Urinary Tract Changes in Older Adults

Presented by: Group 6

 Although bladder disorders are common among the elderly population, bladder disorders are not a normal part of aging or of being in an institution. Therefore, when properly assessed and treated, bladder function can be corrected in about 30% of residents of extended care facilities and suitably managed and controlled in the rest.

Alterations:
Muscle tone decreases decrease the elasticity of the ureters, bladder, and urethraamount of urine the bladder can hold is reduced (bladder capacity decreases) elderly person will not be aware of the need to void until their bladder is almost full Frequency(the need to urinate often),Urgency(an immediate need to urinate ), Nocturia( waking at night to urinate),Incontinence(inability to hold urine )

 The sensory nerve tracts from the bladder (through the spinal cord) to the brain often wear out, creating breaks in the neural pathway. Consequently, there is a shortcircuiting of nerve firing and messages from the urinary system may not completely reach the brain. In general, the nervous system takes longer to respond to sensory stimuli. This causes the bladder urge sensation (telling the person to void) to be delayed.

 Due to an incomplete nerve pathway there is an increase in bladder spasms or bladder overactivity small frequent contractions that create the urge to void before the bladder is fullThese bladder contractions cause urine leakage (urinary urge incontinence)

 The bladder does not empty completely capacity of the bladder is decreasedneed to void often in small amountsThe urine that remains in the bladder after the person has voided (post-void residual, or PVR) may become infected with bacteriaincreased incidence of urinary tract infection.

 Immobility incomplete emptying of the urine from the bladder and kidneysurine is retained too long as with any fluid standing stillbegins to grow bacteriaresulting in infection and development of kidney stones (calculi).

 the pelvic floor muscles normally get weakened with age(especially in womenthese pelvic muscles sometimes grow so weak that the bladder and urethra prolapse, or fall into the vaginaolder women may become incontinent, or lose urine involuntarily.

 Urine flow can also be blocked by an enlarged prostate gland in men(BPH,and is common in aging men) Tissue artophy Reduced ability of the tubule cells to selectively secrete and reabsorb fluid and electrolytes alteration Decreased GFRmaybe due to multiple medicationsincrerased risk of adverse drug affects and drug - drug interaction.

 Decreased their thirst stimulation already diminished fluid volume deficit prone to develop hypernatremia.

Nursing Management:
Prevent urinary stasis by: - encourage liberal fluid intake (The fluid intake and output must be accurately measured for all patients with any urinary related issues. Unless a patient is on fluid restrictions they should be offered fluids frequently and have them fresh and readily available at their bedside. Fluids should include a variety of juices, tea, soups and most of all water.

Adequate hydration keeps the urinary system clean and prevents urine from becoming concentrated. The fluid intake should be no less then 2500 cc every day. Unless fluids are being lost through excessive perspiration, vomiting or diarrhea the output should be approximately 2000 cc ( if their intake was 2500cc). - encourage frequent change in position - encourage ambulation

 Prevent skin breakdown by thorough cleansing. Keep the patient covered up with a call light in reach espacially if patient is experiencing nocturia Early recognition of urinary tract infection and other renal diorders. Promptly respond to call for bathroom or bed pan (If you have a mobile patient it is best to have a hat in the commode to catch the urine.)