Childcare

My chosen topic area of care for Lucile is continence, Lucile is a 72 year old women living in a house alone with her daughter in-law as her only carer who lives locally, Lucile’s health has been deteriorating in last 2 and they receive no help from services such as social care. She has had numerous falls she is a smoker with a productive cough with yellow sputum, she does not drink likes to read an go church she wears glasses as she has poor eyesight, Lucile usually mobilises with a walking stick but is now immobile due to latest fall. This admission has come about a fall she has had the morning she presents with several bruises to her upper body pain in her right hip, mild confusion, incontinence indigestion. Current medications are gaviscon when required ibuprofen and aspirin. Her observations were as follows saturations 95% temperature 37.8 heart rate 96 b/p 120/70 respirations 25 shallow and regular and ketones proteins and leukocytes are present in her urine. In the assignment I will looking at a continence assessment tool and using it to assess Lucile’s continence analysing the tool to see good and bad points of the tool in regards to assessing Lucile and looking at national guidelines policies that give the best practice for managing continence. I will then analyse the care that she needs whilst she is admitted such as appropriate referrals and investigations that will be needed with consent gained. As continence is not Lucile’s only health issue I will look and analyse the holistic impacts continence has other aspects of her life understand how she may be feeling. And putting referrals in place for her continued care one she is discharged. I have chosen to use a continent tool to asses Lucile’s management of her continence. The tool asks for general information such as name date of birth medical and surgical history and any medication currently being taken. The tool begins by asking a series of questions on lifestyle factors, such as do you smoke, your usual routetein of urinary elimination. The tool then continues onto symptoms you may be experiencing of the bladder to try and define what type of incontinence a patient such as Lucile may be having. There are different types of incontinence one might suffer from such as stress incontinence, overactive bladders, overflow e.t.c, which will enable health professional, eliminate and correctly diagnose. In regards to using this tool to assess Lucile you can gather her medical history and social history but due to her mild confusion she may not be able to give an accurate accounts of her continence problem as to when it started and if it’s getting any worse, as the questions are pacific to gain an overall picture. Lucile had been incontinent for three days prior to her being admitted as she lives alone with the onset of confusion her explanation may be altered making it difficult to assess. The tool asks for urinalysis results which Lucile does have a urine infection which could be causing her confusion along with her low saturations of 95 percent. By using a tool to assess continence you can be able to give an elderly patient like Lucile better quality of care whilst the issues are being resolved. It then gives options of treatment depending on the type of incontinence in regards to Lucile it may be underactive bladder, the tool then suggests actions such as catheterisation, bladder scanning and future referrals. There has been research done that by using an assessment tool is an effective method of assessment. the British journal of nursing who developed the pathways for continence state that pathways are being used by many trust and have improved care of continence even thought they have been adapted to simplify for assessment which was anticipated, using these tools are encouraged because they are promoted in guidelines for care (department of health 2000). Lucile has been admitted with a number of health issues including her continence state which requires nursing attention to assess and meet the needs she requires. Lucile’s continence will have to be assessed with her consent and looking after Lucile along with her assessment a bladder diary is required to monitor Mrs. McKenzie’s urine output. Bladder diaries are said to be used by nice guidelines to enable the health worker to recognise a pattern of how frequent and the times of the day of continence episodes. “Bladder diaries are a reliable method of quantifying urinary frequency and incontinence episodes” (nice clinical guidelines). Whilst Lucile is admitted into hospital care we can begin to meet her health and emotional needs. Once admitted as nurses we can also talk to Lucile to see how she is feeling explain to her what going on and discuss the plan of care to her, to give her peace of mind. With regards to Lucile’s continence appropriate assessments and referrals need to made to ensure Lucile’s needs are met all patients presenting with incontinence should be offered an initial assessment by a trained individual (good practice in continence service DH 2000). Such as putting her on a food diary to monitor what she has eaten and drank throughout the day, make a dietician referral as she has lost her appetite, and maybe diet is having an effect on her continence. She has many factor which can affect her continence, also a referral to tissue viability as has a red painful soar on her sacrum, which will need assessing as she has urinary continence issues, urine can aggravate the skin due to ph acidity levels causing it to irritate and breakdown the skin also heightening the risk of infection. If not resolved and develops into a pressure ulcer. (the epidermis is the first layer of defence once the ulcer has broken through and works it way through the subcutaneous layer electrolytes and proteins are lost) pg 164 clinical nursing skills and techniques. So it is vital to sort out the incontinence to help maintain dignity and respect and to minimise further discomfort for Lucile. As the nurse a waterlow assessment will need to be carried out so she may be on a suitable mattress to also minimise the development of a pressure ulcer. She has lost weight recently as she has lost her appetite from this we can see if, With the consent of Lucile once observations are done other tests like bloods may need to be taken for investigation for abnormalities, infections as she has a high temp blood gases to check O2 saturations, also catheterization may also be required to monitor her urine output, referrals to physiotherapist to help Lucile mobilise, this is factor for her incontinence as she may not be able to make it to the toilet on time, and may also be restricted by the pain in her joints. occupational therapist can provide aids Lucile may need whilst in hospital and on discharge such as walking aids, modifications in the home such as rails ramps equipment to help with bathing as if this is made easier life on Lucile and her carer can be a little easier to maintain hygiene, as Lucile has been unkempt for a while, and with the right equipment in place will enable task such as bathing easier, these issues can be discussed with Lucile and her carer to identify what help is needed social workers are needed as Lucile gets no help from community services. Also the doctor will have to review her medications as these can have an effect on incontinence such as diuretics oxygen may have to be prescribed as Lucile has shortness of breath at rest. With the referrals and investigations put in place this should help to meet Lucile’s requirements and updates to the medical team and other members of the multidisciplinary team on her progress to be continually assessed and re-evaluate. To give her a better quality of life with her and her carer managing the continence adhering to best practice at all times whilst in my nursing care. In relation to Lucile’s incontinence this will have a huge impact on many factors that will have affecting her holistically on her emotional well being and mental state Lucile has already become withdrawn as she no longer integrates in society like she use to. Her mood has become lower and she no longer goes to church, she realises that she is not as kept as she’s accustomed to be as she no longer takes time on herself to look her best. Lucile may be feeling embarrassed due to the smell of urine on her skin and clothes and with impaired vision this may have an effect on her falls when trying to mobilize and tripping over obstructions in her home. She feels Self conscious as she suffers more problems that are impacting her life. As a nurse I would give Lucile and her carer advice on how to maintain dignity and respect for Lucile as an older adult for her to feel more empowered and motivated giving appropriate advice on continence management so it does not restrict her enjoying the things she uses to do like going to church, fixing Lucile’s glasses so her sight not impaired so she can enjoy reading again. She has become immobile due to numerous falls, unable to mobilise fully has restricted her getting to the toilet on time. So with the loss of independence she has become vulnerable and dependant which will be affecting her as she has a loss of appetite and has lost weight. With lack of food and drink Lucile may also be restricting her fluid intake to help with not having to pass urine more frequently which can cause her to become dehydrated. By completing a MUST assessment we can help to meet Lucile’s dietary requirements. “a must tool provides theoretically and practical framework for the clinical detection and management of nutritionally responsive conditions, caused by physical and psychological problems the tool is simple, reliable and suitable for health care workers operating in different settings”(bapen 2011). There may also be safeguarding issues with Lucile as she has bruising to the chest and back which may not be caused by her falls even though she is a vulnerable adult she has human rights to be treated appropriately there are guidelines put in place from government bodies the department of health state that a consistent and effective response is needed to act on grounds of expressed concerns and anxiety, the aim is to prevent abuse but if unable to so then agencies need to ensure appropriate actions are made to deal with incidents of abuse. This is ensuring best practice is used to enable the vulnerable to be protected improving all aspects of wellbeing. Once Lucile is ready for discharge appropriate referrals have been made to her G.P informing them of Lucile’s care, social services to help with services available Lucile may need and financial support. She will may need physio referrals as an outpatient to continue her care in mobility and equipment at home such as rails walking aids commodes if unable to reach the bathroom by having a package of care put in place this should meet her physical needs hopefully having an holistic impact with a knock on effect that her low mood may lift. For the carer to manage Lucile’s continence, such as designated toilet times along with new support in place for both.