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Gerontology Case Study Week 7
Kalyn Madej
Lakeview College of Nursing
N309 Nursing of the Gerontological Client
March 4, 2012
14.3	Functional Incontinence

1.	Urinary incontinence is defined as the involuntary loss of urine. There are many different types of incontinence. Functional incontinence is when the patient is incontinent because they cannot physically get to the bathroom at the time when they have the urge to void. (Chang, 2009). This type of incontinence was noted by the nurse since Mr. Carson fell on his way to the bathroom. He was trying to get himself to the bathroom and could not make it. There are some other medical problems included that are affecting his ability to make it to the bathroom such as his spinal stenosis which has lead to his unsteady, slower gait.
2.	When reading over this case study there were a variety of factors that were in Mr. Carson’s environment that contribute to his incontinence. While reviewing his medical history it was noted that he had spinal stenosis, which has caused the unsteady and slower gait. While moving throughout his home he has to use a three pronged cane to get around and he also lives alone. He does not have someone to assist him to the bathroom if a problem was to occur. Since he was in the hospital he was hooked up to an IV line and pole. This made it harder for him to get to the restroom. He also is used to doing things on his own so he felt that he did not need assistance from the nurse to the bathroom so disregarded her request for him to use the call light and wait since they were taking so long. He also had high blood pressure which may have caused him to become dizzy and lightheaded. 
3.	When going over Mr. Carson’s diet history there were some related factors that may be contributing to his incontinence. According to Mauk, “It is not uncommon for patients with urgency and urge incontinence to report a fluid intake that consists primarily of bladder irritants (e.g., diet drinks, carbonated caffeinated beverages) and minimal to no water” (Mauk, 2010, p. 479). It has been reported that he drinks an occasional wine and beer along with the sweet teas which are all related factors that can irritate the bladder. It is important to keep him hydrated and suggest more water intake over other fluids. Fluids should be limited after dinner to help decrease the chances of incontinence. Modification in diet may also help with his urinary incontinence. 
4.	When deciding whether or not an indwelling urinary catheter there are many things to consider. In this case the use of the catheter is not the best treatment for functional incontinence. The indwelling catheter is used to fully drain the bladder which is not needed this patient just physically cannot get there in time. Catheters are used for urine leaking and controlling when a patient urinates. These patients do not have those problems. So that makes the use of a catheter a poor solution. Also using a catheter can increase Mr. Carson’s risk for infection and UTIs which should be avoided as often as possible in the hospital setting.
5.	According to the Hartford Institute for Geriatric Nursing’s Standard of practice protocol, there are a variety of strategies a nurse can use to care for patients with urinary incontinence. The nurse should initially identify and treat the causes of urinary incontinence. After that an individualized plan of care for the patient can be made using the data from this history and physical examination. Looking over the medications taken previously or prescribed should be done to make sure the medications that contribute to urinary continence should be avoided.  The use of indwelling catheters should also be avoided. The nurse should also monitor the fluid intake and make sure the patient is receiving adequate hydration. Monitoring the environment to make sure the patient can get to the bathroom if needed to. If there were an accident the patient should be assessed to prevent the potential skin breakdown.  (Dowling-Castronovo, & Bradway, 2008). All of the nursing implementations listed above can help treat patients with urinary incontinence.
6.	Mr. Carson has some concerns about incontinence and the fact that he will be staying in his daughter’s home. While making a discharge plan it is important to include his concerns. The nurse will make sure to inform the patient to monitor his fluid intake to make sure he is receiving the appropriate hydration. He also should be advised to limit the dietary elements that irritate the bladder. A long term goal that may be advised for him would be to have some weight loss. Since he will be living with his daughter for a period of time it should have an environment that is used to facilitate continence. The patient should be provided individualized scheduled toileting and prompted voiding. If Mr. Carson still has some concerns when he gets home he can be referred to a physical or occupational therapy if he feels it is needed. (Dowling-Castronovo, & Bradway, 2008). 
7.	Since there is a significant drop in the blood pressure when Mr. Carson stands this is quite a concern. This is he is limiting his fluid intake this can lead to orthostatic hypotension. A cause of orthostatic hypotension is dehydration. When someone becomes dehydrated they can experience signs of weakness, dizziness, and fatigue. All of which are serious issues for a patient who is having problems physically getting to the bathroom. In patients with orthostatic hypotension falling down or fainting are common complications. There also may an increase risk of stroke with this type of hypotension.
8.	From the listed website there are a variety of interventions that should be preformed to help Mr. Carson with his incontinence.  The home health nurse should practice the same ways as the hospitals at the nurse. She should identify and treat the causes of his functional incontinence. She should than come up with a plan of care to help eliminate the functional incontinence. She should make sure that none of the prescribed medications are leading to this problem. The nurse should also monitor this patient to make sure that he is consuming the adequate amount of fluids and is fully hydrated. She should monitor the environment he is in to make sure there are no obstacles in the way of getting to the bathroom safe and effectively. If he is having reoccurring functional incontinence the nurse should assess the patient to make sure there is no skin break down that can lead to infection. (Dowling-Castronovo, & Bradway, 2008). 

References
Castronovo, A. D., & Bradway, C. (2008). Urinary Incontinence Nursing Standard of Practice
	 Protocol: Urinary Incontinence (UI) in Older Adults Admitted to Acute Care. In 	Editors 	name (Ed.), Geriatric Nursing Resources for Care of Older Adults. Retrieved 
from http://consultgerirn.org/topics/urinary_incontinence/want_to_know_more#Wrap

Chang, L. (2009). Functional Urinary Incontinence: Symptoms, Causes, Treatments, and
 More.  WebMD - Better information. Better health. Retrieved from 
http://www.webmd.com/urinary-incontinence-oab/functional-incontinence?page=2

Mauk. K. L., (2010). Management of Common Illnesses, Diseased, and Health
 
Conditions. In K. L. Mauk (Ed.), Gerontological Nursing: Competencies for Care. (2nd ed., pp. 426-

427). Sudbury, MA: Jones & Bartlett