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Case Study 14.3
Simone Walker
Lakeview College of Nursing
Nursing of the Gerontological Client
March 11, 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?
	The definition of functional incontinence is urine loss caused by the inability to reach the toilet because of environmental barriers, physical limitations, loss of memory, or disorientation (Taylor, Lillis, LeMone, & Lynn, 2011). If the nurse asks the patient questions like: how did you fall; why did you get up or what made you get up out of bed and start walking. These questions can give the nurse insight into why the patient got up and the possibly reason why the patient urinated on themselves. This will also allow the patient to explain the events that led up to them falling. Obtain a history from the patient about their urinary habits and have they had any changes when they urinate. Based off of the definition of functional incontinence, it is evident that this is what the patient experienced due the patient falling and not being able to get to the toilet in time to urinate.
2. What factors in Mr. Carson’s environment contributed to his incontinence?
	The factors in the environment that contributed to Mr. Carson’s incontinence was due to the patient not having someone take them to the bathroom, tripping over the IV pole and falling to the floor.
3. What factors in Mr. Carson’s diet contributed to his incontinence?
	The factors in Mr. Carson’s diet that contributed to his incontinence are the sweet tea, occasional beer or glass of wine in the evening.
4. Why is an indwelling urinary catheter not the best treatment for functional urinary 
    incontinence?
	The reason why an indwelling catheter is not the best treatment is because the patient still has the sensation to know when to go to the bathroom and the patient can be taught how to strengthen their pelvic floor muscles by doing Kegel exercises, so they can have improved voluntary control of urination.  
5. According to the Hartford Institute for Geriatric Nursing’s standard of practice protocol, what 
    nursing care strategies should be implemented to care for Mr. Carson’s incontinence?
	The nursing care strategies that should be implemented to care for Mr. Carson is:
1. Identify and treat causes of transient urinary incontinence. 
2. Identify and continue successful prehospital management strategies for established urinary incontinence.
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 urinary incontinence. 
5. Avoid indwelling urinary catheters whenever possible to avoid risk for UTI. 
6. Provide adequate fluid intake and monitor fluid intake and maintain an appropriate hydration schedule.
7. Limit dietary bladder irritants. 
8. Consider adding weight loss as a long-term goal in discharge planning for those with a (basal metabolic rate (BMI) greater than their normal range 
9. Modify environment to maximize independence with continence.
10. Prevent skin breakdown by providing immediate cleansing after an incontinent episode and utilizing barrier ointments. 
11. Teach pelvic floor muscle exercises (PFMEs).
12. Provide toileting assistance PRN. 
13. Provide individualized, scheduled toileting or prompted voiding.
14. Refer for physical and occupational therapy PRN (Dowling-Castronovo & Bradway, 2008).
 6. Create a discharge plan for Mr. Carson that addresses his concerns about his incontinence.
	The discharge plan should include scheduled toileting, teach pelvic floor muscle exercises (Kegel exercises), drink adequate amounts of fluid, avoid foods and drinks that can cause them to have to urinate more than usual (e.g. beer), how to clean after themselves if they have an episode of incontinence, have a bedside commode next to their bed, pathway to the bathroom free of debris or clutter, keep hallways/pathways well lite at night, and sensation to urinate go immediately to the toilet to urinate. 
7. Why is orthostatic hypotension a concern in someone with functional incontinence?
	The reason orthostatic hypotension is a concern with someone who has functional incontinence is because the patient may rush to go to the bathroom to urinate and may fall because their gait is not steady enough for them to walk. Another concern is the patient sitting on the bed until the orthostatic hypotension has passed and accidently having to urinate before getting to the toilet.
8. Using the information on 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?
1. Provide individualized, scheduled toileting or prompted voiding. 
2. Provide adequate fluid intake.
3. Refer for physical and occupational therapy PRN.
4. Modify environment to maximize independence with continence (Dowling-Castronovo & Bradway, 2008).
The nurse should educate patient about functional incontinence and not to limit their fluid intake. The nurse should also help the patient in obtaining a bedside commode.

References
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 
Taylor, C. R., Lillis, C., LeMone, P., & Lynn, P. (2011). Fundamentals of nursing: The art and 
	science of nursing care (7th ed.). Philadelphia, PA: Lippincott Williams and Wilkins.