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同学们好
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
-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
--【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
-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
-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
-Concept Map
--【Concept Map】Elderly Health Assessment(1)
--【Concept Map】Elderly Health Assessment(2)
-【Test】CHAPTER 2
-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
--【Documentary Recommendation】Depression:Out of the Shadows
-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
-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
-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
-5.4 Prevention of Adverse Drug Reactions in the Elderly
--Prevention of Adverse Drug Reactions in the Elderly
-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
-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
-6.3 Urinary Incontinence in the Elderly
--Urinary Incontinence in the Elderly
-6.4 Constipation in the Elderly
-6.5 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
-6.9 Elderly Delirium
-6.10 Elderly Frailty
--【Literature Recommendation】Frailty in elderly people/Frailty in older people
-6.11 Pneumonia in the Elderly
-6.12 Hypertension in the Elderly
--【Literature Recommendation】2018 Chinese Guidelines for Prevention and Treatment of Hypertension
-6.13 Stroke in the Elderly
-6.14 Stable Angina in the Elderly
--Stable Angina in the Elderly
-Concept Map
--【Concept Map】Nursing Care for the Elderly with Common Health Problems and Diseases
-【Test】CHAPTER 6
-7.1 Concept of Hospice Care
--【Website Recommendation】 Definition of Palliative Care,WHO
-7.2 Death Education
--【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
-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