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.
