14.75/15

Case Study Eight (14.3)
Nina Fainter
Lakeview College of Nursing
N309
March 11, 2012

Case Study Eight (14.3)
1.	Functional incontinence is usually caused by some sort of mental of physical disability. Sometimes there are obstacles that may keep the person from reaching the bathroom quick enough, the patient may not be able to remove their clothes quick enough, or they may not be able to transfer from a wheel chair to toileting device quick enough. Sometimes the person may have physical disabilities such as pain, Parkinson’s, or multiple sclerosis. These may prevent the person from being able to reach the bathroom fast enough. Sometimes the person may have a mental disability such as Alzheimer’s or dementia. They may not recognize the need to toilet or be able to find the bathroom. Sometimes in cases of depression people lose the desire to care. Medications can also cause this, such as taking sedatives. The nurse would know that Mr. Carson experienced functional incontinence because he had his call light on signify he was cognitive enough to know he had to use the bathroom. The fact that he had fallen over the IV pole would show he had a physical limitation to the bathroom signifying functional incontinence. He also has spinal stenosis which may have contributed to him falling and having an unsteady get (WebMD, n.d.). 

2.	Mr. Carson had the IV pole and the side rail which made it difficult for him to ambulate. He has an unsteady gait so having these other obstacles only increases the risk of falling and incontinence. He had IV fluids running which increased the need to urinate. He had pressed the call light but did not receive a response which led him to get up on his own. This then led him to fall and urinate on himself. If the call light had been answered, he would not have gotten up on his own and fallen, therefore he would not have been incontinent. He also waited until his daughter left instead of using the bathroom while she was there. This also means he probably waited until he had to use the bathroom more than normal. 

3.	At home, Mr. Carson drinks the occasional beer or glass of wine. While in the hospital, he had a sweet tea for dinner. He also has IV fluids running. 

4.	Indwelling catheters are used in cases of urinary incontinence when the person is unable to control when they urinate, urinary retention, surgery, and medical conditions such as MS, dementia, or spinal cord injury. Mr. Carson’s case of incontinence was caused by many environmental factors, not because he could not control it. Catheters can also cause complications such as infection, bladder stones, hematuria, urethral injury, and kidney damage. So the avoidance of a catheter should be taken when possible (MedlinePlus, n.d.). 

5.	Certain nursing care strategies should be taken for all forms of urinary incontinence. The cause of the urinary incontinence should be identified and treated. Successful management should be taken and identified at home before being admitted to the hospital in urinary incontinence. Using the history the nurse has obtained and a physical exam, the nurse should collaborate with other team members to create and individualized plan of care. Any medications that may contribute to urinary incontinence should be avoided. Avoid the risk of a UTI by not using an indwelling catheter when it’s not necessary and also monitor intake and an appropriate hydration schedule. If the patient has a high BMI, educate the patient on weight loss upon discharge with a possible long term goal. Avoid dietary bladder irritants and be mindful of the environment to help avoid any obstacles that may contribute to urinary incontinence. Sometimes undergarments may be provided if incontinence is expected. If incontinence occurs, provide appropriate skin cleansing immediately to prevent skin breakdown. Diapers have been associated with diapers so appropriate absorbent products should be used instead when possible (Bradway, 2008). 

6.	The nurse can suggest bladder training in which Mr. Carson schedules time between bathroom trips. He should start with a small amount of time such as two hours. If he has to go between then, he should stand or sit still while contracting pelvic muscles, and trying to make the urge go away by concentrating on something else. After staying dry for two hours, increasing the intervals to longer periods of time is suggested. Pelvic muscle exercises are suggested to strengthen the muscle that supports the bladder to prevent leakage. Also, walking is useful because it can help sense when the bladder is filling. Scheduled bathroom trips are suggested so that it is unlikely that Mr. Carson will to need urinate in a hurry. Also, it’s important to make sure that there is a clear path to the bathroom (WebMD, n.d.).

7.	Mr. Carson may become dehydrated if he is limiting his fluid intake. This may cause orthostatic hypotension. If he is experiencing orthostatic hypotension he is at increased risk for dizziness and lightheadedness. These would put him at an increased risk of falling. If he falls, he may get hurt but also there is the chance he will be incontinent again.

8.	Mr. Carson should try to avoid any medications that may contribute to urinary incontinence. He should maintain an appropriate amount of fluid intake and determine a hydration schedule to prevent incontinence during the night and frequent trips to the bathroom. At home, make sure that the pathway to the bathroom is clear and that there is adequate lighting at night. Having regularly schedule bathroom times may help prevent incontinence also. Asking for assistance walking to the bathroom may benefit him too while he is staying with his daughter (Bradway, 2008).

References
Bradway, C., Dowling-Castronovo, A. (2008, January). Nursing standard of practice protocol: Urinary incontinence in older adults admitted to acute care. Hartford Institute for Geriatric Nursing. Retrieved from http://consultgerirn.com/topics/urinary_incontinence/want_to_know_more#item_5

MedlinePlus. (n.d.). Urinary catheters. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/003981.htm

WebMD. (n.d.). Functional incontinence. Retrieved from http://www.webmd.com/urinary-incontinence-oab/functional-incontinence