Student in need of advice.

[joannemojo]

I have a presentation to do on wednesday on incontinence. We have a case study to use (72 yr old female). They haven't really told us what to include in the presentation but I know that we have to include care plans, SMART, potential and actual problems etc.

It's the care plans that have stumped me. All thats said about the patient in terms of incontinence is that she is 'occasionally incontinent and her urine in concentrated and smelly'. Because of this there isn't much to give me an idea of the causes of it and the type she suffers from.

When I have been on the ward the only incontinence care plans (if u can call them care plans) involve ensuring that the patient rings in time for the toilet and that we minimise pressure sore risk.

Can anybody help me with this? What sort of care plans have u seen for incontinence and what do they involve? Also the rationale behind them.

Another thing I want your opinion on is that I read in a book that 'All assessment on incontinence MUST include questioning about sexual dysfunction'. I feel that when assessing this patient it would be inappropriate. She's an elderly lady who lost her husband 5 years ago and is still grieving for him. She says she just wants to be with him and has given up. I would say to omit that line of questioning as it could be detremental to her emotional well being. What are your thoughts on this?

Thanx guys,

Jo

P.S I hate presentations and UCE doesn't know its orifice from it's hand sometimes!!! :angryfire

[Silverdragon102, BSN]

Hi

It has been a while since I last used care plans but let see if I can think of a few things for you

I would ensure (like previously mentioned) that the buzzer is near by so she can call when needs the toilet.

Regular toileting

Ward test urine sample and also send MSU and just confirm UTI and whether medication is required.

If she is still grieving for her husband I would include a plan to address this.

When incontinent ensure good washing and observation of pressure areas

Sometimes it is relevant to question her re sexual dysfunction as a bladder or lady partsl prolapse may be the cause

This is just a quick reply but hope it helps

[Spidey's mom, ADN, BSN, RN]

Concentrated urine may = dehydration. I'd want chemistries done and then rehydration.

IV, push fluids, etc.

I HATE Care Plans. We put them in the chart and NEVER look at them.

steph

[joannemojo]

Thanx for the replies.

It's a big case study and we are in a group. Each of us is addressing a different problem. Dehydration, possible diabetes (drinking loads but mouth is cracked), sleeping problems, deperession and so on.

The main problem I have is that there isn't really anything about her incontinence. Nothing about how/why/when it happens. I think i will have to just say that an assessment would need to be carried out to define her incontinence before any medical may be needed.

It says that she becomes dizzy on rising so maybe she isn't going to the toilet through fear of falling and subsequently wetting herself.

Well, with the careplans on my clinical placements I NEVER saw a single incontinence specific one.

With the SMART thing. It think I will be able to do it. My aim is for the lady to be continent.

It will be specific because the aim is to stop the incontinence.

Measurable because we will be keeping an eye on every incidence of incontinence and recording it

Acheiveable because as far as we know there isn't a medical condition causing it (this would change if it was found that she had an untreatable medical condition which meant that she couldn't stop)

Realistic - This would only be realistic if there was no medical problem. If she has a prolapse it wouldn't be realistic for me to set the goal as her being continent.

Timed - Thats easy because I would record daily her episodes of incontinence. It would be a daily thing and therefore easy to spot a improvement or decline.

Sorry about the rambling, I'm just all confused at the moment as I don't know exactly what they expect from the presentation. Plus we are being marked on it as one of our assignments.

Thanx for the bit about the sexual dysfunction. I can now express my concerns about her emotional wellbeing but also put forward the reasons for asking the questions in regards to her health.