Promoting Urinary Continence After Stroke

Almost half (45%) of all people with incontinence wait at least five years before they get help, according to Karen Logan, a continence nurse at Gwent Healthcare NHS Trust.

This reflection case study will be discussing urinary continence management using Gibbs reflective framework (Gibbs,1988). This will include what is urinary incontinence management, the pathophysiology of urinary incontinence after stroke, how continence affect patient and current clinical practice and the role of the nurse and multi-disciplinary team within continence management. Also using the evidence based research and national guidelines.

Incontinence is one of the major problems faced by the elderly. Nurses can play a significant role in discovering continence problems (Lea R.et.al.2007). Urinary incontinence is the unintentional passing of urine. It is a very common problem and is thought to affect more than 50 million people in the developed world.(NHS.UK). To identify the problem and provide necessary treatment at the early stage, a thorough physical assessment is necessary.

First, neurological disorders can occur, as seen with Alzheimer’s disease and Parkinson’s disease, which can lead to neurogenic bladder (“Neurology/Neurogenic Bladder,” 2017). Next, physiological disorders can occur as seen with enlarged prostate in men or shortening of the urethra in women (Jaipaul, 2017). Anticipating the above changes appropriately will aid in understanding what leads to urinary retention in older adults, the resulting need of catheterizations, and the CAUTIs that can follow. Having a foundation to build on, it would be beneficial to explore what nurses can do prevent urinary tract infections in patients who require catheterization.

J. (2015). Addressing the burden of stroke caregivers: a literature review. Journal of Clinical Nursing, 24(17-18), 2376-2382. doi:10.1111/jocn.12884

“Oh, this is awful,” Jenny muttered to herself. She was sitting on the toilet with a pair of very wet panties and slacks around her ankles. Jenny never knew when it would hit―this need to urinate quickly. She would find herself running to the bathroom like a woman possessed and then usually not making it in time. “It also seems like I’m peeing all the time,” she said. “This is getting old really fast,” she thought, as she continued trying to squeeze the urine out of her panties using quantities of toilet paper.

The patient and their families must be aware of the infection, the source of infection, signs and symptoms, treatments, and measures to apply at home to decrease their risk of receiving an infection. Because geriatric patients are incontinent they may need a catheter in place to help remove their urine. Nurses must perform aseptic technique, wearing proper gloves when inserting or removing device. Another way to help reduce the risk of elderly urinary tract infections would be to avoid or remove catheter soon as possible. Once patients are cleared for discharge they must be aware of the steps to take to insure proper bladder

According to the evidence based research done by Overton Brooks VA Medical Center “implement a bladder retraining trial in compliance with the NPSG to prevent CAUTIs. The goal was to decrease infection risk by decreasing the length of time catheters were in use and reinsertions. Decreasing reinsertion rates not only reduces infection risk but also decreases post-op length of stay, saving money and resources.” (Shreveport, 2013).The way I would share with my employment would be to have in service education for all staffs and share the information about normal bladder function. Also instruct nurses to teach patients to have voiding schedule that incorporates regular delay of voiding by using interruption and relaxation techniques, self-monitoring,

Evidence-Base practice (EBP) is defined as based on problems identified from nursing practice; using best evidence and professional expertise and merging them into current practice to ensure patients receive quality care (French, 1999). Evidence-based practice is a part of quality improvement process; it is made of evidence, clinical expertise, patient preference and the context of care (Barker, 2013). In brief, evidence-based practice is the guideline in the nursing practice that requires nurses gather and use clinical evidence to help diagnose or assess patients correctly by using their knowledge and experience in order they can deliver the quality of care to the patients (Ellis, 2013). In the other words, in the nursing practice the clinical evidence supports all the nursing procedures performed.

In almost all cases of dementia, stroke is the main pre-cause towards this disease. The first thing to prevent this disease will be to understand what a stroke is and how to prevent it from occurring, although some cases in which a stroke surfaced, the subject was not at risk of any symptoms for a stroke, so it can be a guessing game. Seizures, hypotension and urinary incontinence are the three strongest predictive signs of post stroke dementia. Scientists use a new predictive theory to lay down a concrete analysis on whether or not a patient is at risk for post-stroke dementia. In summary, a stroke is associated with an increased risk of dementia. “About 1-in-10 patients are demented prior to first stroke, 1-in-10 develop new dementia soon after first stroke, and over 1-in-3 are demented after a recurrent stroke.” The number one pre-stroke dementia care factor is optimal acute stroke care and prevention of recurrent stroke are likely to be effective in slowing the pain of post-stroke

Urinary incontinence (UI) can be defined as, “involuntary leakage of urine to a degree that it is troubling to a person” (Mauk, p. 545). Not only it is a common problem for the elderly, which has a tremendous impact on their quality of life, it is also a common health problems that affects more than 17 millions of Americans (Testa, p. 82). Even though urinary incontinence is a common problem for the senior it is not a normal part of the aging process, however vast majority of people still does not seek help due to the fact that they think it is a normal part of aging and the embarrassment related to the social stigma associated with the disease. As a healthcare

Stroke survivors commonly experience medical complications during their rehabilitation stay. Depression, urinary tract infection, and limb pain have been reported as three of the most common complications experienced among stroke survivors (Doshi et al., 2003, McLean, 2004). The use of medical tubes (tracheostromies, enteral feeding tubes, and indwelling urinary catheters), and associated complications, are also on the increase in rehabilitation units (Roth and Lovell, 2003). (Ostwald, Sharon K., et al.,

The services will be provided to the clients in the Chicago's northwest suburban community. The main target group would be people who are 18 and older with one or more urinary related issues; including age and postpartum incontinence. The Urinary Continence and Wellness Clinic Services will adopt an approach to service that embraces a philosophy of respect for, and partnership with, people receiving services. A client centered urinary continence service

For many people, getting older can be difficult because of fear. They worry about what could happen to them or what type of diseases they might develop later on. To become a more mature adult is a stage of life that each individual will experience in a certain point. Statistics shows that eighty-eight percent of those of sixty-five years of age and older have at least one chronic health condition such as diabetes, dementia, Parkinson’s disease or cancer. (ezinearticles.com). This scholarly essay will focus mainly on urinary incontinence (UI) which is a common health problem that elderly may have.

Stroke is seen as a major health concern and this is due to the fact that every year, as many as 110,000 individuals suffers from strokes making it a key issue. (NHS 2014)