...DULOXETINE VS PLACEBO FOR URINARY INCONTINENCE DULOXETINE VS PLACEBO FOR URINARY INCONTINENCE TAMMY RILEY OKLAHOMA PANHANDLE STATE UNIVERSITY STRESS INCONTINENCE Stress urinary incontinence is the involuntary leakage of urine on effort or exertion or on sneezing, coughing, or laughing. These symptoms affect many women between the ages of 33-75 years of age. The current treatment options for stress incontinence is limited to pelvic floor muscle training, devices, behavioral interventions and surgery . EVIDENCE BASED PRACTICE GUIDELINES The title of the guideline is Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guidelines. The guideline was developed as a framework for diagnosis and treatment of non-neurogenic overactive bladder (OAB) and to provide direction to clinicians and patients regarding how to recognize non neurogenic overactive bladder. The direction of the study was to “conduct a valid diagnostic process and approach treatment with the goals of maximizing symptom control and patient quality of life while minimizing adverse events and patient burden” (National Guideline Clearinghouse, 2014). Another guideline objective was to serve as a guide for all types of providers who evaluate and treat OAB patients, including those in general practice as well as those who specialize in various branches of medicine. The guideline of the evidence based practice states that the first line of treatment...
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...Urinary tract infections are common infections prevalent in bole males and females around the world. I am going to explain to you what an urinary tract infection (UTI) is, how it relates to the Helene Feld School of Nursing (HFSON) Conceptual Framework, nursing roles that relate to urinary tract infections, a care plan for urinary tract infection and evidence-based practice related to urinary tract infections. The urinary tract is composed of: two kidneys, two ureters, a bladder, a prostate (in men only) and an urethra; therefore an UTI is an infection of any of the foregoing organs, ducts and/or gland. Urinary tract infections vary depending on the location in the urinary tract and can be caused by a variety of mechanisms. The various factors...
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...An APIC Guide 2008 Guide to the Elimination of Catheter-Associated Urinary Tract Infections (CAUTIs) Developing and Applying Facility-Based Prevention Interventions in Acute and Long-Term Care Settings About APIC APIC’s mission is to improve health and patient safety by reducing risks of infection and other adverse outcomes. The Association’s more than 12,000 members have primary responsibility for infection prevention, control and hospital epidemiology in healthcare settings around the globe. APIC’s members are nurses, epidemiologists, physicians, microbiologists, clinical pathologists, laboratory technologists and public health professionals. APIC advances its mission through education, research, consultation, collaboration, public policy, practice guidance and credentialing. Look for other topics in APIC’s Elimination Guide Series, including: • • • • Catheter-Related Bloodstream Infections Clostridium difficile Mediastinitis MRSA in Long-Term Care Copyright © 2008 by APIC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission of the publisher. All inquires about this document or other APIC products and services may be addressed to: APIC Headquarters 1275 K Street, NW Suite 1000 Washington, DC 20005 Phone: 202.789.1890 Email: APICinfo@apic.org Web: www.apic.org ISBN: 1-933013-39-7 ...
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...Urinary Tract Infection in the Geriatric Population Elizabeth Shultz Abstract The geriatric population is very vulnerable to Urinary Tract Infection (UTI) and its negative consequences. If left untreated, UTI in the elderly patient can have negative consequences such as delirium or even death. UTI can also contribute to the onset of acute or chronic kidney infections, which could permanently damage the kidneys and result in renal failure. In view of this, the purpose of this paper is to review related literature to find current evidence or best practices related to UTI in the geriatric population and to objectively critique the evidence. CINAHL and MEDLINE computer databases were mainly searched from January, 2005 to January, 2015 using a combination of manual and computer-based methods. Keywords: elderly, urinary tract, elderly infection management, urinary tract infection prevention, elderly and UTI. Introduction By convention, a Urinary tract infection (UTI) is defined either as a lower tract (acute cystitis) or upper tract (acute pyelonephritis) infection (Nicolle, 2014). Urinary tract infection (UTI) is the most common infectious problem among older adults both in the community and institutional settings (Midthun, Paur, Bruce, & Midthun, 2005). The elderly population is most likely to experience UTI due to many reasons, not the least of which is their overall susceptibility to all infections...
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...Concept Paper 1 Concept Paper Atypical Presentation of Illness in Older Adults 2 An atypical presentation of an illness in an older adult can appear as a subtle, nonspecific, or unusual manifestation that is outside the normal range of signs and symptoms for a specific illness. Nursing care of an older adult requires a through assessment of acute, chronic or complex illnesses. Illness in older adults is complicated by numerous medical problems and the physical changes of aging. Identification of an illness can be overlooked simply because symptoms might be reported vaguely. Multiple overlapping factors such as environmental, sociologic, physiologic and psychologic aspects need to be considered in the nursing assessment. It’s essential that nurses recognize atypical presentations of illness in older adults early to help improve patient care. Early detection can reduce the risk of missed diagnoses, death and/or prolonged hospitalization, and reduce rates of co-morbidity from treatable geriatric syndromes (GrayMiceli, 2007). Aging causes physiologic changes to the body. These normal age related changes could be similar to changes seen in the presence of pathological conditions. This causes a problem when normal changes mask early signs of an acute illness. Changes to the musculoskeletal system can affect a patient’s ability to function. Reduced bone mineral density leads to osteoporosis and an increased risk for fall-related fractures (Ebersole, Hess, Touhy,...
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...Enuresis is a disorder known as bed-wetting. The Bed-wetting is a problem of elimination that indicates the voluntary or involuntary impulse of urine into bedding, clothing or other improper locations. In the other hand, in adults can occur these problems known as loss of bladder control that sometimes happen as urinary incontinence rather than Enuresis. People who have Alzheimer's disease and dementia are normally linked with this diseases. In childhood, the most abundant aspects with psychosocial problems has been Enuresis disorders. Many researches have shown an absence of union about explanations and terminology. Aspects such as age, frequency and duration of wetting episodes have been the most important point revealed by Psychiatric classification systems. During the day, Enuresis disorder and Daytime wetting are considered as Biopsychosocial problems with signals for Pathophysiologic and commonly are related with Psychiatric/psychological problems. The loss of confidence and self-esteem are important...
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...NURSING CARE PLAN COURSE: Basic Adult Health CLIENT INITIALS: DATE OF ADMISSION: AGE: GENDER: JL June 13, 2011 85 M HT: WT: ALLERGIES: 140 lbs. NKA CODE STATUS: FULL RACE/ETHNICITY: CULTURAL CONSIDERATIONS: Caucasian None RELIGION/SPIRITUAL CONSIDERATIONS: Unknown OCCUPATION/HOBBIES/RECREATIONAL ACTIVITIES: Retired LIVING SITUATION/WITH WHOM: (home, assisted living, LTC, etc) Lives with daughter. SOCIAL HISTORY: (tobacco, ETOH, illicit drugs, family dynamics) Quit smoking many years ago, no history of ETOH or drug use. NURSING CARE PLAN ADMITTING MEDICAL DIAGNOSIS: Client's principal admitting diagnosis was leukocytosis. Definition: (from Taber’s) “An increase in the number of leukocytes (usually above 10,000/mm3) in the blood. It occurs most commonly in disease processes involving infection, inflammation, trauma, or stress, but it also can result from the use of some medications” (Venes, 2009, p. 1327). Etiology/pathophysiology: ( NOT from Taber’s or Wikipedia) Etiology: Causes of leukocytosis are infection, inflammation, tissue damage, immune reaction, bone marrow problems, medications, and stress (Drug Information Online, 2011). Pathophysiology: “Leukocytosis can be a reaction to various infectious, inflammatory, and, in certain instances, physiologic processes (eg, stress, exercise). This reaction is mediated by several molecules, which are released or regulated in response to stimulatory events that include growth or survival factors (eg, granulocyte...
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...The n e w e ng l a n d j o u r na l of m e dic i n e Clinical Practice Caren G. Solomon, M.D., M.P.H., Editor Urinary Tract Infections in Older Men Anthony J. Schaeffer, M.D., and Lindsay E. Nicolle, M.D. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors’ clinical recommendations. From the Feinberg School of Medicine, Northwestern University, Chicago (A.J.S.); and the University of Manitoba, Winnipeg, Canada (L.E.N.). Address reprint requests to Dr. Schaeffer at the Feinberg School of Medicine, Northwestern University, 303 E. Chicago Ave., Tarry Bldg. 16-703, Chicago, IL 60611, or at jschaeffer@ a northwestern.edu. N Engl J Med 2016;374:562-71. DOI: 10.1056/NEJMcp1503950 Copyright © 2016 Massachusetts Medical Society. An audio version of this article is available at NEJM.org 562 A 79-year-old community-dwelling man presents with urinary frequency, dysuria, and fever. Culture reveals extended-spectrum beta-lactamase Escherichia coli. He had a similar infection several months ago, with the same organism isolated, and he had a response to nitrofurantoin treatment. How would you further evaluate and manage this case? U The Cl inic a l Probl em rinary tract infection in men without indwelling catheters is uncommon among men younger...
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...Assessment task 2- Scenario 2 Urinary tract infection is one of the most common infections diagnosed among women in the world. There has been increasing concern for alternative method to treat urinary tract infection over antibiotics since misuse of antibiotics can led to bacterial resistance(Scholes et al., 2004). This essay will establish PICO (population, intervention, comparison and outcome) question in the given scenario where a 22 year old Susan visits the GP with symptoms of urinary frequency, dysuria, lower back pain and shivering. She was diagnosed with Urinary tract infection (hereby referred as UTI) and antibiotics were prescribed. However after developing thrush due to antibiotics for urinary tract infection previously, she is reluctant to take antibiotics. On surfing the internet she read about cranberry juice being used to treat UTI and is considering to stop her antibiotics. PICO question development In order to provide the right pathway to commence our research and ensuring that every questions are suitable and relevant, PICO model will be used which is Population, Intervention, Comparison and Outcome(Bronson and Davis, 2011). In the given scenario, population would be women suffering from UTI. Similarly intervention is using cranberry juice to prevent UTI and comparison is to use antibiotics. Richardson et al., 2014 mentioned that the outcome would analyze the effectiveness of the intervention. Therefore the outcome would be effectiveness of cranberry...
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...pregnancy ------------------------------------------------- Urinary tract infection (UTI) incorporates a range of conditions including acute pyelonephritis or kidney infection. It is almost invariably caused by bacteria (Brown et al 2005, Le 2004). The incidence of this disease in pregnancy has decreased in recent years (Dawkins et al 2012), possibly due to improved antenatal care. However, it remains one of the most common complications in pregnancy (Hill et al 2005) affecting 1-2% of pregnant women (Dawkins et al 2012, Hill et al 2005, McCormick 2008). Acute Pylonephritis is the most serious urinary tract infection in pregnancy (Le 2004, McCormick et al 2008) and successful treatment usually requires hospital admission (Jolly and Wing 2010). It is most often seen in nullparous and younger women and there appears to be a link with lower socioeconomic status, diabetes and sickle cell disease, although not with ethnicity (Hill et al 2005, Jolley et al 2012). It is more common in the 2nd and 3rd trimester (Archabald et al 2009, Hazhir 2007, Hill et al 2005) as the presence of urinary pathogens seems to increase as pregnancy advances (Hill et al 2005). There does appear to be an association between repeated urinary tract infections and sexual activity (Bernard et al 2011, Pfau and Sacks 1992). If not effectively treated, acute pyelonephritis may have serious consequences for both the mother and fetus. Urinary tract infections in pregnancy may lead to septic shock, anaemia...
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...Health History and Screening of an Adolescent or Young Adult Client Save this form on your computer as a Microsoft Word document. You can expand or shrink each area as you need to include the relevant data for your client. Student Name: Leigh Hinson | Date: 10/19/2015 | Biographical Data | Patient/Client Initials: ECN | Phone No: 910-654-1107 | Address: 6893 Princess Ann Rd. Evergreen NC 28438 | Birth Date:7-20-1999 | Age: 16 | Sex:F | Birthplace: Whiteville, NC | Marital Status:Single | Race/Ethnic Origin: White | Occupation: Cashier | Employer: Food Lion | Financial Status: (Income adequate for lifestyle and/or health concerns. Is there a source of health insurance? Employment disability?) She is a full time high school student. She works a part time job as a cashier at a local Food Lion. Her parents and grandparents help her financially. She receives health insurance from her parents. | Source and Reliability of Informant: Patient is very reliable and dependable. | Past Use of Health Care System and Health Seeking Behaviors: None | Present Health or History of Present Illness: Constipation | Past Health History | General Health: (Patient’s own words)Patient states she is in overall good health. | Allergies: (include food and medication allergies) Strawberries | Reaction: Hives | Current Medications:None | Last Exam Date: 4/2015 | Immunizations: All immunizations are up to date. | Childhood...
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...The purpose of this paper is to perform a holistic assessment of the older adult using the SPICES tool. What is SPICES? The acronym SPICES stands for Sleeping disorder, Problems with eating and feeding, Incontinence, Confusion, Evidence of falls, and Skin breakdown (Fulmer & Wallace, n.d.). Each area of the tool is important to assess in order to address problems and develop interventions or solutions to the problems to ultimately provide quality patient care. Sleep is important not only for promoting healing, but also for the overall well-being of the individual. When there are problems with the sleeping pattern, it impacts the overall health and safety of the older adult. The person will not have enough rest and too tired to perform...
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...Health History and Screening of an Adolescent or Young Adult Client Save this form on your computer as a Microsoft Word document. You can expand or shrink each area as you need to include the relevant data for your client. Student Name: Shannon landrum | Date:04/08/16 | Biographical Data | Patient/Client Initials:VPL | Phone No:270-543-8411 | Address:1645 Fairview road Bremen key | Birth Date:02/16/06 | Age:16 | Sex:female | Birthplace: Greenville, KY | Marital Status: single | Race/Ethnic Origin: Caucasian | Occupation: student | Employer: none | Financial Status: (Income adequate for lifestyle and/or health concerns. Is there a source of health insurance? Employment disability?)Does not work, father provides insurance | Source and Reliability of Informant:parents | Past Use of Health Care System and Health Seeking Behaviors:Frequent checkups at primary physician | Present Health or History of Present Illness:tonsillitis | Past Health History | General Health: (Patient’s own words)Over all good health with frequent sore throats | Allergies: (include food and medication allergies) NKDA | Reaction: | Current Medications:Oral birth controlAmoxicillin BID x 7 days r/t tonsillitis | Last Exam Date:03/21/16 | Immunizations:Up to date, had at 15 | Childhood Illnesses: tonsillitis | Serious or Chronic Illnesses:Had RSV at age 13 months, reoccurring tonsillitis...
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...1 NUR 201 DRUG CARD Student: ________________________ Generic Name: Bupropion hydrobromide________ Trade Name(s): Wellbutrin, Aplenzin, Zyban_ Classification: Antidepressant – atypical (heterocyclic), Aminoketone_____________________________ Administration Routes: PO _√_ SQ ___ IM ___ IV ___ Transdermal ____ Ophth_____ Action: Mechanism of action is not known; the drug does not inhibit MAO, and it only weakly blocks neuronal uptake of epinephrine, serotonin, and dopamine. However, its action is believed to be mediated by noradrenergic and/or dopaminergic mechanisms. Exerts moderate anticholinergic and sedative effects, but only slight orthostatic hypotension. Indications: (1) Treatment of major depressive disorder (immediate-release and extended-release). (2) Major depressive episodes in those with a history of seasonal affective disorder (Wellbutrin XL only). (3) Aid to stop smoking (Zyban only); may be combined with a nicotine transdermal system. Contraindications: Hypersensitivity to bupropion or any ingredients. Seizure disorders; presence or history of bulimia or anorexia nervosa due to the higher incidence of seizures in such clients. Concomitant use of an MAOI. Use in clients undergoing abrupt discontinuation of alcohol and sedatives, including benzodiazepines. Use in clients who have shown an allergic response to bupropion or other components of the various products. Wellbutrin, Wellbutrin SR, Wellbutrin XL, and Zyban all contain bupropion; do not use together. Lactation...
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...Health History and Screening of an Adolescent or Young Adult Client Save this form on your computer as a Microsoft Word document. You can expand or shrink each area as you need to include the relevant data for your client. Student Name: Date: Biographical Data Patient/Client Initials: C. M Phone No: Address: Birth Date: Age: 15 Sex: Female Birthplace: Marital Status: Single Race/Ethnic Origin: White Occupation: Student Employer: N/A Financial Status: (Income adequate for lifestyle and/or health concerns. Is there a source of health insurance? Employment disability?) Income is adequate for life style, patient is a High School Student at the current time, and lives at home with parents, there is a concern regarding her health, regarding asthma, bronchitis at this time. Patient is unemployed, but is covered under parents insurance BCBS. Source and Reliability of Informant: Patient is a poor historian, but patients mother is present at the time and is a good historian for patient. Past Use of Health Care System and Health Seeking Behaviors: There is a previous use of Health Care System for hospitilation, mother states that the patient does not usually have any health seeking behaviors. Present Health or History of Present Illness: Patient during the past 3 days has developed a progressive cough with mild production of green phlegm, and nasal congestion, that has not been relieve with OTC medication...
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