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Urinary Incontinence in the Elderly课程教案、知识点、字幕

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今天我们来讲尿失禁的护理

尿失禁是指由于膀胱括约肌的损伤

或神经功能障碍

而丧失排尿自控的能力

使尿液不受主观控制

而自尿道口溢出或流出的状态

尿失禁是老年人中最为常见的健康问题

不同性别 种族的尿失禁发生率

都随着年龄的增加而增高

国内一项多区域调查表明

中国女性尿失禁发病率为30.9%

中国的男性尿失禁发病率为3%~10%

到2050年

中国60岁及以上的老年人口将达到4.3亿左右

护理评估

一 健康史

一 一般资料

收集尿失禁患者的年龄 性别

家庭结构 社会参与 饮酒等基本信息

二 尿失禁的原因

一 中枢神经系统疾患

如脑卒中

脊髓病变等引起的神经源性膀胱

二 手术创伤

如前列腺切除术 膀胱手术

可损伤膀胱及其括约肌的

运动或感觉神经

三 尿潴留

如前列腺增生等引起

四 不稳定性的膀胱

如膀胱肿瘤 结石

炎症 异物等均可引起

五 妇女绝经期后

雌激素缺乏引起尿道壁

和盆底肌肉张力减退

引起的一个尿失禁

六 分娩损伤

子宫脱垂 膀胱膨出等

引起的括约肌功能减弱

七 药物作用

利尿药 抗胆碱能药

抗抑郁药等均可引起

八 心理问题

焦虑 抑郁也可以引起尿失禁

九 其他

有无粪便嵌顿

以及活动异常等

二 尿失禁的状况

一 排尿时是否伴发其他症状

如尿急 尿频

日间排尿大于7次

夜尿 突然出现的排尿急迫感等

二 是否有诱发尿失禁的原因如咳嗽

打喷嚏等

三 尿失禁发生的时间

失禁时流出的尿量

及其失禁时有无尿意等

三辅助检查

一 尿常规 尿培养及其生化检查

二 测定残余尿量

三 尿动力学检查

膀胱内压测定

尿流量测定

尿流压测定

尿道功能测定 肌电图

四 膀胱尿道镜检查

五 尿垫试验

六 排尿记录

四 心理社会状况

尿失禁对大多数老年人的生命

无直接影响

但是它所造成的身体异味

尿路反复感染及其皮肤溃烂等

均可导致老年人发生孤僻

抑郁等心理问题

尿失禁的类型

压力性的尿失禁

急迫性的尿失禁

混合性的尿失禁

三种尿失禁的类型

护理诊断与问题

一 压力性尿失禁

与老年退行性变化

手术 肥胖等原因有关

二 急迫性尿失禁

与老年退行性变化 创伤 腹部手术

留置导尿管 液体摄入过多

尿道感染 神经源性病变等有关

三 反射性尿失禁

与老年退行性变化

脊髓损伤

肿瘤等引起的输出障碍有关

四 社会交往障碍

与尿频 异味引起的不适

担心等有关

五 知识缺乏

缺乏尿失禁治疗

护理及预防等有关

六 与皮肤完整性受损的危险

与尿液刺激会阴部皮肤

辅助用具使用不当有关

尿失禁治疗与护理的总目标

一患者日常需求得到满足

二 行为异常与药物治疗有效

患者信心增强

能正确使用外引流和护垫

做到饮食控制及规律的康复锻炼等

三 患者接受现状

积极配合治疗护理

恢复参与社交交往

一 尿失禁护理用具的选择与护理

失禁护垫 纸尿裤

是最为普遍且安全的方法

可以有效处理尿失禁的问题

二 高级透气接尿器

适用于老弱病残 骨折

瘫痪及卧床不起

不能自理的患者

三 避孕套式接尿袋

优点是不影响患者翻身和外出

四 保鲜膜袋的接尿法

五 一次性导尿管及其密闭性的引流袋

适用的人群

烦躁不安尿潴留的患者

二 协助行为治疗

行为治疗包括生活方式干预

盆底肌肉训练 膀胱训练

生活方式的训练包括几个 合理膳食

减轻体重 戒烟 规律运动等

盆底肌肉训练可分为站立

坐位 仰卧位进行训练

膀胱训练

具体步骤

一 让患者在白天每小时

饮水量150-200ml左右

并记录饮水量以及饮入时间

二 根据患者平常的排尿间隔

鼓励患者在急迫性尿意感发生之前

进行如厕排尿

三 如能自行控制排尿

2小时内没发生尿失禁现象

可将排尿间隔延长到30分钟

直到将排尿间隔逐渐延长到3-4小时

三 用药护理

指导老年人遵医嘱正确用药

详细具体地讲解药物的作用

及其注意事项

并告知患者不要依赖药物

而要配合功能锻炼的重要性

四 手术护理

手术方法不断更新

根据患者具体情况选择不同手术方法

对需要手术治疗的患者

做好相应的术前 术后护理

术后康复指导

五 心理调适

一 从患者的角度思考和处理问题

建立互信的护患关系

二 注意患者的感受

进行尿失禁护理操作时

应用屏风等遮挡保护患者的隐私

三 尊重患者的保密意愿

先征求老年人同意后

才可以就其健康问题

与其家属或照顾者交谈

四 向患者及家属讲解

尿失禁问题的处理

六 健康指导

指导患者及其照护者

及时更换尿失禁护理用具

注意会阴部清洁卫生

每日用温水擦洗

保持会阴部的皮肤清洁干燥

二 饮水

保持每日摄入的液体量

在2000-2500ml之间

适当调整饮水时间和量

睡前限制饮水

以减少夜尿

避免摄入有利尿作用的咖啡

浓茶 可乐 酒等饮料

三 饮食与大便管理

告诉患者宜均衡饮食

保证足量热量和蛋白质供应

摄取足够的纤维素

必要时用药物或者灌肠

等方法保持大便通畅

四 康复活动

鼓励老年人坚持做

盆底肌肉训练与膀胱训练

健身操等适当活动

减少肌肉松弛

促进尿失禁的康复

五 其他指导

老年人的卧室尽量安排在

靠近厕所的位置

夜间应有适宜的照明灯

老年护理学(Gerontological Nursing)课程列表:

CHAPTER 1: General Introduction to Geronological Nursing

-1.1 Human Life Expectancy and Age Classification of the Elderly

--Human Life Expectancy and Age Classification of the Elderly

--【Vedio Recommendation】 How do we measure life expectancy ?

-1.2 Population Aging

--Population Aging

--【Literature Recommendation】World Report on Ageing and Health: 2015

-1.3 Influence and Countermeasures of Population Aging

--Influence and Countermeasures of Population Aging

--【Literature Recommendation】World Population Ageing Highlights:2019

-1.4 Goals and Principles of Elderly Care

--Goals and Principles of Elderly Care

--【Book Recommendation】Evidence-Based Geriatric Nursing Protocols for Best Practice

-1.5 Theories Related to Elderly Care

--1.5.1 Personality Development Theory and Life Review

--1.5.2 Disengagement Theory and Activity Theory

--1.5.3 Self-efficacy and Chronic Disease Management

--【Vedio Recommendation】8 Stages of Development by Erik Erikson

--【Literature Recommendation】Activity Theory, Disengagement Theory, and Successful Aging

--【Book Recommendation】Self-Efficacy in Changing Societies

--【Literature Recommendation】Obstacles and Policies of the Social Capital Participates in the Combination of Medical Care and Pension: A Literature Review

-1.6 Elderly Support and Elderly Care

--1.6.1 Concepts of Elderly Healthcare, Elderly Support and Elderly Care

--1.6.2 Home-based Elderly Care Model

--1.6.3 Institutional Elderly Care Model

--1.6.4 Integrated Medical and Nursing Care Model

--【Vedio Recommendation】Day in the Life of Home Care

--【Website Recommendation】Official Website of the National Institutes of Health

-Concept Map

--【Concept Map】General Introduction to Geronological Nursing

-【Test】CHAPTER 1

-【Case Discussion】CHAPTER 1

CHAPTER 2: Elderly Health Assessment

-2.1 Aging Changes in the Elderly

--2.1.1 Aging of the Respiratory System

--2.1.2 Aging of the Cardiovascular System

--2.1.3 Aging of the Digestive System

--2.1.4 Aging of the Urinary System

--2.1.5 Aging of the Endocrine System

--2.1.6 Aging of the Motor System

--2.1.7 Aging of the Nervous System

--2.1.8 Aging of the Sensory System

--【Literature Recommendation】Exercise Attenuates the Major Hallmarks of Aging

--【Book Recommendation】Hazzard's Geriatric Medicine and Gerontology

-2.2 Comprehensive Health Assessment of the Elderly

--Comprehensive Health Assessment of the Elderly

--【Literature Recommendation】Instruments to evaluate mental well-being in old age: a systematic review

-2.3 Principles of Elderly Health Assessment

--Principles of Elderly Health Assessment

-2.4 Assessment of the Functional Status of the Elderly

--Assessment of the Functional Status of the Elderly

--【Literature Recommendation】The Lawton Instrumental Activities of Daily Living (IADL) Scale

-2.5 Assessment of Cognitive Function in the Elderly

--Assessment of Cognitive Function in the Elderly

-2.6 Assessment and Adjustment of the Living Environment for the Elderly

--Assessment and Adjustment of the Living Environment for the Elderly

--【Literature Recommendation】Age-friendliness of living environments from the older person’s viewpoint: development of the Age-friendly Environment Assessment Tool

-Concept Map

--【Concept Map】Elderly Health Assessment(1)

--【Concept Map】Elderly Health Assessment(2)

-【Test】CHAPTER 2

-【Case Discussion】CHAPTER 2

CHAPTER3: Elderly Mental Health and Mental Health care

-3.1 Overview of the Psychological Characteristics of the Elderly

--Overview of the Psychological Characteristics of the Elderly

-3.2 Influencing Factors of Psychological Changes in the Elderly

--Influencing Factors of Psychological Changes in the Elderly

-3.3 Common Psychological Issues and Their Management in the Elderly

--3.3.1 Common Psychological Issues and Their Management in the Elderly (1)

--3.3.2 Common Psychological Issues and Their Management in the Elderly (2)

--【Book Recommendation】Development Through the Lifespan

-3.4 Depression in the Elderly

--3.4.1 Overview of Depression in the Elderly

--3.4.2 Clinical Symptoms of Depression in the Elderly

--3.4.3 Caring for Elderly Patients with Depression

--【Website Recommendation】

--【Documentary Recommendation】Depression:Out of the Shadows

--【Literature Recommendation】Management of depression in older adults:A review depression in older people

-3.5 Elderly Patients with Dementia

--3.5.1 Identification of Dementia Symptoms in the Elderly

--3.5.2 Intelligence Rehabilitation of Elderly Patients with Dementia

--3.5.3 Safety Care of Elderly Patients with Dementia

--【Website Recommendation】The Global Voice on Demaentia

-Concept Map

--【Concept Map】Elderly Mental Health and Mental Health Care

-【Test】CHAPTER 3

-【Case Discussion】CHAPTER 3

CHAPTER4: Elderly Daily Care

-4.1 Precautions for Daily Care of the Elderly

--Precautions for Daily Care of the Elderly

-4.2 General Care of Elderly Skin

--4.2.1 Characteristics and General Care of Elderly Skin

--4.2.2 Skin Itching and Its Management in the Elderly

--【Website Recommendation】American Academy of Dermatology

-4.3 Clothing Hygiene for the Elderly

--Clothing Hygiene for the Elderly

--【Literature Recommendation】The Design Methods of Functional Clothing for the Elderly

-4.4 Dietary Care for the Elderly

--4.4.1 Nutritional Needs of the Elderly and Influencing Factors of these Needs

--4.4.2 Dietary Care for the Elderly

--【Book Recommendation】Nutrition Care of the Older Adult: a Handbook for Dietetics

--【Website Recommendation】Nutrition for older persons

-4.5 Sleep Guidance for the Elderly

--4.5.1 Sleep Characteristics of the Elderly

--4.5.2 Sleep Guidance for the Elderly

--【Book Recommendation】An Occupational Therapist's Guide to Sleep and Sleep Problems

--【Website Recommendation】American Academy of Sleep Medicine

-4.6 Exercises Guidance for the Elderly

--4.6.1 Evaluation of Exercise Intensity in the Elderly

--4.6.2 Precautions Elderly Undertaking Exercises

--【Website Recommendation】American College of Sport Medicine

--【Book Recommendation】Handbook of Activities for the Elderly

-Concept Map

--【Concept Map】Elderly Daily Care

-【Test】CHAPTER 4

-【Case Discussion】CHAPTER 4

CHAPTER5:Medication Safety and Care for the Elderly

-5.1 Characteristics of Drug Metabolism and Pharmacodynamics in the Elderly

--Characteristics of Drug Metabolism and Pharmacodynamics in the Elderly

--【Website Recommendation】How Drugs Work In the Elderly

-5.2 Common Adverse Drug Reactions and Their Causes in the Elderly

--Common Adverse Drug Reactions and Their Causes in the Elderly

-5.3 The Principles of the Use of Medications in the Elderly

--The Principles of the Use of Medications in the Elderly

--【Literature Recommendation】The American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

-5.4 Prevention of Adverse Drug Reactions in the Elderly

--Prevention of Adverse Drug Reactions in the Elderly

--【Literature Recommendation】Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies

-5.5 Medication Compliance in the Elderly

--Medication Compliance in the Elderly

-Concept Map

--【Concept Map】Medication Safety and Care for the Elderly

-【Test】CHAPTER 5

-【Case Discussion】CHAPTER 5

CHAPTER6:Nursing Care for the Elderly with Common Health Problems and Diseases

-6.1 Falls in the Elderly

--6.1.1 Epidemiological Characteristics of Elderly Falls

--6.1.2 Risk Factors for Falls in the Elderly

--6.1.3 Prevention of Falls in the Elderly

--【Website Recommendation】CDC STEADI(Stopping Elderly Accidents, Deaths & Injuries Tool Kit)

-6.2 Dysphagia in the Elderly

--Dysphagia in the Elderly

-6.3 Urinary Incontinence in the Elderly

--Urinary Incontinence in the Elderly

-6.4 Constipation in the Elderly

--Constipation in the Elderly

--【Literature Recommendation】Chronic Constipation in the Elderly Patient: Updates in Evaluation and Management

-6.5 Dry Mouth in the Elderly

--Dry Mouth in the Elderly

--【Website Recommendation】Academy of Nutrition and Dietetics

-6.6 Elderly Nutritional Deficiencies

--Elderly Nutritional Deficiencies - emaciation

-6.7 Visual Impairment in the Elderly

--Visual Impairment in the Elderly

--【Website Recommendation】Senior Eye Exams

-6.8 Senile Deafness

--Senile Deafness

-6.9 Elderly Delirium

--Elderly Delirium

-6.10 Elderly Frailty

--Elderly Frailty

--【Literature Recommendation】Frailty in elderly people/Frailty in older people

-6.11 Pneumonia in the Elderly

--Pneumonia in the Elderly

-6.12 Hypertension in the Elderly

--Hypertension in the Elderly

--【Literature Recommendation】2018 Chinese Guidelines for Prevention and Treatment of Hypertension

-6.13 Stroke in the Elderly

--Stroke in the Elderly

-6.14 Stable Angina in the Elderly

--Stable Angina in the Elderly

--【Literature Recommendation】2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes

-Concept Map

--【Concept Map】Nursing Care for the Elderly with Common Health Problems and Diseases

-【Test】CHAPTER 6

-【Case Discussion】CHAPTER 6

CHAPTER7 Hospice Care for the Elderly

-7.1 Concept of Hospice Care

--Concept of Hospice Care

--【Website Recommendation】 Definition of Palliative Care,WHO

-7.2 Death Education

--7.2.1 Death Education (1)

--7.2.2 Death Education (2)

--【Book Recommendation】The Meaning of Death by Herman Feife

-7.3 Nursing for Pain in the Dying Elderly

--Nursing for Pain in the Dying Elderly

--【Journal Recommendation】

-7.4 Nursing for Major Bleeding in the Dying Elderly

--Nursing for Major Bleeding in the Dying Elderly

-7.5 Nursing for Delirium in the Dying Elderly

--Nursing for Delirium in the Dying Elderly

-7.6 Nursing for Dyspnea in the Dying Elderly

--Nursing for Dyspnea in the Dying Elderly

--【Website Recommendation】The Hospice and Palliative Nurses Association,HPNA

-7.7 Psychological Problems and Nursing in the Dying Elderly

--Psychological Problems and Nursing in the Dying Elderly

--【Book Recommendation】On Death and Dying ,by Elisabeth Kübler-Ross

-7.8 Grief Counseling for the Widowed Elderly

--Grief Counseling for the Widowed Elderly

--【Book Recommendation】I Wasn't Ready to Say Goodbye,by Noel·Brook,Blair·Pamela

-Concept Map

--【Concept Map】Hospice Care for the Elderly

-【Test】CHAPTER 7

-【Case Discussion】CHAPTER 7

Urinary Incontinence in the Elderly笔记与讨论

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