Incontinence and the individual with AD

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webinar presented October 2007

webinar presented October 2007

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  • 1. INCONTINENCE AND THE INDIVIDUAL WITH ALZEIMER’S DISEASE Featuring: Terri Decker, RN, CWOCN, Deborah H. Perkins M.S., APRN, BC, GNP and moderated by Ayn Welleford, PhD WEBINAR Nov 19, 2007
  • 2. PROBLEM SCOPE INCONTINENCE FECAL URINARY
  • 3. URINARY INCONTINENCE - PREVALENCE
  • 4. URINARY and FECAL INCONTINENCE STATISTICS
  • 5. BLADDER CONTROL SYSTEM Source: The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) - http://kidney.niddk.nih.gov/kudiseases/pubs/bodydesign_ez/index.htm
  • 6. DIGESTIVE SYSTEM Source: The The National Digestive Diseases Information Clearinghouse (NDDIC) - http://digestive.niddk.nih.gov/ddiseases/pubs/yrdd/ Anatomy of the rectum and anus
  • 7. TYPES OF URINARY INCONTINENCE
    • STRESS
      • Leakage of small amounts of urine during physical movements such as coughing, laughing, sneezing.
    • URGE
      • Leakage of large amounts of urine unexpectedly; associated with strong urge to void.
    • MIXED
      • Combination of Stress and Urge Incontinence
    • OVERFLOW
      • Unexpected leakage of small amounts of urine because of a full bladder; due to blockage or ineffective bladder contraction.
  • 8. TYPES OF URINARY INCONTINENCE
    • Functional
      • Untimely urination because of:
        • Physical disability
        • External obstacles
        • Problems in thinking or communicating
  • 9. TRANSIENT CAUSES OF INCONTINENCE
      • Transient Urinary Incontinence :
        • Bladder Infections
        • Medications
        • Constipation
        • Urethritis, Vaginitis
        • Dietary Irritants
      • Transient Bowel Incontinence:
        • Fecal Impaction
        • Dietary Irritants
        • Bacterial/Viral Infections
        • Medications
  • 10. TYPES OF URINARY INCONTINENCE Source: National Institute of Diabetes and Digestive and Kidney Diseases , NATIONAL INSTITUTES OF HEALTH STRESS TRANSIENT URGE OVERFLOW FUNCTIONAL MIXED OVERACTIVE BLADDER Types of Urinary Incontinence
  • 11. Alzheimer’s Disease and INCONTINENCE CHECK WITH HEALTHCARE PROVIDER TO RULE OUT TRANSIENT PROBLEMS Bladder infection Fecal impaction USE BOWEL AND BLADDER DIARY HOUSE TIPS: Use picture of toilet on bathroom door Good lighting in the hallway and bathroom Use of bedside commode or urinal APPROACH Matter-of-Fact Attitude Sense of Humor Assist with changing garments from behind Avoid Constipation Helps guide prompting to toilet based on person’s habits Toileting Schedule Ease of Use Clothing Stay Calm
  • 12. ABSORBENT INCONTINENCE PRODUCTS
    • When absorbent incontinence products become necessary, use of bladder control pads or pull-on style briefs is usually better (in terms of tolerance) than the tape-tab style briefs.
    • There is a wide range of absorbency levels within the bladder pad and pull-on categories and newer technology allows for moisture to be pulled into the disposable product keeping the skin drier.
    • There are also reusable, cloth underwear products which can be well-tolerated as they closely resemble regular underwear.
    • For persons confined to bed, those with heavy urine loss, or bowel incontinence, the tape tab style brief or “adult-diaper” is the most absorbent product designed for these situations. Heavy night-time wetness is also best contained by the higher absorbent tape tab style briefs.
    • Disposable as well as cloth chair and bed pads are also very useful for the home situation. For example, the washable cloth bed pads can be used to help lift or turn a bedridden person more safely and easily.
    Images courtesy of Attends Healthcare
    • Tape-Tab style Brief 
    • Heavy Incontinence
    • Frequently Incontinent of bladder and/or bowel movements
    • Large amount of urine loss/ night-time use
    • Immobile or Bed-Bound individual
    • Protective Underwear or
    • Adult Style Pull-On
    • Moderate Incontinence
    • Moderate amount of urine loss (more than a leak, less than a full void)
    • Attempts to get to the bathroom, by self or with assistance
    • Usually every 2-3 hours
    • Mentally alert or may have mild confusion at times
    • Bladder Control Pads
    • Male Guards
    • Belted Undergarments
    • Light Urinary Incontinence
    • Occasional leaks of urine--may occur with laugh, cough, or sneeze.
    • Mentally alert, able to communicate
    Best product options are: If your situation is:
  • 13. SKIN CARE
    • Care of the skin after an incontinent episode is important since moisture, ammonia from the urine, as well as enzymes from the stool can all affect the skin and contribute to rashes, skin breakdown, and other complications.
    • Mild, pH-balanced skin cleansers are designed to gently cleanse the skin. Protective barrier products are also useful to protect the skin and prevent skin breakdown.
    • High quality absorbent incontinence products are also effective in preserving skin integrity as they effectively wick away wetness to help reduce trauma to the skin.
  • 14. HELP AND RESOURCES
    • Contact healthcare provider
    • Reading materials on urinary incontinence: http://www.niapublications.org/agepages/urinary.asp
    • Reading materials on fecal incontinence: http://digestive.niddk.nih.gov/ddiseases/pubs/fecalincontinence/index.htm
    • Contact the Alzheimer’s Association in your area http://www.alz.org/apps/findus.asp?SearchState=VA&SearchByState=Search&FormSent=1#SearchStart
    • Medical Suppliers such as Home Care Delivered (800-565-5644 or www.homecaredelivered.com ) offering an extensive line of quality, name-brand medical supplies delivered to the home.