14.5/15
Case Study 14.3
Gregory Cahill
Lakeview College of Nursing
March 11, 2012

1.  Functional incontinence refers to problems not related to the urinary tract such as a physical or cognitive impairment (Mauk, 2010).  His physical disability caused his incontinence.

2.  Factors that contribiuted to his incontinence include waiting to long to urinate, being in a hurry to get to the bathroom, having problems ambulating, having to wait on the nurse and not being familiar with how to walk with the IV pole.

3.  The sweet tea contains caffeine and contributed to his incontinence.Cite source

4.  Better options than an indwelling catheter are available.  He could use an urinal or the nurse could explain to call before has that much of an urge to urinate.  The indwelling catheter can introduce bacteria to his urinary tract and should not be used until it is needed.

5.  The following taken form Dowling-Castronovo & Bradway, 2008 are steps to implement for Mr. Carson.  Identify and treat causes of transient UI. 2. Identify and continue successful prehospital management strategies for established UI. 3. Develop an individualized plan of care using data obtained from the history and physical examination and in collaboration with other team members. 4. Avoid medications that may contribute to UI. 5. Avoid indwelling urinary catheters whenever possible to avoid risk for UTI.
6. Monitor fluid intake and maintain an appropriate hydration schedule.
7. Limit dietary bladder irritants. 8. Modify the environment to facilitate continence. 9. Provide patients with usual undergarments in expectation of continence, if possible. 10. Prevent skin breakdown by providing immediate cleansing after an incontinent episode and utilizing barrier ointments. 

6.  I would teach Mr. Carson what fluids and foods can contribute to his incontinence and also talk to him about a voiding schedule.

7.  If Mr. Carson gets up quickly to try to get to the bathroom his orthostatic hypotension could cause him to fall.

8.  Provide patient/caregiver discharge teaching regarding outpatient referral and management, incorporate continuous quality improvement (CQI) criteria into existing program, identify areas for improvement and enlist multidisciplinary assistance in devising strategies for improvement (Dowling et. al., 2008)

 References
Dowling-Castronovo, A., & Bradway, C. (2008, Janu). Nursing standard of practice 
     protocol: Urinary incontinence (ui) in older adults admitted to acute care. Retrieved    
     from http://consultgerirn.com/topics/urinary_incontinence/want_to_know_more
Mauk, K. L. (2010). Identifying and preventing common risk factors in the elderly.
                   In Gerontological nursing (2nd ed., pp. 354-380). Sudbury, MA: Jones 
                    & Bartlett.