Medication and incontinence — Transcript

Full transcript

1. 0:06okay
2. 0:07um this lecture is going to be about
3. 0:11medication use and incontinence
4. 0:15um do kind of small things we kind of
5. 0:18put at the end
6. 0:19but like i said with the other lecture
7. 0:21still very very important
8. 0:24but these are just kind of specific
9. 0:26things to medications
10. 0:29and the other powerpoint to this on
11. 0:31these
12. 0:32specific things to address with
13. 0:35incontinence which these things will be
14. 0:38on the final
15. 0:39so make sure you've reviewed these
16. 0:41things as well
17. 0:44this powerpoint and section of the
18. 0:46lecture is
19. 0:47from chapter 13 in your elders book
20. 0:51some of the stuff you should find
21. 0:53familiar from
22. 0:55farm class so let's talk
23. 0:58just couple term pieces of terminology
24. 1:01polypharmacy um it's
25. 1:04use of multiple medications in a single
26. 1:08individual
27. 1:09okay this is going to be highly common
28. 1:11in our elderly
29. 1:12so we need to be very aware they're
30. 1:14going to be on multiple medications
31. 1:17i've had patients that i've seen upwards
32. 1:19of the nurses handing them
33. 1:2120 pills at a time you know so you're
34. 1:24looking into that oh my
35. 1:26gosh what all is involved with all that
36. 1:28medication
37. 1:29and kind of knowing what could be going
38. 1:31on could some of their symptoms be
39. 1:33related to some of
40. 1:34all this medication that they're on
41. 1:37um which is things that will happen you
42. 1:40will have some drug to drug
43. 1:42interactions you know as much as we
44. 1:44would like to think that the doctors are
45. 1:46looking over
46. 1:47everything that's going on you know
47. 1:50especially in the elderly they're going
48. 1:52to multiple doctors and i have a
49. 1:53cardiologist
50. 1:55or neurologist a pulmonologist
51. 1:58all of them don't talk to see what all
52. 2:01prescriptions everybody is on
53. 2:03i do have to say that it's getting
54. 2:05better and better with electronic
55. 2:10health records i think more doctors are
56. 2:13able to see what other doctors are doing
57. 2:15so we're getting a better handle on this
58. 2:20but we also need to know that not
59. 2:22everybody is told
60. 2:24every doctor everything you know they
61. 2:26might you know hop
62. 2:27doctors top pharmacies you know they've
63. 2:30got multiple diseases at this point
64. 2:33so just knowing you know that some of
65. 2:36the symptoms that they're having
66. 2:38might be caused from some sort of drug
67. 2:40to drug interaction
68. 2:42or some side effects from some
69. 2:45medications
70. 2:47you also might get adverse drug
71. 2:50reactions
72. 2:52especially with kidney and liver
73. 2:54functions
74. 2:56that naturally decreases with age
75. 2:59and once you start adding in the
76. 3:01medications that a lot of the elderly
77. 3:04are on
78. 3:05it could cause even further decrease in
79. 3:08the function of these
80. 3:10so you just have to kind of be aware of
81. 3:13you know
82. 3:14far some of the symptoms that you're
83. 3:16seeing
84. 3:17could they be caused from any kidney or
85. 3:20liver dysfunction
86. 3:23by no means does that mean you need to
87. 3:25memorize absolutely every medication
88. 3:28you just kind of have to know okay my
89. 3:30patient just like i said i saw my
90. 3:32patient on
91. 3:33trying to take 20 pills this morning i
92. 3:35was doing their adls the nurse brought
93. 3:36in 20 and you're like
94. 3:37oh my gosh what all are they on that
95. 3:41kind of might be a red flag to you
96. 3:43here are they on anything that could be
97. 3:45causing any
98. 3:47reactions that i might need to be aware
99. 3:49of well then the nurse will know
100. 3:51everything that they're on and can kind
101. 3:52of help you with that
102. 3:54and if they don't know you don't pull
103. 3:56the pharmacist in
104. 3:58but just being aware of if you see
105. 4:00somebody with multiple diagnoses
106. 4:03you're probably going to see multiple
107. 4:04medications
108. 4:06and with multiple communications you
109. 4:08might see multiple complications
110. 4:10so you just want to be aware of those
111. 4:12kinds of things
112. 4:15make sure you review table 13 1
113. 4:18and fable 13 2.
114. 4:21most of that should be a review from
115. 4:23farm class
116. 4:25so i just want you to think about
117. 4:28um what side effects that you will see
118. 4:32on 13 2 if you see any of those side
119. 4:36effects
120. 4:37what you might need to change in your
121. 4:39treatment session
122. 4:40you know what's going to if you see one
123. 4:43of those side effects from those
124. 4:44medications
125. 4:46does that matter for us you know some of
126. 4:48them it might
127. 4:49some of it's going to make a huge
128. 4:51difference in what we're going to do
129. 4:54so make sure you're aware of you know if
130. 4:57they
131. 4:57are on some kind of heart medication
132. 4:59that they cannot be overly stressed
133. 5:03okay that's going to play a big role in
134. 5:05what kind of treatment we provide for
135. 5:07them
136. 5:07so you're going to need to be aware of
137. 5:09that those are the types of medications
138. 5:11that we
139. 5:11really need to be making ourselves aware
140. 5:13of along with
141. 5:15do some of them make them really tired
142. 5:18you know the psychotropic meds are huge
143. 5:23for me
144. 5:24causing sleepiness well maybe that's why
145. 5:26my patient isn't cooperative you know
146. 5:27what time are they getting these
147. 5:29medications
148. 5:31that's what those are the kinds of meds
149. 5:32that i want you to look at when you're
150. 5:34looking at you know
151. 5:35oh my gosh do i need to know all of
152. 5:37these meds
153. 5:38no just you know kind of the more common
154. 5:41ones to the elderly population
155. 5:44as well as which ones would cause some
156. 5:47sort of
157. 5:48treatment change for me if i saw some of
158. 5:50those symptoms
159. 5:55and then another big thing this um
160. 5:58okay right now this is on the final this
161. 6:00part right here the compliance
162. 6:02is on the final there's two huge reasons
163. 6:06why uh um an elderly patient
164. 6:10will have non-compliance it's either
165. 6:12gonna be over adherence
166. 6:14or under adherence over adherence is
167. 6:18they're gonna take too much
168. 6:20they're going to take way more than they
169. 6:23needed
170. 6:26we will most likely find that with
171. 6:28somebody who's having some cognitive
172. 6:30deficits they're not going to remember
173. 6:32if they took their medication so they're
174. 6:34going to go ahead and take it anyway
175. 6:35well they might have just taken their
176. 6:37heart medication two hours ago and
177. 6:39they're taking it again because they
178. 6:40don't remember
179. 6:42that's going to cause huge problems okay
180. 6:44because
181. 6:45they're on their certain dose for a
182. 6:46reason
183. 6:48well then there's the opposite problem
184. 6:50of under adherence
185. 6:52could be that same dementia patient for
186. 6:56example or any cognitive deficits
187. 6:59since they don't remember if they took
188. 7:01them they won't take them at all
189. 7:02so they could go the entire day week
190. 7:05without taking any of their medications
191. 7:07that could be one reason the other
192. 7:10reason for under adherence
193. 7:12could be just the cost of medications
194. 7:15you know a lot of times
195. 7:17if the elderly population if they have
196. 7:19to choose between medication and food
197. 7:22or if they have five medications they
198. 7:24need to fill they need to figure out
199. 7:26which
200. 7:26three they can afford to get so
201. 7:30that could cause an under occurrence
202. 7:33and there i got my lights again i know
203. 7:35everybody loves to see my lights go out
204. 7:38so that can cause under adherence in
205. 7:42how well they're taking their
206. 7:43medications so we have to be aware of
207. 7:46that as well
208. 7:47and figuring out are they somebody are
209. 7:49they able to get all the medications
210. 7:51that they need
211. 7:56we've got some skills for being
212. 7:59independent with self medication
213. 8:01you need to have these skills in order
214. 8:04to be independent with your self
215. 8:05medication
216. 8:06okay your values links to behaviors
217. 8:10well you have to value that this
218. 8:12medication is going to work
219. 8:14if you don't think the medication's
220. 8:16going to work you're not going to take
221. 8:17it
222. 8:19you know there are people who don't
223. 8:21believe in western medicine
224. 8:23you know with taking a lot of
225. 8:24medications they would rather
226. 8:26do some alternative things
227. 8:29okay so they're not gonna be you know if
228. 8:32a doctor prescribes a specific
229. 8:33medication for them
230. 8:35they're not going to take it because
231. 8:37they don't value
232. 8:40you know the belief that goes along with
233. 8:42taking that medication
234. 8:45mental function or memory functions i'm
235. 8:48sorry under the mental functions
236. 8:49is memory you know long-term working
237. 8:52memory
238. 8:54they need to be able to have as long as
239. 8:56as well as short term
240. 8:58also to know whether they took the
241. 8:59medication or not
242. 9:03problem solving is huge
243. 9:06do they know what to do when they run
244. 9:08out of medication
245. 9:10do they know what to do if they look
246. 9:12down and realize they didn't take any
247. 9:15do they know how to you know
248. 9:18adjust if they took some in the morning
249. 9:23when is the next time they can take some
250. 9:25you know say for example
251. 9:26pain medication is every they can take
252. 9:28some every four to six hours
253. 9:31they know they took it at eight but at
254. 9:33ten o'clock in the morning they're still
255. 9:35in pain
256. 9:36they know that they can't take anymore
257. 9:40again or will they go ahead and take it
258. 9:42that's a problem okay so problem solving
259. 9:45is huge
260. 9:46it's also motivation do they want to
261. 9:50feel better do they see the value
262. 9:53it goes back to the values of taking
263. 9:55this medication
264. 9:57if they don't think it's going to do
265. 9:59them any good they're not going to take
266. 10:00it
267. 10:01i've seen several patients i don't know
268. 10:03why i'm taking that water pill i'm just
269. 10:05going to the bathroom
270. 10:06all the time i don't understand why i'm
271. 10:08taking it i don't want to take it
272. 10:09anymore so i'm not going to take it
273. 10:11okay they're not motivated they don't
274. 10:14see the benefit to taking it so they're
275. 10:15not going to
276. 10:17so that's huge sensory functions
277. 10:21and pain so think about all of those
278. 10:25visual perceptual deficits that we
279. 10:28talked about this semester
280. 10:29if any of those are impaired how is that
281. 10:33going to make
282. 10:36um taking your medication difficult
283. 10:39can they tell the difference between the
284. 10:41pills if i have a bunch of white
285. 10:42pills i have no idea which one's which
286. 10:46you know you hopefully they're at least
287. 10:49different colors and shapes and sizes
288. 10:51but you don't know
289. 10:52you know i took this white pill this
290. 10:54morning but i have another white pill i
291. 10:57have to take
292. 10:57later i can't tell the difference
293. 10:59between them
294. 11:02um even depth perception you know
295. 11:05if you set up a pill container which
296. 11:07will be great we'll talk about that in a
297. 11:08minute with adaptive
298. 11:10devices but can they feel to the bottom
299. 11:13to know they've gotten all the pills
300. 11:15or can do can they get all of them out
301. 11:18of the pill bottle
302. 11:21can they see the pills just to begin
303. 11:23with you know a lot of these pills are
304. 11:25so teeny tiny it's hard for
305. 11:27people with normal vision to be able to
306. 11:30see them
307. 11:33and then even hearing because if hearing
308. 11:35is that this might seem funny
309. 11:37why would somebody need hearing in order
310. 11:39to do self medication
311. 11:41well some of the things adapt the things
312. 11:44that you can do
313. 11:44is set alarms for somebody so they
314. 11:46remember oh that's right eight o'clock i
315. 11:48need to take my meds
316. 11:50okay well if they have hearing
317. 11:52difficulties alarms is not going to help
318. 11:55them
319. 11:56they might need a flashing red light
320. 11:58because they can't hear an alarm telling
321. 12:00eight o'clock time to take your
322. 12:01medication
323. 12:03so you need to be aware of what their
324. 12:06deficits are
325. 12:11along with that are now all their
326. 12:13neuromuscular skeletal
327. 12:15you know just think manual dexter
328. 12:18you know those child proof bottles are
329. 12:20not only child proof but they're usually
330. 12:22adult proof
331. 12:24so if you don't have the manual
332. 12:26dexterity and the strength to open those
333. 12:28pill bottles
334. 12:29imagine how frustrating is that's going
335. 12:32to be i you know i know i need to take
336. 12:34this medication
337. 12:36i can't get the pill bottles open or
338. 12:39i had a really nice nurse set up my pill
339. 12:42bottles or my
340. 12:43pill container for me but i can't lift
341. 12:45the lids
342. 12:47you know sometimes try and open those
343. 12:49plastic containers those those are still
344. 12:51a little harder
345. 12:52depending how they're set up
346. 12:55mobility can they get to the pharmacy to
347. 12:58get their prescriptions
348. 13:01you know that might be able to be fixed
349. 13:03like can they have their prescriptions
350. 13:05mail order
351. 13:06can the pharmacy deliver do they have
352. 13:09somebody that can go out to the pharmacy
353. 13:11for them to pick them up
354. 13:12but they need to be able to go get you
355. 13:14know get the medication to them
356. 13:21a couple weeks ago when we talked about
357. 13:23swallowing
358. 13:24is swallowing difficult you know how
359. 13:27many of you still have problems now
360. 13:29swallowing pills
361. 13:30you know is there a certain technique
362. 13:32that you've kind of figured out for
363. 13:33yourself
364. 13:35um my eight-year-old is just now
365. 13:36starting to figure out how to swallow
366. 13:38pills
367. 13:39we're usually still into the stick it in
368. 13:42some yogurt
369. 13:43or some applesauce
370. 13:46to kind of trigger that swallow for it
371. 13:48to go down
372. 13:50you'll also see that in a lot of the
373. 13:51nursing homes they've got a lot of
374. 13:53applesauce on their cart and i'll hear
375. 13:54my patients i'm
376. 13:56tired of applesauce that's the only way
377. 13:58they're getting their pills down
378. 14:02but knowing is that a problem is that
379. 14:04going to cause them to not want to take
380. 14:06some of their medication
381. 14:10one little thing to keep in mind too
382. 14:12just kind of on a side note it's not
383. 14:14always this
384. 14:15big pills that are the problems
385. 14:18um i've noticed some patients do really
386. 14:22well with large pills
387. 14:24whereas some do really well with small
388. 14:26pills
389. 14:28some patients will and it's always
390. 14:30amazed me that patient that had 20 pills
391. 14:33took them out of the cup from the nurse
392. 14:35packed them in their mouth and just took
393. 14:37a swig of water and swallowed them all
394. 14:38down i was in total off
395. 14:41then you've got the next patient who's
396. 14:43got 20 medications who has to take each
397. 14:45one
398. 14:46individually and it will never fail
399. 14:49that will be the person you're going to
400. 14:51get and they will not come down to
401. 14:53therapy
402. 14:53until they get every one of their pills
403. 14:56okay
404. 14:57figure out how to make that into a
405. 14:58therapy session it's gonna take him
406. 15:00probably 20 minutes to get all those
407. 15:02pills down
408. 15:04so you don't want to wait so how can we
409. 15:06figure out how to
410. 15:08make pill taking into therapy
411. 15:12communication
412. 15:14can they communicate their needs
413. 15:17think about the other thing to think
414. 15:19about this one kind of
415. 15:21medication what you know what needs do
416. 15:23they need to make no
417. 15:24well what if they're having any side
418. 15:26effects from their medications
419. 15:28you know if they're not able to make
420. 15:30their needs known
421. 15:31or things that are giving them problems
422. 15:35you know you might not know that they're
423. 15:38not sleeping at night
424. 15:40or you might not know that something's
425. 15:43causing them
426. 15:44busy cells or that they've been feeling
427. 15:47erasing
428. 15:48heart rate if they don't feel that they
429. 15:50can communicate very well
430. 15:52um with you or the nursing staff
431. 15:57there are more activity demands
432. 16:02to make sure that you look at in
433. 16:06this chapter it's um on page 176.
434. 16:10i'm trying to move around to keep the
435. 16:12lights going um
436. 16:14it's tables 13 3 and 13 4.
437. 16:18um it's just more activity demands and
438. 16:20then more kind of skills needed
439. 16:23um just kind of get your brains thinking
440. 16:25about oh my gosh i didn't realize they
441. 16:27would probably need that for some sort
442. 16:28of medication use
443. 16:34and then there's also um
444. 16:37a little questionnaire that you can kind
445. 16:39of ask your patient to kind of figure
446. 16:41out
447. 16:42where they might need some help it's at
448. 16:45the bottom of that page on 176
449. 16:48things like um tell me about all the
450. 16:50medications that you take
451. 16:53don't forget anything over the counter
452. 16:55you know
453. 16:56are they you know patients are known for
454. 16:59forgetting to tell you they take some
455. 17:00nyquil before they go to bed but they're
456. 17:02also taking a sleeping pill prescribed
457. 17:04by their doctor
458. 17:06okay that's when we're getting into the
459. 17:07over adherence because they're taking
460. 17:09too much but they don't even realize
461. 17:11they are
462. 17:13if they didn't tell their doctor all the
463. 17:15over-the-counters that they're taking
464. 17:19or describe your routine with taking
465. 17:22medications
466. 17:24if you can help them stick to their some
467. 17:27sort of normal routine
468. 17:28they're more likely to remember to take
469. 17:30them you know did you always take them
470. 17:33at you know eight o'clock in the morning
471. 17:34and eight o'clock at night
472. 17:36you know helping them stick to their
473. 17:38routine
474. 17:40because that'll be more oh it's nine
475. 17:42o'clock i didn't take my medication
476. 17:45okay so that's how you're just going to
477. 17:46get to know them a little better
478. 17:49so you can help them set up the plan
479. 17:52appropriately
480. 17:57here are some commercial aids that you
481. 17:59can use or these are assistive devices
482. 18:02this is just a small example
483. 18:06i want you to be able to go through and
484. 18:08kind of think of what would be an
485. 18:10advantage and a disadvantage
486. 18:13to each of these so you can think of it
487. 18:16like this
488. 18:16who would benefit most from just a
489. 18:19calendar
490. 18:20okay think of the type of person that
491. 18:22would really benefit from just a
492. 18:24calendar
493. 18:26who would benefit from a pill storage
494. 18:29container so that would be one of these
495. 18:32okay who's going to benefit from that
496. 18:36okay there are my lights again sorry
497. 18:38guys insulin holders
498. 18:41okay that's going to be the um those are
499. 18:44holders
500. 18:45for syringes for the insulin
501. 18:50pill splitters or pill crushers who
502. 18:53might need one of those
503. 18:55think about your performance skills what
504. 18:58would a person be lacking that a pill
505. 19:00splitter or a pill crusher
506. 19:02might help them with
507. 19:06and then any like the sensory alarms and
508. 19:09stuff so that could be like these an
509. 19:11alarm will go off
510. 19:13these will be they even have some that
511. 19:16are really really cool
512. 19:18that someone else will probably set up
513. 19:22because this is good for a dementia
514. 19:23patient
515. 19:24if they're to only take these
516. 19:26medications let's say eight
517. 19:28three and eight that will
518. 19:31only open up at eight o'clock in the
519. 19:34next section
520. 19:37like over here for example would not
521. 19:40unlock
522. 19:41until three o'clock so
523. 19:45they couldn't and i think um if i'm not
524. 19:49mistaken you can set like a lock on it
525. 19:51so
526. 19:52for example if they forgot to eight
527. 19:54o'clock
528. 19:55the three o'clock goes off they don't
529. 19:58take both the eight
530. 19:59and the three together so you kind of
531. 20:01set time periods when each section will
532. 20:03unlock so you can help make sure they're
533. 20:07only taking what they need at a certain
534. 20:09period of time
535. 20:10and then when you come to the next day
536. 20:12to set up the next day you can see
537. 20:14did they take everything that they were
538. 20:16supposed to
539. 20:18so they're coming up with a lot of
540. 20:20really cool different little gadgets to
541. 20:22help
542. 20:22with um medication stuff
543. 20:28even just keeping a medication diary
544. 20:30everything that you're
545. 20:31on how much
546. 20:34i have seen and i've i've always found
547. 20:37it funny but you know they're
548. 20:38frequent hospital visitors i've had a
549. 20:41couple patients who have their
550. 20:43prescriptions on a little laminated card
551. 20:47because they're afraid they're gonna
552. 20:48forget stuff because they're on
553. 20:50so much so they just have everything
554. 20:53that they're normally on
555. 20:54on this little laminated card that they
556. 20:56keep in their wallet so whenever they go
557. 20:58to the doctor's office or next to the
558. 21:00hospital or anybody that might need to
559. 21:02know all their meds
560. 21:04they can just hand that right over to
561. 21:06them it's
562. 21:07really nice and then or
563. 21:10i've had people that they'll um
564. 21:12photograph take pictures
565. 21:14of all their labels and kind of make a
566. 21:16printout so they have just the printout
567. 21:18here this is everything that i'm on
568. 21:25having special storage cups for them
569. 21:29there's actually a picture of a storage
570. 21:30cup on 177
571. 21:33with the little pill organizer it's just
572. 21:35little cups
573. 21:37those are really nice if you're going to
574. 21:40go out and about during the day
575. 21:42you can just put your you know maybe
576. 21:44your noon pills you're going to be
577. 21:46out so you just carry that little dosage
578. 21:49um with you but you want to make sure
579. 21:53that you know who those would be
580. 21:55beneficial for and who they wouldn't be
581. 22:00making sure when you're looking at the
582. 22:02whole program
583. 22:03if this is another one of those it's in
584. 22:06your treatment plan but you want to make
585. 22:07sure that you're
586. 22:09you know it's a whole team approach it's
587. 22:11not just
588. 22:13you know are all the doctors looking at
589. 22:15everything have the pharmacist looked at
590. 22:16everything
591. 22:18you know have you made nursing aware of
592. 22:20any
593. 22:21um side effects that you've been seeing
594. 22:24you know you know what this medic i've
595. 22:27been seeing this medications causing
596. 22:29something funny with my patient they're
597. 22:31you know seem to be a little more sleepy
598. 22:32and confused is something going on
599. 22:36you know knowing
600. 22:39can they operate all the adaptive
601. 22:42equipment
602. 22:44you know if you're going to suggest an
603. 22:46insulin holder for your patient
604. 22:49is nursing helping you with help with
605. 22:54the patient learning how to use it
606. 22:55correctly
607. 22:56you know so you kind of have to work
608. 22:58together on how to set all that up
609. 23:07now what i want you to do is there's a
610. 23:08small case study
611. 23:10on page 179
612. 23:15it's just about i think it's a little
613. 23:17lady
614. 23:19i'm not mistaken yes pat and her husband
615. 23:22and it kind of lists their medications
616. 23:26and i want you to answer um
617. 23:29questions one and two and five and six
618. 23:33these are kind of some things that might
619. 23:34get phrased
620. 23:36how they might be on the final so make
621. 23:40sure
622. 23:40that you have kind of answered those
623. 23:43questions
624. 23:45and i'm gonna we're gonna pause right
625. 23:47here and switch to incontinence and i'm
626. 23:49going to
627. 23:50flick the lights so hopefully they will
628. 23:52start cooperating
629. 24:00okay i'm back and hopefully our lights
630. 24:02will stay in with
631. 24:04us we got this little section here on
632. 24:07incontinence this section is from
633. 24:11chapter 17
634. 24:13in the elders book
635. 24:18so that kind of talk about what is the
636. 24:20etiology behind
637. 24:21incontinence it can either be caused
638. 24:24from some sort of pathology you know an
639. 24:28illness um something has gone wrong in
640. 24:31the anatomy
641. 24:33um portion with the bladder or the
642. 24:36urethra
643. 24:38any of your pelvic floor muscles if
644. 24:40something's happened
645. 24:42or it can be actually excited there can
646. 24:44be a psychological reason
647. 24:46that it is going on most
648. 24:50of the causes are reversible so
649. 24:53things like if they're caused by uti
650. 24:56urinary tract infection
651. 24:58or some other infections once that is
652. 25:01cleared up
653. 25:02then then the continence will be better
654. 25:07certain medications will cause
655. 25:09incontinence
656. 25:11so back to what we're just talking about
657. 25:13with medications
658. 25:14if your patient is suddenly complaining
659. 25:16of you know having some incontinent
660. 25:19issues they don't know why they would
661. 25:20you know usually didn't have
662. 25:22trouble making it to the bathroom you
663. 25:24might need to go back and look at their
664. 25:26medications there might be something
665. 25:28going on
666. 25:30that's causing them to go more
667. 25:32frequently
668. 25:34um so the doctor needs to be made aware
669. 25:36of any of those
670. 25:37changes that might be made it could also
671. 25:40be
672. 25:40some medical conditions like some
673. 25:43diabetes
674. 25:44congestive heart failure um some venous
675. 25:48insufficiency
676. 25:49that will be causing our patients to go
677. 25:52to the bathroom more they've got
678. 25:53more fluid that they need to get rid of
679. 25:56so because of that increase in fluid
680. 25:58that the body's trying to get rid of
681. 26:01they're going to have to go to the
682. 26:02bathroom more well if
683. 26:05you know you know that urge you know
684. 26:06when you're younger you can usually hold
685. 26:08it a heck of a lot longer you know maybe
686. 26:09you can go all day without going to the
687. 26:11bathroom
688. 26:12guess what the older you get you can't
689. 26:15hold it as well anymore
690. 26:16so if you're constantly going to the
691. 26:18bathroom
692. 26:20if you have any other physical deficits
693. 26:23that
694. 26:23make it difficult for you to get around
695. 26:26imagine now how difficult it is to get
696. 26:28to the bathroom every
697. 26:30you know every 20 30 minutes you know
698. 26:33because of some medical issue that's
699. 26:35making you go
700. 26:35to pee all the time you have to look at
701. 26:38this whole thing so your patients
702. 26:40understand
703. 26:42okay your body's got all this extra
704. 26:43fluid to get rid of
705. 26:45so you're gonna have to be going to the
706. 26:47bathroom or what can we do about it
707. 26:53there are five different types of
708. 26:56incontinence
709. 26:58this is on the final i want you to
710. 27:00understand the
711. 27:01differences
712. 27:04earned or urgency
713. 27:07is that involuntary leakage with sudden
714. 27:10urgency
715. 27:11so this is where the and you can sit
716. 27:14there and laugh and imagine to yourself
717. 27:17but you've held it all day but you know
718. 27:19and okay
719. 27:20it's time i have to go and as soon as
720. 27:22you get into the bathroom you're doing
721. 27:23everything you can
722. 27:26to not pee your pants okay you've got
723. 27:28that sudden urgency to go but because
724. 27:30you've held it for so long
725. 27:32some of it starts to come out okay you
726. 27:34can in your head secretly admit that
727. 27:36that's probably happened to you once or
728. 27:37twice because you've avoided going and
729. 27:39then you just couldn't help it anymore
730. 27:42okay well imagine once you've gotten
731. 27:45older
732. 27:46in this cause it happens more often
733. 27:49there's that in there's that little bit
734. 27:50of leakage when all of a sudden you've
735. 27:52got to go
736. 27:55the next one is probably more common and
737. 27:58i mean
738. 27:59you know though women will laugh because
739. 28:01this is you know
740. 28:02older women who've had kids it's that
741. 28:04stress
742. 28:05incontinence that's an incontinence that
743. 28:08happens when you laugh
744. 28:10cough sneeze you know especially if you
745. 28:14know i've heard you know if you've had a
746. 28:15big belly
747. 28:16laugh and you just feel like oh my gosh
748. 28:17i just want my pants from laughing
749. 28:19that's stress incontinence that's a
750. 28:22difference from
751. 28:22urgency okay urgency is
752. 28:26you really needed to go and because you
753. 28:29couldn't
754. 28:30hold it anymore some of it leaked out
755. 28:33versus stress think about what happens
756. 28:36when you cough
757. 28:37you kind of especially if you had a big
758. 28:39cough
759. 28:41you know your whole body kind of tends
760. 28:43to get into that cough
761. 28:44and everything will contract and that
762. 28:46kind
763. 28:47to make some of the urine come out okay
764. 28:50so that's more of a stress that there
765. 28:52was an outside stretch like the cough
766. 28:54the laughing the sneezing
767. 28:57then there's overflow
768. 29:01this will happen um
769. 29:05your patients will complain that they've
770. 29:07constantly got this dribbling
771. 29:09you know but there's always this little
772. 29:11wetness that they're feeling
773. 29:14well that's happening because the
774. 29:15bladder never fully emptied out
775. 29:19so your patient might have felt that
776. 29:20they emptied out their bladder
777. 29:22but for some reason it didn't totally
778. 29:25empty out so it's just kind of slowly
779. 29:27dribbling out
780. 29:30and then there's a mix where there's the
781. 29:33combination between
782. 29:34urge and stress that's probably the
783. 29:38pretty common one that i saw
784. 29:41because urge there would be that leakage
785. 29:45because the muscle the pelvic floor
786. 29:48muscles weren't strong enough anymore
787. 29:51to hold it and then they would cough and
788. 29:54sneeze or something on top of it and
789. 29:56then
790. 29:57they would you know the whole bladder
791. 29:59would just empty out
792. 30:01because their pelvic floor muscles
793. 30:03weren't strong enough to hold it in
794. 30:04anymore
795. 30:07so those are the four main ones
796. 30:10those are the four that can be
797. 30:13we can really help those as far as
798. 30:16um make better um functional
799. 30:19incontinence
800. 30:21will happen with people who have
801. 30:22decreased cognitive function
802. 30:25so these will be the people they don't
803. 30:28remember that they have to go
804. 30:31as strange as that sounds
805. 30:34these will be those patients who may be
806. 30:37towards the end if they're
807. 30:39considered like a dementia patient who's
808. 30:41just wandering up and down the halls up
809. 30:43and down the halls
810. 30:44and they seem very agitated and confused
811. 30:47well they're not realizing that they
812. 30:49have to go to the bathroom but that's
813. 30:51what's making they're having this
814. 30:52urgency if something's wrong something's
815. 30:54wrong but i don't remember what it is
816. 30:56anymore
817. 30:58you know so they you know there's been a
818. 31:01lot
819. 31:01you know do you need to go to the
820. 31:02bathroom or just guide them to the
821. 31:04bathroom and then that could help ease
822. 31:06some of the anxiety
823. 31:09but it's because they don't have the
824. 31:10cognitive ability
825. 31:12to know what they need to do to go to
826. 31:15the bathroom
827. 31:18and then there is also fecal
828. 31:20incontinence which
829. 31:22that comes just from problems in the gi
830. 31:24tract and the colon
831. 31:27and no it's not necessarily pleasant to
832. 31:29deal with
833. 31:31but imagine it's even less pleasant for
834. 31:34your patients
835. 31:35you know so imagine how embarrassed they
836. 31:37are you know
837. 31:38i don't want to say that you know
838. 31:40urinary incontinence isn't embarrassing
839. 31:42but since it's a little more
840. 31:43common you can kind of be a little more
841. 31:46discreet about it especially with all of
842. 31:48the products that they have out on the
843. 31:50market to kind of make it a little more
844. 31:52discreet that you're having problems
845. 31:56you can't hide people incontinence so
846. 31:59there's no way around it you know if
847. 32:01that happens
848. 32:02everybody's gonna know so imagine how
849. 32:04embarrassed
850. 32:05your patient is um and i've had several
851. 32:09patients you know if we've had colostomy
852. 32:11bags
853. 32:12they are so embarrassed and mortified if
854. 32:15you have to help them clean it up
855. 32:16because they
856. 32:17feel bad they know it's not a pleasant
857. 32:19thing to do
858. 32:21so you need to kind of hide that from
859. 32:24them
860. 32:24as much as possible and how
861. 32:26uncomfortable you feel because that's
862. 32:28just going to compound the problem
863. 32:30so just kind of take a look at it a
864. 32:32little bit this isn't any more pleasant
865. 32:34for them than it is for me
866. 32:39and then what are some of the strategies
867. 32:41we can do well you
868. 32:42there are medications out that can help
869. 32:45with the incontinence
870. 32:47there are things like dietary changes
871. 32:50like no caffeine
872. 32:51after you know two o'clock this caffeine
873. 32:55will
874. 32:55stimulate the bladder so making some of
875. 32:58those kind of
876. 32:59changes you know if you know maybe no
877. 33:02liquids at all
878. 33:03after dinner you know so you're not
879. 33:06having any incontinence issues at night
880. 33:10so making those kind of adjustments can
881. 33:12be huge
882. 33:13um to someone bow and bladder program
883. 33:17this is what you'll hear set up
884. 33:19especially at the nursing home
885. 33:20they want just about everybody on a
886. 33:22bowel and bladder program
887. 33:24what that is is pretty much setting up a
888. 33:26schedule you know so
889. 33:28it's pretty much probably about every
890. 33:29two hours seems to be the general
891. 33:31consensus
892. 33:33um you know getting the patient to go
893. 33:35every two hours
894. 33:36you know kind of gets them on some sort
895. 33:38of schedule kind of gets their body into
896. 33:40some predictability
897. 33:42it might not need to be two hours maybe
898. 33:45it needs to be
899. 33:46before and after every meal some sort of
900. 33:49schedule like that whatever is going to
901. 33:51work for your patient
902. 33:54um speech will work with
903. 33:57can the patient make their needs known
904. 34:00okay if this patient is just wandering
905. 34:01up and down the halls and nobody has any
906. 34:03idea why
907. 34:05it's going to be hard to be able to keep
908. 34:07them continent
909. 34:09if nobody knows that they need to go to
910. 34:10the bathroom so speech can be huge with
911. 34:13the communication
912. 34:15pt can work with can they ambulate and
913. 34:19make the transfers into the bathroom
914. 34:21okay can they get on and off the toilet
915. 34:24well guess what that's also us
916. 34:26too can they transfer on and off the
917. 34:27toilet
918. 34:29so a lot of times ot will be called in
919. 34:31too because they see toileting
920. 34:34adl ot which is fine because we can
921. 34:37address the transfers just as well as pt
922. 34:39can't
923. 34:40but you might get pt to come in and work
924. 34:42on the ambulation if they have a
925. 34:44distance to walk to get to the bathroom
926. 34:47then we're going to look at the clothing
927. 34:50management and hygiene
928. 34:51and they pull their pants up and down
929. 34:53can they clean themselves
930. 34:56after voiding can they
931. 35:00if they've had an incontinent episode
932. 35:03change their products this was something
933. 35:07that became huge you know i had a
934. 35:09patient they could pull their pants up
935. 35:10and down
936. 35:11they could get to the bathroom that was
937. 35:12fine
938. 35:14but what would happen was they couldn't
939. 35:16always get there on time
940. 35:18so as we were working on
941. 35:21say this last one doing pelvic floor
942. 35:23exercises
943. 35:25while we were working on getting them
944. 35:27stronger they were still having those
945. 35:28incontinent episodes
946. 35:31but once they got there they didn't know
947. 35:33how to change their products so they
948. 35:35didn't know how to change the pads
949. 35:37they couldn't do all the lower body
950. 35:40dressing to take their pants all the way
951. 35:42off
952. 35:43put a new depends on and put brand new
953. 35:45pants on
954. 35:46so you have to look at the whole thing
955. 35:48just because they can get there and pull
956. 35:50their pants up and it down
957. 35:52isn't all of it entirely do they know
958. 35:54what to do
959. 35:55if they have an accident
960. 35:58and then both pt and ot can do pelvic
961. 36:01floor exercises
962. 36:03i actually got to do um
963. 36:07a couple of the nursing homes that i
964. 36:08worked with
965. 36:10um and since it's been a couple years i
966. 36:12can't remember the program
967. 36:14um but some of you might think they have
968. 36:16the e-stem the ultrasound is one company
969. 36:19that does it all
970. 36:20um they have a specific incontinence
971. 36:23program that there's certain exercises
972. 36:25to follow
973. 36:26if you're talking about the kegel
974. 36:27exercises but there's certain exercises
975. 36:30to do to strengthen the pelvic floor
976. 36:34so our patients are able to hold it so
977. 36:36they can get there
978. 36:38because imagine if it's going you know
979. 36:39if they're having any mobility issues
980. 36:42it's going to take them twice as long to
981. 36:43get to the bathroom so you have to think
982. 36:46they almost have to have those muscles
983. 36:47twice as strong so they can make it
984. 36:49there
985. 36:51or getting our patients trained with
986. 36:54some kind of
987. 36:54program to know okay don't wait till
988. 36:58it's urgent
989. 36:59you know you can't wait till just the
990. 37:02last second like you used to
991. 37:0320 years ago you know you've got to plan
992. 37:06ahead
993. 37:08get going you know so it's not
994. 37:11urgent because the other thing that will
995. 37:13happen
996. 37:15and this is typically when
997. 37:18um ot would get called in as there would
998. 37:20be false and we would try to figure out
999. 37:22why did somebody fall
1000. 37:23they fell trying to get to the bathroom
1001. 37:26well why were they trying to get to the
1002. 37:27bathroom so quick
1003. 37:29well they were having incontinence
1004. 37:31issues and they felt earth they had to
1005. 37:32go right now so they got up and probably
1006. 37:34started walking without their walker
1007. 37:36because they were in such a hurry and
1008. 37:37then fell
1009. 37:39okay so trying to catch some of these
1010. 37:41things beforehand
1011. 37:44so our patients don't fall
1012. 37:52these are some environmental adaptations
1013. 37:55i just have
1014. 37:56a couple of pictures um
1015. 37:59but on 247 and your book has got a list
1016. 38:03of several others
1017. 38:04so things just like having a well-lit um
1018. 38:07having some night lights so the lighting
1019. 38:09is
1020. 38:10adequate or adequate overhead lighting
1021. 38:15do they need ground bars in the toilet
1022. 38:16so they can get on and off
1023. 38:18appropriately do we need bedside commons
1024. 38:22at night
1025. 38:23so they don't have to you know wake up
1026. 38:27um try to get to the bathroom when they
1027. 38:30were just in some sort of deep sleep
1028. 38:32they just have a close bedside commode
1029. 38:35but there's a lot of other adaptations
1030. 38:38that are in the book that i want you to
1031. 38:39look at
1032. 38:42and then thinking about clothing
1033. 38:44management you know this one's a really
1034. 38:46good example you know
1035. 38:48think about when you really have to go
1036. 38:50that's the one time where the button on
1037. 38:51your jeans will not come
1038. 38:53undone you know so let's think can we
1039. 38:56get rid of as many of those problem
1040. 38:59areas as possible
1041. 39:00so can we make their pants velcro so
1042. 39:02they would be easy off easy on
1043. 39:05okay or giving them the elastic
1044. 39:08waistband so we don't have zippers and
1045. 39:10buttons to have to mess with
1046. 39:12you know anything that would be easy on
1047. 39:14easy off up down
1048. 39:16there you know you decrease the
1049. 39:17complexity of that you know
1050. 39:19because think if you're standing that
1051. 39:20you're trying to you know undo that
1052. 39:22zipper
1053. 39:22and concentrate on holding your bladder
1054. 39:25at the same time
1055. 39:26it's usually not going to happen
1056. 39:32so yes here's a little more homework
1057. 39:34it's not bad
1058. 39:36there's another little case study
1059. 39:39and i gave just specific questions that
1060. 39:42i want you to go back and answer so i
1061. 39:43want you to answer one
1062. 39:45three four six and seven
1063. 39:49again those are type of questions that
1064. 39:51you might be asked on the final
1065. 39:54so i want you to start okay let's go
1066. 39:55back and look those up see
1067. 39:57you know make sure you understand all
1068. 39:58the different types of incontinence and
1069. 40:00things that ot
1070. 40:01can do to help
1071. 40:13you