Nursing Care Plan about Functional Urinary Incontinence

Cases :

Mrs.Kay the home care nurse, is seeing Mrs. Grayson, a 75 years old widow at her home. Mrs. Grayson has type 2 diabetes mellitus and arthtritis and was referred by her physician because of urinary incontinence. She lives alone, but her daughter lives less than 10 minutes drive away. Mrs.Kay's assesment included a discussion of Mrs.Grayson's current health problems with emphasis on the more recent urinary concerns.

ASSESSMENT ACTIVITIES

- Ask Mrs.Grayson about the effects of her arthritis on her mobility. Observe Mrs.Grayson's gait and ability to get up and down.
- Ask Mrs.Grayson about any other effects that her difficulty in walking have had.

NURSING DIAGNOSIS

Functional incontinence related to impaired mobility.

PLANNING
Goal

- Client will have reduced episodes of incontinence within 1 week.
- Client will ambulate with less discomfort within 1 week.

Expected Outcomes*
Urinary Continence
- Client will report less frequent episodes of incontinence following initiation of a pattern of timed voiding.

Independent Toileting
- Client will demonstrate ability to walk comfortably with a steady gait to bathroom within 1 week.

INTERVENTIONS
Urinary Incontinence Care
- Have client complete a 3 day 24hour log of urination.
- Estabkish interval for toileting to anticipate need for voiding based on bladder log data. Interval may vary from 1 1/2 to 4hours.
- Work with client to establish a reasonable, manageable voiding program using environmental cues to minimize or eliminate incontinence episodes.
- Consult with physician to prescribe an alternative antiarthritic.

RATIONALE
- the bladder log provides objective verification of urine elimination pattern and patterns of urine leakage and provides a baseline for evaluation of effectiveness of management plans (Lyons and Specht, 2001; Wymrn, 2003). Bladder log also demonstrates pattern of voiding that may indicate more serious urinary problems related to urinary tract infections or other renal diseases (Lewis, Heitkemper, and Dirksen, 2000).
- Timed voiding (habit training) will empty the bladder before the usual stimuli (bladder stretch) and avoid association with inability to get to bathroom facilities in time (Lyons and Specht, 2001; Wyman, 2003).
- Uncontrolled incontinence can lead to institutionalization of older adults who prefer to remain in their own homes and contributes to increased illness (urinary tract infections, skin breakdown) (Gray, 2003).
- Reduction in joint pain will increase mobility.

Communication Throughout in Nursing Process

Assessment :

Verbal interviewing and history taking
Visual and intuitive observation of nonverbal behavior
Visual, tactile, and auditory, data gathering during physical examination
Written medical records, diagnostic tests, and literature review

Nursing Diagnosis :

Interpersonal analysis of assessment findings
Validation of health care needs and priorities via verbal discussion with client
Handwritten or computer-medicated documentation of nursing diagnosis

Planning :
Interpersonal or small-group health them planning sessions
Interpersonal collaboration with client and family to determine implementation methods
Written documentation of expect outcomes
Written or verbal referral to health team members

Implementation :

Delegation and verbal discussion with health care team
Verbal, visual, auditory, and tactile health teaching activities
Provision of support via therapeutic communication techniques
Contact with other health resources
Written documentation of client's progress in medical record

Evaluation :

Acquisition of verbal of verbal and nonverbal feedback
Comparison of actual and expected outcomes
Identification of factors affecting outcomes
Modification and update of care plan
Verbal and/or written explanation of revisions of care plan to client

Respiratory Gas Exchanges

Respiratory gases are exchanged in the alveoli and the capillaries of the body tissues. Oxygen is transferred from the lungs to the blood, and carbon dioxide is transferred from the blood to the alveoli to be exhaled as a wate product. At the tissue level, oxygen is transferred from the blood to tissues and carbon dioxide is transferred from tissues to the blood to return to the alveoli and be exhaled. This transfer is dependent on the profess of diffusion.
As mentioned, diffusion is the movement of molecules from an area of higher concentration to an area of lower concentration. Diffusion of respiratory gases occurs at the alveolocappillary membrane, and the rate of diffusion can be affected bt the thickness of the membrane. Increased thickness of the membrane impedes diffusion because gases take longer to transfer across. Clients with pulmonary edema, pulmonary infiltrates,or a pulmonary effusion have an increased thickness of the alveolocapilary membrane, resulting the slowed diffusion, slowed exchange of respiratory gases, and impaired delivery of oxygen to tissues. The surface area of the membrane can be altered as a result of chronic disease (e.g.,emphysema), an acure disease (e.g.,pneumothorax), or surgical process(e.g.,lobectomy). The alveolocappilary membrane can be destroyed or many thicken, changing the rate of diffusion. When fewer alveoli are functioning, the surface area is decreased.
Oxygen transport. The oxygen transport system consist of the lungs and cardiovascular system. Delivery depends on the amount of oxygen entering the lungs (ventilation), blood flow to the lungs and tissues(perfusion),rate of diffusion,and oxygen-carrying capacity. The capacity of the blood to carry oxygen is influenced by the amount of dissolved oxygen in the plasma, amount of hemoglobin, and tendency of hemoglobin to bind with oxygen. Only a relatively small amount of required oxygen, less than 1%,is dissolved in the plasma. Most oxygen is transported by hemoglobin,which serves as a carrier for oxygen and carbon dioxide. The hemoglobin molecules combines with oxygen to form oxyhemoglobin. The formation of oxyhemoglobin is easily reversible,allowing hemoglobin and oxygen to dissociate,which frees oxygen to enter tissues.
Carbon dioxide transport. Carbon dioxide diffuses into red blood cells and is rapidly hydrated into carbonic acid(H2CO3) because of the presence of carbonic anhydrase. The carbonic acid then dissociates into hydrogen (H+-) and bicarbonate (H2CO3-) ions. The hydrogen ion is buffered by hemoglobin,and the HCO3- diffuses into the plasma. In addition,some of the carbon dioxide in red blood cells reacts with amino acid groups,forming carbamino compounds. This reaction can occur rapidly without the presence of an anzyme. Reduced hemoglobin(deoxyhemoglobin) can combine with carbon dioxide more easily than oxyhemoglobin, and therefore venous blood transports the majority of carbon dioxide.

Nursing Today

Nursing is in art and a science. this means that a proffesional nurse learns to deliver care artfully with compassion, caring, and a respect for each clients dignity and personhood. as a science, nursing is based upon a body of knowledge that is always changing with new discoveries and innovations. when nurses integrate the science and art of nursing into their practice, the quality of care provided to clients is at a level of excellence that benefits clients in innumerable ways.

it is an exciting time to become a nurse. the opportunities for a nursing career are limitless. a new professional may choose any number of careers, including clinical practice, education, research, management, administration, and even entrepreneurship. there are many excellent health care facilities and educational institutions in this country to prepare nurses with the very best skill and knowledge. as a student beginning his or her career, it is important to understand the scope of nursing practice and how nursing influence the lives of the clients we care for.

when giving care, a professional registered nurse provides a specified service according to standards of practice and follows a code of ethics. the foundation for professional practice arises from theories of nursing,scientific knowledge, relevance to basic social values, professional autonomy, a sense of commitment, a sense community, and a code of ethics (Bernhard and Walsh,1995).

Nursing has many different philosophies and definitions. The following definition was developed by the American Nurse Association (ANA) :

Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations (ANA,2003)