A nurse cares for a 92-year-old woman with urinary incontinence. ...

[sabina]

A nurse cares for a 92-year-old woman with urinary incontinence. Which of the following age-related changes is the rationale behind assisting client to the bathroom every 2 hours?
 
  A) Decreased estrogen levels
  B) Degenerative changes in the cerebral cortex
  C) Demyelination of parasympathetic nerves
  D) Diminished thirst perception

Question 2

A nurse administers medications to older adults in a long-term care facility. Which of the following actions is most appropriate when the client with dementia is newly prescribed an antimuscarinic agent for urge urinary incontinence?
 
  A) Administer with a full glass of water
  B) Assess the client for drooling and diarrhea
  C) Monitor the client closely for worsening cognitive impairment
  D) Toilet the client before administering the medication

[LP]

Answer to Question 1

Ans: B
Decreased estrogen levels cause a loss of tone, strength, and collagen support in the urogenital tissues and can predispose the urinary system to leakage problems; but in older adults, degenerative changes in the cerebral cortex may alter both the sensation of bladder fullness and the ability to empty the bladder completely. The degenerative changes in this 91-year-old woman more directly impact the decision to toilet every 2 hours. Younger adults perceive a sensation of fullness when the bladder is about half full, but this occurs at a later point for older adults. Normal aging does not include the demyelination of parasympathetic nerves. Diminished thirst is not impacted by toileting every 2 hours.

Answer to Question 2

Ans: C
Antimuscarinic agents are used for urge urinary incontinence. Oxybutynin is the medication most commonly associated with cognitive impairment, but all antimuscarinic agents need to be used with caution in older adults with preexisting dementia. These medications have the same adverse effect profile as other anticholinergics, such as dry mouth, constipation, blurred vision, and mental changes. There is no need to toilet before, water is important, but cognition is the priority.

[sabina]

Thank you

[LP]

No problemo