NCMB 314 - M2-Cu10

BACHELOR OF SCIENCE IN NURSING
NCMB 314 CARE OF THE OLDER ADULT

COURSE MODULE COURSE UNIT WEEK
2 10 11
GENITOURINARY SYSTEM AND SEX AMONG ELDERLY
✔ Read course and unit objectives

✔ Read study guide prior to class attendance
✔ Read required learning resources; refer to unit
terminologies for jargons
✔ Proactively participate in online discussions
✔ Participate in weekly discussion board (Canvas)
✔ Answer and submit course unit tasks
At the end of the course unit (CU), learners will be able to:
Cognitive:
1. Describe age-related changes that affect urinary elimination.

2. List measures that promote urinary system health.
3. Outline factors to consider in assessing the urinary system.
Affective:
1. Listen attentively during class discussions
2. Demonstrate tact and respect when challenging other people’s opinions and
ideas
3. Accept comments and reactions of classmates on one’s opinions openly and
graciously.
Psychomotor:
1. Participate actively during class discussions and group activities
2. Express opinion and thoughts in front of the class
Mauk, Kristen. (2010). Gerontological nursing: competencies for care.MA: Jones & Bartlett
Publishers.610.7365 G31 2010
Eliopoulos (2018). Gerontological Nursing 9th Edition.Wolters Kluwer
GENITOURINARY SYSTEM
Urinary Structural Changes with Age
- Kidneys – shrink in length and weight
o The number of glumeruli decreases (30-40% at 90 years old)
o Changes in blood flow and GFR
- Bladder – decreases in size and develops fibrous matter in the bladder
wall.
- Urethra
o Thins with age.
o Male: Prostate Gland enlargement and sphincter elevates from the
prostate encompassing the urethra.
o Female: extends 3-4 cm
- Urination
o The amount of urine expelled from the body decreases with age.
- Homeostasis changes
- Hormone changes
o Plasma renin and aldosterone concentration level gradually declines
with age.
I. BPH (BENIGN PROSTATIC HYPERPLASIA (or HYPERTROPHY)

- Also known as Prostatism.
- Associated with advanced age.
Signs and Symptoms:

- Decreased Urinary stream.
- Urinary Frequency
- Urinary Urgency
- Nocturia
- Urinary Incontinence
- Incomplete Bladder emptying
- Urinary Dribbling
- Feelings of urge to void but difficulty starting urine stream
- Decreased quality of life related to symptoms
- Altered sleep patterns related to nocturia
Diagnosis:
- Urinalysis
- postvoiding residual
- Prostate specific antigen
- urodynamic studies
- ultrasound
- cystoscopy
Treatment:
- Medical Treatment
o Alpha blockers – relaxing the smooth muscle of the Prostate and
bladder neck.
 doxasozin (Cardura), terasozin (Hytrin BPH) and Tamsulosin
(Flomax MR)
o 5-alpha-reductase-inhibitors – shrinks the prostate but may cause
impotence.
 Finasteride (Proscar)
- Surgical Intervention
o Transurethral Resection of the Prostate – “Rotor Rooter” Procedure.
 Nursing Care after TURP:
 Watch out for bleeding.
 Maintain Continuous Bladder Irigation (CBI)
 Assess the color of the urine, the number and size of
clots, amount of urine
II. PROSTATE CANCER

- Second leading cause of cancer in males.
- Incidence increases with age.
Risk Factors:
- Advanced age
- Diet high in saturated fats
- family history
- race/ethinicity
Signs and Symptoms:
- Maybe Asymptomatic
- Urinary Urgency
- Nocturia
- painful ejaculation
- blood in the urine or semen.
- pain or stiffness in the back of thighs
Diagnosis:
- Digital rectal exam
- PSA
o Age 60-69 years old: less than 4 ng/ml
o Age 70-79 years old: 7ng/ml
o Above 10 ng/ml : diagnosis for Prostate Cancer
- Confirmatory test: Biopsy
Treatment:
- depends on the stage of cancer growth.
- Options:
1. Radical Prostatectomy
2. Radiation therapy
3. Surveillance
- Holistic approach
- Nursing care:
o helping families to explore the options
o Linking to community resources
o Providing education
III. Urinary Incontinence

- Involuntary leakage of urine
- Associated with aging, being female and sequela to bearing children.
Forms of Urinary Incontinence:
1. Stress Incontinence
2. Urge Incontinence
3. Mixed Incontinence
4. Overflow Incontinence
5. Functional Incontinence
6. Gross total Incontinence
Prevalence:
- Affects men and women in all health care settings.
- It is not a normal consequence of aging.
Implications of UI
- Impact on Physical and Psychosocial Functioning:
o Anxiety and depression
o Social relationship
o risk factors for development of skin breakdown
- Economic Impact
- Alteration with one’s perception to self.
Assessment:
- Categories of Urinary Incontinence according to onset and Etiology.
1. Transient (Acute) Incontinence
- Lists of common transient cause of UI and reversible factors “DIAPPERS”
o Delirium/Dementia
o Infection agents
o Endocrine disease
o Restricted mobility
o Stool impaction
2. Established (Chronic) Incontinence
- Comprises of:
o Stress Incontinence – involuntary loss of urine during activities that
increase intra-abdominal pressure.
o Urge Incontinence – strong, abrupt desire to void and inability to
inhibit leakage in time to reach a toilet.
 Stroke and multiple sclerosis, infection or ingestion of bladder
irritants (caffeine)
 Reflex Incontinence – variation of Urge Incontinence
o Mixed Incontinence – existence of symptoms of urge and stress
incontinence at the same time.
COMPONENTS OF A BASIC EVALUATION FOR URINARY INCONTINENCE

I. History
- Focused Medical, Neurologic and genitourinary history
- Assessment of risk factors
- Review of Medications
- Detailed exploration of the symptoms of incontinence
II. Physical Examination
- General Examination
- Abdominal Examination
- Rectal Examination
- Pelvic Examination in women
- Genital Examination in men
III. Postvoided residual volume
IV. Urinalysis
Goals of Treatment of UI
- Control of voiding that occurs on various levels extending from loss of
control (Incontinence) to independent continence.
- Social Continence – continence cannot be achieved but urine leakage is

contained to maintain dignity and comfort.
- Partial Continence – caregiver’s assistance is helpful in achieving

continence.
Interventions/ Strategies of Care

I. Behavioral Therapy – modification of the patient’s behavior or
environment.
- First line of treatment.
a. Managing Hydration
- Focuses on maintaining fluid balance.
- Maintaining Bowel regularity
b. Prompted Voiding
- Monitoring
- Prompting
- Praising
c. Bladder Training – program of education, scheduled voiding, and
reinforcement to provide patients with the skills to improve the
ability to control urgency, decrease frequency and incontinent
episodes and prolong the interval between voiding.
d. Pelvic Muscle Relaxation (Pelvic Muscle Rehabilitation)
- Increases the strength, tone and control of the pelvic floor muscles
to facilitate a person’s ability to voluntarily control the flow of urine
and suppress the urgency.
e. Biofeedback
f. Pelvic Floor Electrical Stimulus – application of electric current to
sacral and pudendal afferent.
II. Pharmacological Management
- Alpha Agonists Pseudoephedrine – acts at the bladder neck,
increasing urethral tone and decreases leakage
- Duloxetine – serotonin and norepinephrine reuptake inhibitor.
- Estrogen – to treat urogenital atrophy
- Drugs for BPH
o Alpha Antagonists (Doxazosin) – relax the urinary sphincters.
o 5 – α reductase inhibitors (Finesteride and dutasteride)
III. Devices and Products
- Choice of protective undergarments
- Meticulous skin care
- Indwelling urinary catheter
● Functional incontinence – loss of voluntary control of urine due to disabilities that

prevent independent toileting, sedation, inaccessible bathroom, medication that impair
cognition, or any other factor interfering with the ability to reach a bathroom
● Nocturia – voiding at least once during the night
● Stress incontinence – involuntary loss of urine when pressure is placed on the pelvic
floor (e.g. from laughing, sneezing, or coughing)
● Urinary incontinence – involuntary loss of urine
Watch and Learn:
https://www.youtube.com/watch?v=bsqMk42pPe8
https://www.nia.nih.gov/health/bladder-health-older-adults
1. What are the components of a basic evaluation for urinary incontinence?

2. Factors that may lead to urinary incontinence.
3. Explain different forms of urinary incontinence.
4. What are the different strategies/ interventions of care with urinary incontinence?
Textbooks:
Mauk, Kristen. (2010). Gerontological nursing: competencies for care.MA: Jones & Bartlett
Publishers.610.7365 G31 2010
Eliopoulos (2018). Gerontological Nursing 9 th Edition.Wolters Kluwer
Meiner (2019). Gerontologic Nursing 6th Edition. ELS
Miller (2019).Nursing for Wellness in Older Adults 8th Edition . Wolters Kluwer
Touhy ( 2018). Ebersole and Hess Gerontological Nursing and Health Aging
Filit (2017). Brocklehurts Testbook of Geriatric Medicine and Gerontology
Patińo, Mary Jane. (2016). Caregiving volume 1. Manila: Rex Book Store. F 649.1 P27
2016,v.1, c1
Doenges, Marylinn E. (2002). Nursing care plans: guidelines for individualizing patient care,
6th ed. Philadelphia: F. A. Davis Company. R 610.73 D67 2002, c5
Meiner, S. E. (2007). Gerontological Nursing 3rd Edition. Quezon City. pp. 310-311, 371.
Wold, Gloria Hoffman. (2012). Basic geriatric nursing, 5th ed. MO: Elsevier.618.970231
W83 2012, c1
Websites:
www.ebscohost.com
www.doh.gov.ph

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BACHELOR OF SCIENCE IN NURSING

NCMB 314 CARE OF THE OLDER ADULT

✔ Read course and unit objectives

1. Describe age-related changes that affect urinary elimination.

I. BPH (BENIGN PROSTATIC HYPERPLASIA (or HYPERTROPHY)

Signs and Symptoms:

II. PROSTATE CANCER

III. Urinary Incontinence

COMPONENTS OF A BASIC EVALUATION FOR URINARY INCONTINENCE

- Social Continence – continence cannot be achieved but urine leakage is

- Partial Continence – caregiver’s assistance is helpful in achieving

Interventions/ Strategies of Care

● Functional incontinence – loss of voluntary control of urine due to disabilities that

Watch and Learn:

1. What are the components of a basic evaluation for urinary incontinence?

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