Question

Urinary Incontinence Case Study: Mrs. Kingsley

A Case Study for Nursing Staff

Goals: 1) Raise awareness of value of UI assessment

2) Raise awareness of resident quality of life related to UI

3) Raise awareness of improving dialogue between all levels of nursing staff and

residents pertaining to UI

4) Raise awareness of the value of toileting programs for residents

Part I

Mrs. Kingsley moved into Gardens on the Green Care Center this afternoon. Her

husband of 54 years suffered a heart attack and died a month ago. Mr. Kingsley was Mrs.

Kingsley’s primary care giver for the last 3 years after Mrs. Kingsley had a stroke which resulted

in limited mobility of her right arm and a slow gait. Mrs. Kingsley enjoys using her mind and

enjoys being around other people, but she has been generally physically slower after her stroke.

The Kingsleys have 3 children. The 3 adult children live out of town. They tried to coordinate

home care for their mother over the last month after their father, Mr. Kingsley, died. But the care

was fragmented at best. The children offered to have Mrs. Kingsley move in with them, but Mrs.

Kingsley did not want to leave Evansville, the city where she grew up and where she raised her

family.

Mrs. Kingsley needs assistance with her activities of daily living. She needs assistance

with dressing because of limited mobility in her right arm. She can feed herself on her own

slowly, but does need help with meal preparations. She is able to walk with a cane, but moves

slowly. Mrs. Kingsley is considered “usually continent” – she has approximately one episode of

incontinence once every three weeks or so simply because she cannot get to the bathroom

quickly enough. Before he died, Mr. Kingsley reminded her to use the bathroom every 2-3 hours

and then took her to the bathroom once in the middle of the night.

On her first evening at the nursing home, the certified nurse’s aide, Sue, met Mrs.

Kingsley. As Sue was helping Mrs. Kingsley get ready for bed, Sue set up pads on Mrs.

Kingsley’s bed and explained to her that she will just put the pads on her bed in case Mrs.

Kingsley has an accident at night. Mrs. Kingsley was nervous because this was her first night at

Gardens on the Green. She did not say anything, but she wondered why she needed these pads.

After all, as long as she went to the bathroom once during the night before 3 am she never had a

problem with “accidents” as Sue called them. She did not want to seem like a pest and ask too

many questions on her first night. Sue’s charge nurse did not suggest that she wake Mrs.

Kingsley at night therefore Sue was just doing what she knew to do.

The next morning, Sue was gone and another certified nurse’s assistant named Kelsi was

helping Mrs. Kingsley get dressed and asked her to wear a Depends just in case she could not get

to the bathroom in time. The charge nurse was busy and Kelsi did not receive any other

instruction about Mrs. Kingsley’s toileting habits. Kelsi did not ask her if Mrs. Kingsley wanted

to wear the Depends and did not ask her about her bathroom habits. Mrs. Kingsley wanted to

talk about it, but Kelsi seemed rushed and Mrs. Kingsley did not want to be a bother on her first

day. After Kelsi left the room, Mrs. Kingsley sat and cried softly.

(End of part 1)

Questions – Part I:

1. How do you handle urinary incontinence with new residents who move into your nursing

home?

Answer: By asking them about what their daily bathroom habits ! if they are comfortable with placing a pad under them or wearing Depends.

2. How can you improve dialog with residents on the topic of urinary incontinence?

Answer: we can improve dialog with residents with good communication skills , asking them about their routine , by Reminding them 2-3 hours and taking them once or as need at night to the bathroom.

Part II.

A month later the same routine continued with Mrs. Kingsley. She used pads on her bed

at night and wore Depends during the day. She was no longer “usually continent”. She was now

classified as “occasionally incontinent” – having a few episodes of incontinence each week. Her

husband was no longer around to remind her to use the restroom and it was hard for the nurses’

aides to remember to remind her. Mrs. Kingsley was very self-conscious about her incontinence

episodes and wanted to stay in her room close to the bathroom in case she had to use the

bathroom. As a result, she was not attending activities and she was showing signs of depression.

Mrs. Kingsley felt helpless.

(End of part 2)

Questions – Part II:

 From this story, we only know some basic information on Mrs. Kingsley’s continence

patterns. What type(s) of incontinence could Mrs. Kingsley have and explain your

thought process?

1. What type of toileting program could you suggest in order to help Mrs. Kingsley?

Answer:

2. How would a toileting program impact Mrs. Kingsley quality of life?
3. How would a toileting program for Mrs. Kingsley impact your quality of life as a

caregiver?

Part II

Create a concept map on incontinence. Include these sections in your concept map

1. What is incontinence
2. Name Three Nursing diagnoses that a person can experience with incontinence
3. Identify one goal for each of your nursing diagnosis
4. Identify one intervention for each goal

Answer 1

What type of toileting program you suggest

Maintain a schedule for voiding at every 2 hours for 1-2 weeks, then gradually increase the time interval from 2 hours to 3 or 4.It should empty the bladder at right time, thus no more incontinanace can happen. Along with this, limit the fluid intake at night.

how would toileting program impact Mrs Kingsly's quality of life

Toileting programme can bring a positive outcome and she will be comfortable in that care center .She may feel self confidence in controlling and managing her tiolet needs.So she can get out of depression and participate in activities and can increase the quality of life.

How would a toileting program for Mrs. Kingsley impact your quality of life as a caregiver?

With the effectiveness of this programme, the patient will be more comfortable with your care and that can make a positive impact during the duty. Reduced frequency of linen change can reduce the workload as well

Nursing diagnosis	Intervention	Goal
Risk for urinary tract infection.	Timely assessment for the colour and odour of urine maintain acidic environment by using agents such as vitamin c, urinary antiseptic creams	Redced risk for urinary tract infection.
potential for impaired skin integrity related to frequent weting	Encourage for perineal care and keep the area dry after each voiding	improved skin integrity
Depression and reduced socialisation associated with incontinence	encourage tiolet training programm	improved social interaction