Question

Mrs. Johnson is a 70-year-old woman who had a stroke less than a year ago. Mrs. Johnson is alert and oriented. She feels the sensation to void but right-sided weakness prevents her from always being able to get to the bathroom in time. For this reason, she wears incontinence undergarments. Mrs. Johnson’s daughter, Amy stops by twice each day to check on her and prepare meals for her. There are times when Mrs. Johnson is incontinent and remains in a wet undergarment until Amy comes to visit.

While assisting Mrs. Johnson in the bathroom, Amy notices that Mrs. Johnson’s coccyx and perineal area are reddened and excoriated. Amy learns that Mrs. Johnson sometimes sits in a wet undergarment until she arrives. Mrs. Johnson explains, “I know I am wet. It is just easier to wait for you to get here than to try and change the undergarment myself.” Amy is concerned. She calls a local visiting nurses association to get some information about how to manage Mrs. Johnson’s incontinence and asks if there is any skin therapy to reduce the redness.

1. Describe at least three factors that affect voiding and may result in incontinence in an adult.
2. What is incontinence? Describe the characteristics of each of the six types of urinary incontinence: stress, reflex, urge, functional, total, and transient.
3. Which type of incontinence does Mrs. Johnson have and what data support the diagnosis?
4. Mrs. Johnson tells the nurse, “I try to limit the amount of fluid I drink to one of two small glasses a day so that I do not have to go to the bathroom as much.” What teaching should the nurse provide in response to this comment?
5. Explain at least three factors that are contributing to Mrs. Johnson’s impaired skin integrity.
6. What will the visiting nurse most likely tell Mrs. Johnson and Amy to consider in an effort to minimize Mrs. Johnson’s incontinent episodes?
7. What are three suggestions the visiting nurse will include while teaching Amy to care for Mrs. Johnson’s skin?
8. List five nursing diagnoses that are appropriate for Mrs. Johnson (three-part diagnoses).

Answer 1

3 factors that affect voiding and may result in incontinence in an adult.

• Age related changes and weak bladder sphincter (here patient is 70 years old)
• Poor pelvic floor muscle competency (As age advances, these muscles function get delayed)
• Being over weight
• Continuous sneezing, coughing (Cause increased abdominal pressure)
• Heavy weight lifting ( Cause incresed abdominal pressure)

What is incontinence? Describe the characteristics of each of the six types of urinary incontinence: stress, reflex, urge, functional, total, and transient.

Incontinenece is a problem associated with poor bladder and bladder sphincter control, which is characterized by episodes of dribbling of urine to loss of ability to control the urine flow following sneezing, coughinh, heavy weight lifting etc.

Stress Incontinence: A type of incontinence, where the leakage of urine will develop following any physical activities like coughing, sneezing,lifting any heavy objects, walking, running etc. All these activities may cause pressure up on the bladder and leads to urine leak.

Reflex incontinence: A type of incontinence develops due to any abnormalities of the bladder muscles. In this type of incontinence, usually the individual do not have an urge to pass the urine.As the bladder fills, the urine will flow out immediately.

Urge Incontinence:A type of incontinence associated with an incresed urge to void, followed by sudden loss of urine.

Functional Incontinence:A type of incontinence, where bladder is functioning well, but due to certain environmental factors, dementia, poor eyesight etc, the individual will pass the urine before they reach the toilet.

Total Incontinence: The type of incontinence associated with complete loss of bladder control. Commonly seen in some neurological disorders, atonic bladder etc.

Transient Incontinence: Type of incontinence associated with any functional etiology. Resolving the etiology will improve the bladder control and reduces the symptoms of incontinence.

Which type of incontinence does Mrs. Johnson have?

As per the clinical data, given mrs. Johnson is having stress incontinence. She is having the sensation to urinate, but due to her musculo skeletal imapirement she cannot reach the toilet on time because of walking difficulty.

Three factors that are contributing to Mrs. Johnson’s impaired skin integrity.

• Continuous exposure of body to moisture: ( since she is wearing incontinence garments, they absorbs urine fast and remain wet, which contains more water content. Continuous exposure to this moisture may cause skin break down.)
• Friction of the skin caused by the incontinence garments: ( Since the incontinence garments are in close contact with the skin it can cause mechanical friction and irritation of the skin leading to skin break down.)
• Restricted physical activities and movement due to stroke

Consider in an effort to minimize Mrs. Johnson’s incontinent episodes?

Advise mrs. Johnson to go for a time planned voiding pattern, this will help the patient to reduce the risk of incontinence due to filling of the bladder. Since she is having stress incontinence associated with stroke and walking difficulties, she can plan to void every 2 hourly. Apart from that if she is capable she can perform the light exercises to improve her mobility.

Three suggestions the visiting nurse will include while teaching Amy to care for Mrs. Johnson’s skin?

• Advise to avoid prolonged sitting on hard surface.
• Provide meticulous skin care with skin soothening lotions, oinments etc.
• If a time set voiding plan is used, no need of wearing the incontinence garments and there by the skin friction can be reduced.
• Dry the skin and avoid exposure to moisture.

List five nursing diagnoses that are appropriate for Mrs. Johnson

Impaired physical mobility related to musculo skeletal impairment as evidenced by restricted movement and difficulty in walking.

Impaired urinary elimination, urinary incontinence related to sensory and motor impairment as evidenced by frequent voiding.

Impaired skin integrity related to mechanical friction of skin as evidenced by presence of skin break down over the coccyx region.

Impaired walking related to musculo skeletal impairement as evidenced by weakness of the right side of the body.

Activity intolerence related to muscle weakness as evidenced by unable to perform activities of daily living by self.