the underlying physical change in condition. Identifying that physical or pathological change will require the persistence to search for a cause and the ability to clearly communicate your findings.
Signs of a urinary tract infection:
- Going to the bathroom more frequently
- Complaining of a burning sensation on urination
- Increased temperature
- Bladder or kidney pain
- Blood or pus in the urine
- Concentrated, dark/cloudy urine
- Rambling talk, disorganized thinking
- Unstable emotions
- Increased problems with judgment or thinking
The elderly with dementia are more likely to be hospitalized for a fracture, lower respiratory infection, urinary infection or a head injury than an elder without dementia. Once admitted, the elder with dementia will usually remain in the hospital twice as long an elder without dementia. The elder with dementia will also be more likely to be re-admitted within 90 days after discharge than an elder without dementia.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on January 15, 2013 - by Nurse Virginia
URINARY INFECTION MAY LEAD TO INCREASED CONFUSION IN THE ELDERLY
(PART I)
Marty was holding on to the handle of the car door threatening to “jump.” No matter what his wife Betty said, nothing seemed to be able to quiet Marty down. He had been pacing the small home they had lived in for the past 40 years, till Betty said, “Let’s go for a drive.” Thinking the car ride would be soothing for whatever was bothering Marty these last few days. He seemed to have a problem that he didn’t seem to be able to put into words. And now here he was threatening to jump from the car.
Marty had always been a very calm, dependable sort of man. Even when he started getting confused, he laughed it off never showing frustration or anger. This kind of outrageous behavior was so unlike the normal manner of this 78year old man. Not knowing what to do, Betty drove directly to their doctor’s office and luckily they took Marty right into an examination room. Marty would not have been good at waiting, not today.
Marty was well known to the doctor and his staff and after what seemed only a short time to Betty the doctor started writing notes. Betty could just make out the doctor’s note reading it upside down. It read, Altered Mental Status, increased confusion probable cause urinary tract infection.
Urinary tract infections are the most common infections in the elderly and the most likely to lead to increased confusion. The second most likely infection to result in increased confusion is an upper respiratory infection or pneumonia. However just about any infection in an elderly individual may result in increased confusion. Many times the increase in confusion is the symptom that leads the caregiver or physician to the cause which may be infection.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on January 14, 2013 - by Nurse Virginia
PLEASE HELP-DAD WON’T WEAR A DIAPER
M. T. writes: My Dad is a stroke patient for more than 6 years. He is in a wheelchair, and is 72 years old. Your advice has been very useful, but I have this problem. Dad does not accept diapers, what do I do?
I well remember a lady some 30 years ago who moved into the nursing community sitting in a wheelchair on a stack of urine soaked newspapers. Myrtle was very offended when ever anyone suggested that she needed to wear a “diaper.” She angrily denied that she was in any way incontinent of urine. After she moved into the nursing community she constantly moved through the common areas looking for newspapers. She never changed the papers, just placed the new ones on top of the old ones.
In those days they didn’t offer pull ups or a variety of sizes. Staff at that time was used to laying the elder down on a bed and changing them much like you would change a baby. No one talked or thought about issues of dignity or even privacy.
Healthcare has come a long way since then, and we have learned how hurtful words can be. Please look on this sight for “Words that Hurt” from 4/2/2009 and also the blog from 1/30/2009.
Whether living in a nursing community or with a family caregiver, when the elder is incontinent and not using an absorbent product, much of life can revolve around this issue. Keeping the elder clean, comfortable and preventing skin breakdown becomes a fulltime job.
Being a caregiver continues to be the hardest job there is.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on October 6, 2010 - by Nurse Virginia
CONSTIPATION – NOT ALWAYS JUST A SIGN OF AN AGING ELDER
Results of Laxative abuse in the elderly.
Many elders abuse laxatives without realizing their regular use is abusive. The elder may be under the assumption that in order to be “regular” they must have a bowel movement every day. Regular use of laxatives makes the intestinal muscles flabby or referred to as a “Lazy bowel.” The ongoing use of these products eventually makes a person dependent on a laxative in order to have a bowel movement.
Laxatives work by irritating the walls of the intestines and causing an increase in the contractions of the muscles in the intestinal wall. The most gentle of these products contain milk and increase the amount of water in the intestine causing a softer stool. The nursing home usually favors the use of one of these milk products (Milk of Magnesium or MOM) for the elder with a constipation problem.
Suppositories
Glycerin suppositories have a more gentle action than Bisacodyl products. Glycerin works by attracting water through the intestinal wall into the bowel and will flush out the waste within 10 minutes. All suppositories are bullet shaped and designed for insertion with the pointed end first and placed next to the wall of the bowel.
A Bisacodyl product acts by irritating the muscles of the bowel, causing contractures (at times extreme) which expels the waste.
When Hypothyroidism is the cause of constipation.
When the elder has an ongoing problem with constipation despite eating a good diet, drinking water through out the day and getting regular exercise, the possibility of hypothyroidism should be looked into. Although hypothyroidism causes dementia, as well as a host of other conditions, physicians are more likely to address each symptom then the cause. A diagnosis of hypothyroidism is very difficult to receive from a physician.
The patient who presents with slow reactions, and moves slowly, you can then assume their digestive system is also moving slowly. A slow moving colon gives the intestinal wall more opportunity to remove fluid and create hard dry stools. Even when the physician suspects Hypothyroidism, unless their lab tests confirm it, the patient will not receive the diagnosis. Hypothyroidism used to be diagnosed strictly by the symptoms reported by the patient and the observation of the physician. Once the medical community determined that the only way to determine this debilitating condition was with the correct labs, many people were no longer diagnosed.
Although hypothyroidism is relatively easy to treat, with low cost thyroid medication and iodine the typical physician is going to dismiss this possibility if the labs don’t back him up.
Although constipation is a difficult condition to live with, the missed diagnosis of Hypothyroidism has the potential to cause many more conditions for the aging population in the future.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com
Posted on October 4, 2010 - by Nurse Virginia
CONSTIPATION – NOT ALWAYS JUST A SIGN OF AN AGING ELDER
(PART II)
Constipation – the difficult passage of hard dry stool.
After food is swallowed, it begins to digest in the stomach where it is broken down into small pieces. Food then continues into the small intestines where it is digested by enzymes and nutrients are absorbed into the bloodstream, as it passes through the many feet of colon. A large amount of fluid is needed for this process. In the large intestine almost all of the fluid is re-absorbed, the remaining substance is waste. This waste is made up of unabsorbed food, fiber and water.
The fiber story.
In 400 B.C. Hippocrates said, “Let food be your medicine.” This couldn’t be better advice than in the case of fiber. Fiber is the part of the plant that can’t be digested. So fiber that is eaten will then be intact in the stool. But fiber not only passes through the system without being digested, it also attracts water. Because fiber has the ability to attract and hold water, it makes the stool a softer consistency and therefore easier to pass.
Benefits of fiber:
· Loose watery stools – fiber will absorb the excess water.
· Decrease the size of hemorrhoids due to the reduced need to strain when having a bowel movement.
· Fiber decreases the absorption of sugar which can be a benefit for diabetics.
· Fiber improves problems of constipation.
Sources of fiber from food:
· Whole-grain products
· Fruit – eat the skin whenever possible
· Vegetables
· Legumes
· High fiber snacks – nuts, seeds, popcorn, whole grain crackers and dried fruit
Fiber found in food will always be superior to the use of fiber supplements.
Some elderly will have a problem tolerating a high fiber diet. These problems may be abdominal pain, cramping or gas. Your physician may suggest an over the counter supplement or testing to determine if the problem of constipation may be related to hypothyroidism.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com
Posted on September 30, 2010 - by Nurse Virginia
CONSTIPATION – NOT ALWAYS JUST A SIGN OF AN AGING ELDER
(Part I)
Statins (Cholesterol Drugs) cause muscle weakness – the colon is a muscle
Charles was 85 that year. His family was aware of his constipation problem. He, like many other elderly people incorporated prunes into his morning routine. Charles came up with his own solution of a hot cup of coffee first thing in the morning with ginger snap cookies heaped in the coffee like a hot cereal and prunes. One of his daughters’ brought him apples, encouraging one a day, which he faithfully complied with. Everyone was coming up with suggestions for a “fix” to this problem of constipation.
Yet Charles ended up in the hospital with a painful and unnecessary bowel obstruction. The first thing the hospital physician did was to review his medications and discontinue the statin drug that caused the problem.
Charles’ daughter was told by the physician that they were getting elderly patients in every month with bowel constipation related to a statin drug.
Signs of muscle weakness.
Now after the fact, Charles’ family could see the signs of weakness they had just assumed were the effects of aging. How he had started to complain of no longer being able to walk as far as he used to and had to sit down frequently because he felt weak. How now when walking in his retirement community he was holding on to the rail along the wall and using his cane. Previously, he had never used a cane and could keep pace with his much younger children when walking the halls.
The 22 foot muscle.
When people reference their muscles they rarely mention the digestive tract. The colon in an adult will be anywhere from 12 ft. to 22 ft. long depending on its musculature tone. Food is digested by enzymes and moved through the colon by involuntary muscle contractures. The tone of the muscular walls of the colon is very important to how fast food travels through the digestive system.
Any drugs that have the potential for causing muscle weakness should be suspect when constipation is an issue.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com
Posted on April 2, 2009 - by Nurse Virginia
CAREGIVER TIPS: When the elder suffers the embarassment of incontinence.
The shame of incontinence.
Her family told us that for the last few years their mother had refused to wear any incontinent product. She collected and sat on piles of newspaper at all times. This had become her normal to a point where she became very angry when anyone even suggested that she was incontinent. During her time with us, she could be seen wheeling around the community searching out discarded newspapers.
Even after we had successfully convinced her to wear “pull-ups” that we always referred to as “her underwear”, she continued to collect and sit on newspaper.
4 Things to remember when your elder is incontinent.
· Make sure the person drinks an adequate amount of fluids. Many people as they begin to have incontinent problems think it will be better not to drink too much, and start restricting their fluids.
· Be careful what you call the incontinent product you use. The word “diaper” is only used with babies. Refer to incontinent products as underwear, underpants, boxers, any adult term that doesn’t make the person feel they are being treated like a baby.
· Take the person to the bathroom at regular times. Right when they get up in the morning, right after all meals, before they go to bed and any time you can tell by body language that they need to use the bathroom. This could be facial or body gestures of discomfort or anxiety.
· Be very careful in your response to incontinent episodes or toileting. It is much easier for the person you care for if you have a very matter of fact attitude.
I remember a retired nurse I once cared for. She asked me if I knew why when the staff came into “change her diaper” at night she always kept her eyes closed. I had always assumed it was because of the staff having a light on to see what they were doing. And that the light had bothered her eyes. She told me “No, I don’t want to see the faces of the people who have to do such a humiliating thing for me.”
Incontinence is hurtful at any age.
Posted on March 23, 2009 - by Nurse Virginia
Caregiver Tips: When the senior you care for has Alzheimer’s disease and suffers from constipation
Constipation may be related to aging or Alzheimer’s.
Constipation is frequently a problem for persons with Alzheimer’s disease. Due to the fact that the same substance that is gumming up the connections in the brain gum up the intestines. When that happens the intestines slow down and slowing the work of the intestines causes constipation.
The intestines can also slow down due to aging and weakened muscles. When your other muscles get weak the muscles used to move food also get weak. Besides aging this can also happen as a side effect of some medication and also your food choices.
Reduce foods known to cause inflamation.
The first thing to try would be do try to eliminate sugar and white flour from the diet. Many times if the person has sensitivity to wheat or dairy you can find that out by eliminating it from the diet for a while.
Increase the amount of water the person drinks – try for the 8 ounces a day that is a standard recommendation. Increase the amount of fruit and vegetables that are eaten. Also some meats are more difficult to digest than others with fish and fowl the easiest to digest.
Tracking how often the person has a bowel movement and how difficult it is for them is just the start of a good bowel program
- Help your elder find comfort, relevance and respect no matter how frail he or she is.
Find out why the quality of life depends so much on the family no matter who the direct caregiver may be.
Find out how to have a meaningful visit with your parent when they have dementia.
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