CASE STUDY 2

Preparing for Clinical Practice

Mrs. Grayson is a 55-year-old woman who has had problems with stress incontinence
for the past 2 years. She has not spoken to anyone about her problems because she is
embarrassed. She finally confides to her health care practitioner that the problem is
causing her to avoid social situations and she would like help to regain urinary control.
Mrs. Grayson weighs 200 pounds, and her height is 5 feet 1 inch. She has been
referred to a continence specialist. A plan of care was developed after a thorough
assessment of her urinary pattern and symptoms.

1. She has recently begun Kegel exercises to attempt improvement in her urinary
control. She doesn’t see any improvement. She has been trying to deal with the
problem by using an absorbent pad in her underwear, but she feels as though everyone
knows her problem. What additional teaching does Mrs. Grayson need?

2. Two months after your first encounter with Mrs. Grayson, she has been seen by her
primary health care provider for burning on urination with increased frequency and
urgency. She has also noted blood in her urine for a week. What is Mrs. Grayson
experiencing and what can you teach her to minimize her symptoms?

3. Mrs. Grayson says she is not satisfied with her current state of urinary control and
has decided on a more permanent solution to her stress incontinence. She opts for a
minimally invasive procedure that will provide support for the urethra. She will be going
home with an indwelling catheter. She asks how to care for the catheter while she is
home. She does not want another urinary tract infection.

What do you tell her about measures at home to remain infection free?