Urinary Incontinence Assessment

"There’s a huge stigma around incontinence despite it being so common," she says. "I would urge anyone with symptoms to come forward as it’s more than likely that we can sort out the problem and really improve their quality of life."

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.

Incontinence can affect individuals mentally as well as physically, it can have a negative effect

Urinary incontinence is very common following a stroke with 40-60% of hospitalised patients experiencing it in the acute phase, 25% on discharge and one third of survivors experiencing ongoing problems at one year (Barrett 2002, Kolominsky-Rabas et al.2003).Bladder and bowel problems are common following a stroke and can have a huge impact on physical and psychological aspects of quality of life, for both patients and carers. Health care professionals can do much to help improve and manage incontinence problems in stroke patients and this starts with a good understanding of key issues. Mobility and manual dexterity problems can compound bladder and bowel symptoms because they can make toileting access difficult, other problems such as visual disturbances, dysphagia and cognition also contribute indirectly to continence difficulties. There is evidence that professional input through structured assessment and management of care, together with the involvement of specialist continence nursing services, may reduce urinary incontinence and related symptoms after stroke. Bladder and bowel care requires active management –this includes a written personalised plan, taking into consideration required assistance, personal needs and goals. This essay is an overview on the importance of timely nursing assessment and management of urinary incontinence

Joint Commission released national patient safety goals for hospitals in January of 2016. These patient safety goals were “established to help accredited organizations address specific areas of concern in regards to patient safety” (Facts about the National Patient Safety Goals, 2015). National patient safety goal 07.06.01 focuses on the prevention of catheter associated urinary tract infections (CAUTI) in hospitalized patients. Evidence based practice should be implemented to stop these common infections occurring in patients nationwide. Indwelling urinary catheters are only recommended in certain patients, for example to prevent further breakdown of sacral wounds or pressure ulcers in incontinent patients, for comfort in end of life care

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.

Father gets up once during night to empty his bladder and mother reports problems with bladder leakage from stress incontinence(Johnson family, personal communication, June 24, 2012).

The three questions addressed were: Who should receive urinary catheters, what are the best practices for those who require urinary catheters and for preventing CAUTI’s acquired from urinary obstruction. This updated guideline offers recommendations for the appropriate use of indwelling catheters utilizing appropriate indications for usage, proper techniques for insertion of indwelling catheters, proper techniques for indwelling catheter maintenance, quality improvement programs, administrative infrastructure and surveillance including identifying those at risk for CAUTI (Gould et al, 2009). The strengths of this guideline are that many questions and scenarios are examined in this document and answered in explicit detail. Any healthcare professional can refer to the document to answer most practice based questions that are posed to them regarding indwelling urinary catheters. One weakness identified is the lack of an alternative explored for the external catheterization for female patients, for example the Purewick solution. However, the Purewick was not released until January 2016 and this guideline was last updated in 2009. Integrative Review

Urge incontinence is defined within the context of overactive bladder syndrome. The overactive bladder is characterized by bothersome urgency (a sudden and strong desire to urinate that is not easily deferred) (Abrams et al, 2002). Overactive bladder is typically associated with frequent daytime voiding and nocturia, and approximately 37% will experience urge urinary incontinence (Stewart et al, 2003).

2011). Incontinence is defined as the complaint of any involuntary loss of urine (urine incontinence) or faecal material (faecal incontinence) or both (double incontinence) (Abrams et al. 2009). Incontinence is a widespread problem in all healthcare settings (Du Moulin et al. 2008; Macmillan et al. 2004). Figures produced by Macmillan et al. (2004) studies on the prevalence of incontinence varied but prevalence was estimated between 10% and 15% for faecal incontinence measured in community-dwelling adults and up to 46% for urinary incontinence measured in older, home-care patients in Du Moulin et al. (2008) studies results. This shows that there is a huge amount of patients at risk for IAD due to them having the risk factor of incontinence. Therefore the prevention of IAD should be paramount in the care of any patients or clients who are at risk for

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

The survey contained two sets of questions. The first set was designed to gain and understand of what the customers thought they were currently paying for urinary incontinence care. This included the actual cost of diaper and catheters, as well as secondary costs such as the cost of nurse/care giver time and the cost of infection/bedsore

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.