NURS 310 Gerontology Systems Inquiry Organization Tool

System: _______Genitourinary System_________________________

Focus Question
Where is this in normal aging?

Notes

If kidneys arent working, what

starts to happen? retain
toxins, medications, etc.,
electrolytes and pH is of

Bladder contractions and more

prone to infections
Systemically, the person is not as
adaptable to dehydration and fluid
overload

Loss of efficiency
Overall slumping of anatomy
And enlargement of prostate
Dehydration is a really big deal
Catheters and infections

Primary system functions: excrete toxins

and waste products of metabolism,
regulate water balance, maintain acidbase balance (PH 7.35 7.45), control
concentration of salts and other
necessary substances
Normal aging results in gradually
decreased efficiency of system
o Still no what they need to do, just
do it less efficiently
o Fewer nephron cells
o Kidneys smaller
Anatomical change: decrease in number
of all basic elements (nephrons,
glomeruli, renal tubules), resulting
decrease in overall size of kidney;
sclerosis of vasculature (more rigid and
less flexible and dont work as
efectively); muscles lose tone and
elasticity, enlarged prostate may also
exist in men.
SO Decreased ability to concentrate
urine and remove toxins, GFR declines,
blood flow through kidney reduced,
incomplete emptying of bladder because
of the previous statements, bladder
capacity decreases (do to less number of
cells), more residual urine, lessened
reserve capacity, delayed signal to
urinate (what does that mean for the
person results below).
Results medications not eliminated
efectively, toxic substances build up,
bladder contractions and infections more
likely, frequency and urgency,
incontinence, less adaptable to
dehydration and water overload,
maintaining acid-base balance in blood
and regulating electrolytes may be more
difficult.
Typical crisis: Water intake reduced out of
confusion (also maybe because of

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frequency, nocturia, etc.), fear of
incontinence, especially if diuretics in use
(diuretics can cause some pretty big
problems)
Age-related disorders usually relate to
greater likelihood of obstruction in
lower tract, and susceptibility to
infection.

What are typical

presentations?

Atypical presentations are not

really an issue here so she
wants us to focus on the
typical presentations.

Not cancerous!!!

I women reproductive organs are

also weak and out of shape. So
these sit in front of the bladder
and the bladder may slump and
crunch and not hold as much
urine

UTIs overall, more common in women,

but increased incidence with age,
especially after 80; women have about
80% of UTIs; higher incidence in
institutionalized older adults; site may be
kidney or bladder (upper or lower);
treatment with antibiotics, usually
longer course in men (antibiotics should
be matched with whatever is found in the
culture, but often doesnt happen; some
facilities have a generalized process);
increased risk with stroke, diabetes,
decreased estrogen levels in women,
neurogenic bladder, prostatic
hyperplasia, and indwelling catheter.
Diagnosis- urine culture and
sensitivity identifies bacteria in urine.
BPH benign (non-malignant) prostatic
hypertrophy of gland in male
reproductive system (located near base
of bladder and surround urethra); nonmalignant; 50% of men 51 60, 90% of
men older than 80; may or may not be
symptomatic; can cause bladder
obstruction. Treat with weight loss,
exercise, behavior modification,
anticholinergic (older people are very
sensitive to anticholinergic drugsso red
flag and be vigilant when these patients
are on them!!) medications first; then
minimally invasive surgery; transurethral
resection (TURP) for most severe.
Urinary Incontinence (happens because
of all of those things we talked about
earlier [less numbers etc.]) involuntary
passing of urine in quantities constituting

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How would you assess this

system?

a social or health problem. More

common in the institutionalized; also
often the reason for institutionalization;
Not an inevitable part of aging, but
common (1 in 3 adults living in
community); women more often afected.
Possible medical causes to rule out:
delerium, drugs, diuretics, infections,
diabetes. Transient (acute) related to
medical condition vs. Established
(chronic) persisting over time WILL
progressively worsening.
Types of established incontinence
o STRESS (weakened muscles in
pelvic floor- very common in
women especially after having kids
or during menopause) most
frequently seen
o URGE (unable to delay) may be
associated with UTI, prostate
enlarged, tumor, CNS impaired
after stroke next most frequently
seen
o REFLEX (variation of Urge, sudden
leaking of large amounts) cerebral cortex lesion, MS, other
neuro these are more serious and
can be related to neurological
conditions
o OVERFLOW (small amounts lead
from distended bladder, frequently
or continuously) prostate
enlargement and obstruction,
medications, nervous system
disturbance afecting bladder
these are more serious and can be
related to neurological conditions

ADLs for a baseline and because their

ADLs will be impacted by incontinence
Do you feel safe?
Sexual history / activity as with any patient
History of UTIs even if theyre not
presenting with a UTI, but a hx of past UTIs
makes you more vulnerable to future UTIs

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Med History and GeroNet Risk Score for

Adverse Drug
Reactions, or something similar (Bates page
932)
Smoking and alcohol smoking can
contribute
Nutrition poor nutritions contributes
PE: GYN vaginal/pelvic exam, Prostate exam
to ID enlargement
10-minute geriatric screener (Bates page
941)

Screen for sources of Incontinence:

DIAPERS (Delerium, Infection, Atrophic
urethritis / vaginitis, Pharmaceuticals, Excess
urine output from conditions like
hyperglycemia or heart failure, restricted
mobility, stool impaction)
OR
DDRRIIPP (Delerieum, drug side efects,
retention of feces, rest4ricted mobility,
infection of urine, inflammation, polyuria and
psychogenic).

What are the interactions with

nutrition, metabolism, mobility,
pain, function, mood, and
coping?

What management and/or

ethical/legal issues are

Dehydration / fluid overload elders are

less adaptable to these really pay
attention to fluid intake and output
Restricted activity / social engagement
Depression / withdrawal consequence
of having to live with these conditions
may contribute to depression

Values issues around sexuality

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involved (acute/chronic/EOL)?

Always heighten abuse screening when red

flags are raised.

What interventions matter

(medical/nursing/iatrogenesis)?

What recommendations for

health promotion exist? What
can the nurse do to facilitate
that?

Exercise
Proper diet including fluid intake
Limited use of medications (some that
cause the problems)
o Be familiar with oxbutinin its an
anticholinergic
o Also know that BPH is treated with
anticholinergic drugs and may
contribute to all of these other
issues
o Look at Beers list
o Look at STARRT/STOPP guide
Not smoking