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Case Study Seven
Amanda L. Miller
N309 Nursing of the Gerontological Client
March 6th 2012

Case Study Seven
According to Mauk, Functional incontinence is when factors in the environment or cognitive abilities are inhibiting the person’s bladder function (p. 478). Mr. Carson had several environmental barriers inhibiting his bladder function. First off he was waited till his urge to urinate was so strong that he couldn’t wait for the nurse to enter his room to assist him to the bathroom. Secondly, Mr. Carson was bound to his IV. This limited his function to ambulate safely, especially since he didn’t have his walker to use. His Gait is already slow, so adding a strong urge to urinate did not help matters. 
Dietary contributions that could attribute to functional incontinence are limited to tell. The only thing we can note is that his daughter brought him a cheeseburger and sweet ice tea. However, We don’t know how he eats on a regular basis at home. Ice tea has caffeine which can increase urination frequency. If he drank the entire cup during his visit with his daughter, he might have a strong urge to urinate.
An indwelling catheter would not be appropriate for Mr. Carson because he doesn’t have a problem urinating. What he needs is someone to come to his room regularly to see if he needs to use the bathroom, and provide him assistance while walking to the bathroom. Mr. Carson needs further teaching on using the call light at the first sign of an urge to urinate. I would also suggest that if Mr. Carson did have a strong urge and can’t wait for a nurse, that a urinal should be provided to him so he won’t have to wait for someone to help him to the bathroom. 
Dowling-Castronovo and Bradway developed nursing strategies for Mr. Carson include the following: Identify the problem, develop an individual plan, avoid medications that could contribute to urinary incontinence, monitor fluids, limit dietary irritants, modify the environment to facilitate continence (2008). 
	Some things Mr. Carson can do to avoid incontinence is to set times when he will use the bathroom throughout the day. For example, going to the bathroom every other hour to empty his bladder. It would also be good for him to have a safe walkway to the bathroom. Reducing fall hazards will reduce his risk of falling when he has an urge to use the bathroom and needs to get in there quickly. 
	The nurse is concerned because orthostatic hypotension could potentially cause Mr. Carson to faint if he gets up to quickly when he has the urge to urinate. This is a problem because not only his is blood pressure decreasing so suddenly, but fainting means he is at risk for falling and hurting himself. 

References
Dowling-Castronovo, A., & Bradway, C. (2008, January). Nursing standard of practice 
protocol: Urinary incontinence (ui) in older adults admitted to acute care. 
Retrieved from http://consultgerirn.org/topics/urinary_incontinence/
want_to_know_more
Mauk, K. L. (2010). Gerontological nursing: Competencies for care (2nd ed.). Boston: 
Jones & Bartlett.