The first 11 pages are the completed study guide from a previous class. 

Pages 11 through 13 are the NR 601 course final exam review topics in outline form (Thanks Lisa Trevino!). Page 13-46 

includes my notes from class and YouTube videos, Kennedy-Malone text (minimal), lessons, and some external 

research. When the information came from an external article, I included a link so that you do not use it as a test 

resource. Hopefully this is helpful for us as both a test and boards review. I kinda sorta (but not really because I’m over

it) apologize for any typos.

How to conduct Mini-Cog- 

 The Mini-Cog has been demonstrated to have comparable psychometric properties to the MMSE 

 The primary advantage of the Mini-Cog is that it is shorter than the MMSE and measures executive function. 

 It is composed of a three-item recall and the Clock Drawing Test (CDT) and takes about 3 minutes to administer

 The Mini-Cog is a short dementia assessment that combines three-word recall with clock-drawing capability.

 Patients are given a total score reflecting accuracy in clock drawing and recollection of the given three words. 

 A score of 0 to 2 is a positive screen for dementia 

Causes of delirium in elderly- 

 Causes of delirium are numerous and in elderly hospitalized patients there are often multiple etiologies, including 

metabolic, infection, cardiac, neurological, pulmonary, sensory impairments, medications, and toxins.

 Regardless of cause, a consistent finding is significant reduction in regional cerebral perfusion during periods of 

delirium in comparison with blood flow patterns after recovery. 

 A possible neurological common pathway may involve acetylcholine and dopamine, and the disruption in the 

sleep-wake cycle in delirium indicates melatonin as a possible factor. (Kennedy-Malone 59)

Agnosia

 Loss of ability to identify objects

ADA criteria for diagnosing DM- 

 FPG ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 h.* 

 2-h PG ≥200 mg/dL (11.1 mmol/L) during OGTT. The test should be performed as described by the WHO, using 

a glucose load containing the equivalent of 75-g anhydrous glucose dissolved in water.* 

 A1C ≥6.5% (48 mmol/mol). The test should be performed in a laboratory using a method that is NGSP certified 

and standardized to the DCCT assay.* 

 In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 

mg/dL (11.1 mmol/L).

• Urinary incontinence- 

 Involuntary loss of urine from the bladder

▪ So common in women many consider it normal

▪ Common in older men w/ enlarged prostate

o Can affect quality of life

o Significance-One of the most common complains w/ older adults, Distress & embarrassment, Cost burden to pt & 

society as a whole, Not life-threatening, may effect QOL, PCP essential to educating individuals

o Epidemiology- Increased prevalence w/ age in men & women, Nursing home population – 40-70%, Often a factor in 

placement

▪ URGENCY UI is greater in men

▪ STRESS UI is greater in women

o Terminology

▪ UI- Unintentional voiding, loss or leakage of urine

▪ Continuous incontinence-Continuous loss or leak of urine

▪ Increased daytime frequency-More frequent during day than considered normal

▪ Nocturia-Interruption of sleep one or more times due to the need to urinate – increases in frequency after age 50

▪ Urgency-Sudden, compelling desire to pass urine that’s difficult to prevent

▪ Overactive bladder syndrome- Urgency, frequency, nocturia w/ or w/o incontinence

o Risk Factors-Aging,Obesity,Smoking, Caffeine,Uncontrolled DM, Constipation,Use of diuretics

o Risk Factors by gender-Women:Aging, obesity, smoking, caffeine intake, DM, pregnancy, multiparity, estrogen 

deficiency, hx of pelvic surgery, diuretics

1

Men:Aging, obesity, smoking, caffeine, DM, prostate dx, hx of prostate surgery, hx of UTIs, diuretics

o Physical changes w/ aging that contribute to UI

▪ Lower urinary tract-Detrusor muscle over activity,Decrease in detrusor contractility, Increase in post void 

residual,Decrease in urethral blood flow

▪ Women – decrease in urethral closure pressure,Low estrogen following menopause - leads to atrophy of ureteral mucosal

epithelium & increase in urethral sensation

▪ Men can experience constriction of urethra due to BPH which may result in bladder outlet obstructing symptoms

- Initial clinical workup for UI in Men

o PMH, PE, UA, DRE: Eval of prostate,PSA w/ new onset in men

- UI workup in women:Exclude underlying causes,PMH, PE, UA, Pelvic exam, vaginal exam, perineal, Identify estrogen 

status of pt, Pelvic prolapse, fistula, 

-Cough test, Integrity of pelvic musculature, leaking of urine

▪ Full bladder

▪ Standing position

▪ Asked to cough

▪ If urine leak is observed, stress incontinence is confirmed

- Red flags in males

o Higher level of suspicion for serious diseases, Refer to urology if Previous pelvic surgery, Pelvic radiation, Pelvic pain, 

Severe incontinence, Severe UTI symptoms, Recurrent urologic infection,Abnl Prostate exam,Elevated PSA

o Be alert to these with NEW ONSET UI- Hematuria,Pelvic pain,Abdominal mass, Dysuria, Proteinuria, Glucosuria, CVA

tenderness,Nodular prostate,Any new neuro symptoms

- Goals of treatment: Reduce symptoms, Improve QOL, Increase social activity, Reduce leakage volumes, increase 

dryness, use less protection; Increase independence in incontinence management; Decrease caregiver burden

- 1st line management guidelines

o AHRQ guidelines for management of UI in women

▪ Behavioral therapy

▪ Lifestyle modification

▪ Try for 3 months before pharm management

o Weight loss, Smoking cessation(Tobacco is a bladder irritant),Less coughing

o Dietary changes-Alcohol, soda, coffee with or without caffeine, acidic foods and spicy foods

o Maintain adequate fluid balance to reduce constipation, provide adequate flow to kidneys

- Behavioral strategies:Bladder training, Bladder control strategies,Timed voiding,Kegels, Pelvic floor training

- 2nd line management - Medication

o Antimuscarinic medication: 1st line for women

▪ Block the parasympathetic muscarinic receptors

▪ Inhibit involuntary detrusor contractions

▪ Side effects due to the effects on other muscarinic receptors

o Outcomes unpredictable and side effects common

o Common s/e: Dry mouth**, Blurred vision, Constipation,Nausea,Dizziness, Headache

o AntimuscarinicsMechanism of action

● Blocks acetylcholine at muscarinic receptors, relaxes bladder smooth muscle, inhibits involuntary detrusor contractions 

(anticholinergic)

● CYP3A4 substrates

▪ Indications: UI and OAB

▪ Contraindications: Untreated/uncontrolled narrow angle glaucoma,Gastric retention, Urinary retention

▪ Precautions:CNS depression,Caution in elderly

● Renal dosing

o CrCl <30>

o Beta 3 Adrenergic Agonist – Mirabegron (Myrbetriq)

▪ Also approved for UI and OAB

▪ Clinical trials – significant reduction in incontinence and micturations

● No anticholinergic s/e

▪ Mech of action

● Selectively stimulates beta-3 adrenergic receptors