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Introduction

This assignment will explore a case study and identifying a specific aspect of care which will be discussed in details. An appropriate assessment tool will be used to help plan care and to examine continence. Mental state,emotional well being, mobility, history of falls and nutritional fluid intake will also be looked into and linked with continence. In addition a description of care give with government and professional guidelines and critical analysis of the care will be included. Initially This assignment will use a case study of a fictitious patient to examine continence. Its management will be discussed within the context of current guidelines. The Bladder and Bowel Assessment Tool (Toronto, 2006) will be introduced to help plan care. Mental health, mobility, history of falls, nutrition and fluid intake will also be explored and linked with continence. Any issues relating to safeguarding adults will also be addressed. Lucille McKenzie, a 72-year-old retired teacher of Jamaican descent who lives alone has been admitted via Accident and Emergency after a fall at home. She presented with fever, dyspnoea, indigestion, low haemoglobin, urinary tract infection, delirium, a painful right hip, dehydration, chest infection and a sore sacrum. Lucille has had these unexplained falls in the past nine months and has become dependent upon her step-daughter Marjorie Wilson (a pseudonym) ...read more.

Middle

Lucille should also be encouraged to quit smoking and to eliminate bladder irritants as these can induce urinary incontinence (Bump and McClish, 1994). However, it is possible that through following the above principles, Lucille?s incontinence may be resolved. Moreover, everyday nursing care should include helping Lucille with self-care needs like personal hygiene, remembering to involve her to optimise independence. This time also affords nurses to inspect her skin integrity. Since Lucille has a red and painful sacrum, nurses should immediately clean her after every episode and utilise barrier creams to prevent exacerbation (Errsser et al, 2005). Nurses should also encourage her to re-position herself to redistribute weight (NICE, 2001). Alternatively, pressure relieving aids like mattresses can be used and a wound care plan must be initiated. In terms of reducing Lucille?s pain, comfortable positions and analgesics should be provided. Scoring scales should be used and a personalised pain plan should be implemented. Rather than focusing on incontinence in isolation, nurses should ensure that Lucille?s fundamental needs such as nutrition and hydration, mental state and emotional well-being, mobility and history of falls are met. Good nutrition and hydration are vital for health and its deficit can lead to a number of serious health problems. Therefore a nutritional assessment should be conducted on Lucille (NICE, 2006) ...read more.

Conclusion

Decision to discharge Lucille should come from multiple sources and nurses should ensure that any services needed by Lucille upon discharge have been put in place. Thus an occupational therapy should be carried out at Lucille?s home and equipment like walking frames and commodes should be provided. Nurses should also inform Lucille?s GP about her discharge and a referral to district nurses for her sacral wound assessment and care should be made. Section 2 must also be issued (NHS Community Care, 2003). This is a notification to Social Services that requires a Social Worker assessment. Also home help or respite care to give Marjorie some down time should be considered since Marjorie is finding it difficult to cope whilst working full-time. Teaching regarding medication should be given and this can be reinforced by the provision of leaflets. Information about local support groups and benefits should be provided to Lucille and Marjorie as they are not getting anything from health and social agencies. Also transport should be arranged and follow-up appointments should be scheduled. In summary, urinary incontinence impacts so much on the quality of life and those who present with it should undergo a holistic assessment so that management strategies can be implemented. Also nurses should be aware of abuse that can befall the elderly. Above all effective discharge should begin at admission. ...read more.

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