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

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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) for her needs. She takes aspirin once daily, ibuprofen and gaviscon when required but has not visited her General Practitioner for several years. She also smokes 10-15 cigarettes daily, has lost weight due to her decreased appetite, is sleep-deprived, unkempt and has been urinary incontinent for over three days. So continence was chosen because it is a fundamental aspect of everyday life (Department of Health, 2001a).    

Urinary incontinence is the complaint of any involuntary loss of urine (Abrams et al, 2009). It presents itself in different forms including stress, urge, mixed and overflow incontinence (NHS Information Centre) and is associated with increased risk of falls, embarrassment, denial, sexual avoidance, prolonged hospitalisation, caregivers burden and many others (Rhodes, 1995).    

However, to deliver high quality care, a comprehensive assessment should be conducted to establish possible transient causes. Transient causes of urinary incontinence can be due to delirium resulting from infection or sleep deprivation, dehydration, stool impaction, depression, medication or restricted mobility (Gray, 2000a).

Prior to this, nurses should explain the process of assessment to Lucille, gain consent (NMC, 2008), allocate sufficient time and establish a nurse-patient relationship that is based on trust, respect and empathy. This will encourage the disclosure of worries and concerns (Letvak, 1995). Also good communication skills are extremely important, as any relationship comes about through communication (Nolan et al, 2003).

It is advisable that nurses use an assessment tool to guide them with their process (NICE, 2006). In this case, the Bladder and Bowel Assessment Tool (Toronto, 2006) can be used to collect information about Lucille’s past medical history, medication, fluid and dietary intake, bowel movement, urinalysis, environmental barriers, dexterity, vision, cognitive, mobility and patterns of voiding which can be ascertained by completing a bladder diary. The bladder diary has been cited as the single most valuable tool in assessing urinary incontinence (Norton, 2001). There are varying opinions in literature as to how many days of recording are useful. Although the seven-day bladder diary is the most studied and reliable tool (Jeyaseelan et al, 2000), a three-day bladder has been found to have a good reliability (Yap and Cromwell, 2006) and is recommended by NICE (2006).

Asking Lucille whether incontinence happens on exertion, coughing, sneezing or when there is a strong urge to the toilet will also help to define the type of incontinence.

Once this has been done, a plan of care that is specific, based upon the goals, needs and strengths must be developed in conjunction with Lucille and her carer (SIGN, 2004). This ensures patient-centred care. Management strategies should include treating urinary tract infection with antibiotics. The aim of antibiotics is to relieve symptoms (SIGN, 2006). Still on this, a midstream specimen should be sent for culture and sensitivity. Although urinalysis is an effective screening tool, it should not be used in isolation to guide treatment because false results can occur if the sample is contaminated or left to stand for too long (Simerville et al, 2005).

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As for her fever (a raised temperature of 37.8C), Lucille should be given anti-pyretics to avoid complications (Kozier et al, 2008) and she should be monitored for signs of deterioration using the Early Warning Scale. This is effective in reducing mortality and morbidity of deteriorating patients (Hourihan et al, 1995). Since Lucille is producing thick yellow sputum, a sample for culture and sensitivity must be obtained and treatment must be commenced immediately. Yellow phlegm is a sure sign of a viral infection.

Other nursing interventions should include referring Lucille to physiotherapists for pelvic floor exercises, referral to Continence ...

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