13.5/15

Case Study 14.3
Caprice Hudson
Lakeview College of Nursing
N 309
March 9, 2012

1.	Urinary incontinence is the involuntary loss of urine. Functional incontinence is caused by no genitourinary factors such as, cognitive or physical impairment which cause the inability to independently void ( Dowling-Castronovo & Bradway, 2008).
2.	Factors in his environment include the IV pole and being out of his normal environment. Because Mr. Carson is not familiar with his environment it could be the major cause of his fall. What about the fact that he waited until his daughter left to void?
3.	The tea that his daughter bought him could have contributed to his incontinence. Caffeinated beverages will often give the urge to void. Mr. Carson’s daughter also bought him a cheeseburger from his favorite restaurant. Restaurant foods typically contain more sodium which is not good for the patient because he has type 2 hypertension.  His kidneys may be trying to retain the salt but he may have more than the body is use to and this initiates a mechanisms that will cause Mr. Carson to void and show signs of incontinence. 
4.	In my path physiology class I learned that indwelling urinary catheters place patients at higher risk for infection. There are other measures that can be taken to manage and treat functional urinary incontinence such as, avoiding medications that may cause UI in the case of Mr. Carson something other than Flomax could help him. Also monitoring fluid and maintaining hydration can help the patient with incontinence issues (Dowling-Castronovo, & Bradway, 2008). A major factor that I think could help Mr. Carson’s is modifying his environment to facilitate continence. ( Dowling-Castronovo & Bradway, 2008).  Perhaps a bedside commode or urinal would be better because he could avoid getting up which will reduce his fall risk and incontinent accidents. Mr. Carson’s experienced incontinence upon tripping on his IV pole and falling. I think substituting the commode and urinal will be a great asset for the patient.
5.	Strategies for implementing care for Mr. Carson’s incontinence include: identifying and treating incontinence, Identify and continue successful pre-hospital management strategies for established UI, Develop an individualized plan of care using data obtained from the history and physical examination and collaborate with other team members.  Avoid medications that may contribute to UI and modify the environment to facilitate continence as mentioned above Provide patients with usual undergarments in expectation of continence, if possible (depends). Prevent skin breakdown by providing immediate cleansing after an incontinent episode and utilizing barrier ointments. Pilot test absorbent products to best meet patient, staff, and institutional preferences, Avoid indwelling urinary catheters whenever possible to avoid risk for UTI. Limit dietary bladder irritants. 
6.	I would inform Mr. Carson to become aware of his environment and make sure he can locate and make it to the bathroom. I would suggest they he use a depends, which would provide extra support if he had an emergency and was unable to make it to the bathroom anytime and experienced another accident. This would probably help decrease his anxiety about his incontinence.
7.	I believe that orthostatic hypotension is a concern in someone with functional incontinence because it places them at high risk for injury. Orthostatic hypotension often causes a person to eventually lose their balance, do to dizziness. Dizziness occurs after standing from a sitting position or rising to fast while laying down. Mr. Carson may be unaware of the change and fall and because falls are the number 1 cause of injury amongst elderly I believe it is important that it is monitor carefully. 
8.	The goals of nurses working with incontinent patients include: the nurses will use comprehensive assessment to identify the type of urinary incontinence. The nurse will collaborate with interdisciplinary team and patient will not have urinary incontinence complications (Dowling-Castronovo & Bradway, 2008). Nursing interventions for preventing complications could include limiting dietary bladder irritants, such as caffeine and preventing skin breakdown after an incontinent episode; by cleaning the person and using a barrier ointment (Dowling-Castronovo & Bradway, 2008). These two strategies involve interventions that will protect the patient from urinary tract infections and skin break down.

References
Mauk, K. L. (2010). Gerontological nursing: Competencies for care. (2nd ed.) Sudbury, MA: Jones and 	Bartlett
Dowling-Castronovo, A., Bradway, C. (2008). Nursing standard of practice protocol: Urinary incontinence 	(UI) in older adults admitted to acute care. The Hartford institute of Geriatric Nursing.  	Retrieved from www.consultgerirn.org