13/15 see comments

Case Study 14.3
Brittany M. Hicks
Lakeview College of Nursing
N-306
March 08, 2012

Case Study 14.3
1.	Define Functional Incontinence. How would the nurse know that Mr. Carson experienced functional incontinence and not some other type?
	Functional Incontinence is characterized in patients who have limited mobility, thinking, or communicating (Mayo Clinic, 2012). This is commonly seen in patients who have Alzheimer’s or Parkinson’s, they lose control of their bladder before making it to the restroom (Mayo Clinic, 2012). I believe that Mr. Carson had functional incontinence because he had impaired mobility; it stated that he needed a three prong cane to get around. The reason that he experienced his incontinence in this instance was due to him getting his IV pole caught in the bed and then tripping over it. 
2.	What factors in Mr. Carson’s environment contributed to his incontinence? 
	There were some safety concerns with tripping hazards, as well as his ability to get around without his cane. He was to call the nurse, but felt that he could do it on his own. The IV pole and the lines attached to it contributed to him falling, her was probably trying to hurry to the restroom in fear of not making it. 
3.	What factors in Mr. Carson’s diet contributed to his incontinence?
	If the tea that his daughter brought him contained caffeine which most tea does unless indicated, the caffeine acts as a diuretic. The cheeseburger from his favorite restaurant was probably loaded with sodium; therefore the kidneys have to work to balance that by excreting it through urination.
4.	Why is an indwelling catheter not the best treatment for functional incontinence? 
	Mr. Carson is not having trouble with eliminating his urine or typical incontinence; it is due to not making it in time. I would suggest that the nurse have him us a urinal or a bedside commode, to prevent it from occurring. Indwelling catheters are used for patients who have urinary retention, bladder obstruction, critically ill, improve comfort, and help with a wound that is not healing in perianal area (Catheter out, 2009). Placing an indwelling catheter puts them at higher risk for a UTI. They could also find an alternative medication to Flomax because it can increase urinary excretion.
5.	According to Hartford Institute for Geriatric Nursing Standards of practice protocol, what nursing care strategies should be implemented to care for Mr. Carson’s incontinence? 
	Strategies that nurses can use to help Mr. Carson with his functional incontinence includes: identify problem, treat accordingly, establish a plan of care, avoid drugs that may contribute to urinary incontinence, decrease dietary irritants, monitor intake (hydration), avoid indwelling catheters, modify environment (making it more convenient), use barrier cream in prevention of impaired skin integrity, and have them use a depend if it is necessary (Dowling-Castronova & Bradway, 2008).
6.	Create a discharge plan for Mr. Carson that addresses his concerns about his incontinence.
	The nurse can help him through by teaching him things that will help prevent the incontinence. He can wear a depend as a prevention method from making a mess; he can also limit his tea or fast food restaurant (sodium) from his diet. Another thing that may help Mr. Carson is to have a urinal container near him if he is not close to the restroom.
7.	Why is orthostatic hypotension a concern in someone with functional incontinence?
	Orthostatic hypotension is a condition where your blood pressure can drop when changing positions (standing up), this can cause syncope in a patient. It is important for someone to be near or for these patients to sit up on the side of the bed before just hopping up. This could be a problem for someone with functional incontinence because they need to get to the restroom fast to prevent an accident from happening. 
8.	Using information of functional incontinence from the Web site http://consultgerirn.org, what interventions should the home health nurse implement in order to help Mr. Carson with his incontinence?
If I were his nurse I would encourage him to wear the depends as a precautionary especially at night, because many times when you wake up you need to use the restroom. I would also talk with the family including his daughter to see if he could have a room close to the restroom, also possibly a urinal or commode at his bedside to maintain dignity for Mr. Carson. Additionally I would limit his caffeine intake in the evening.

References
Dowling-Castronovo, & Bradway (2008). Urinary incontinence 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
Indications for indwelling urinary catheter use. (2009). Retrieved from http://www.catheterout.org/?q=Indications-for-indwelling-urinary-catheter-use
Urinary Incontinence. (2012). Retrieved from http://www.mayoclinic.org/urinary-incontinence/types.html