Case Study 2 : Preparing for Clinical Practice

Mrs. Grayson is a 75-year-old woman who has had a problem with urge incontinence
for the past 2 years. She has not spoken up 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
has type 2 diabetes and is obese. She has been referred to a continence specialist. A plan of
care was developed after a thorough assessment of her urinary pattern and symptoms.

● She has recently begun pelvic muscle exercises (Kegel) and bladder retraining. She
shares her concern that the exercises are not working and that she is still wet multiple
times a day. Which additional teaching does Mrs. Grayson need?
- Urinary incontinence and other pelvic floor issues can be prevented or
controlled with kegel exercises. It will assist the uterus, bladder, small
intestine, and rectum by strengthening the pelvic floor muscles. Kegel
exercises, sometimes referred to as pelvic floor muscle training, can be
performed at any time. You should expect improvements such as less frequent
urine leaks within a few weeks to a few months if you execute Kegel exercises
on a regular basis. Make Kegel exercises a part of your everyday regimen to
reap the benefits in the long run. As a result, as a nurse, we must continue to
stimulate and support Mrs. Grayson to carry on with what she has begun,
because the results or improvement will not always be fast. Sometimes,
patients will not see the effects of the Kegel exercises until 4 weeks. Also, ask
Mrs. Grayson what procedures or techniques she’s doing so that we can
reinforce the right technique or procedures she must follow.
● Two months after your first encounter with Mrs. Grayson, she has been seen by her
primary health care provider for burning on urgency. She was treated with an
antibiotic. Which health teaching does Mrs. Grayson need now?
- Since Mrs. Grayson has already been treated with antibiotics, the next thing
she must do is to learn how to prevent urinary infections (UTI). Therefore, we
must assess the different steps or techniques that she must take to prevent the
UTI, like drinking plenty of water and relieving herself often, wiping from
front to back, washing up before sex and urinating after it, steering clear of
irritating feminine products, and rethinking her birth control. Also, we must
assess Mrs. Grayson's need for good control of her diabetes because
uncontrolled diabetes can increase her incontinence and her risk of UTI.
● Mrs. Grayson is seen in the emergency department for a fever, hematuria, and
elevated postvoid residual (UTI). Which ongoing assessment is needed?
- Chronic urinary retention develops over time and may cause few or no
symptoms, which may make it hard to detect. As a nurse, we must assess Mrs.
Grayson's different signs and symptoms of urinary retention like difficulty
starting to urinate, difficulty fully emptying the bladder, weak dribble or
stream of urine, loss of small amounts of urine during the day, inability to feel
when the bladder is full, increased abdominal pressure, lack of urge to urinate,
strained efforts to push urine out of the bladder, frequent urination, and
nocturia, or waking up more than twice at night to urinate. Mrs. Grayson
should know of these symptoms for her to be aware and prevent them. Also
PVR should be measured within 5 to 10 minutes of voiding.
 REFERENCES:

● Machalinski, A. (2017, February 13). Best ways to lower your chance of getting a
UTI. WebMD. https://www.webmd.com/women/guide/avoid-uti

● Kegel exercises: A how-to guide for women. (2020, September 15). Mayo Clinic.
https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/kegel-
exercises/art-20045283?fbclid=IwAR2CQIORKYejzc19DoyOiW6g68j3Uk2-
XuBzCjY0uJZY_imAP-5BdEx3wCA#:~:text=To%20do%20Kegels%2C%20imagine
%20you,only%20your%20pelvic%20floor%20muscles

● Medtronic. (2018). Urinary retention - Urinary retention causes and symptoms.

Global Healthcare Technology Leader | Medtronic. https://www.medtronic.com/uk-
en/patients/conditions/urinary-retention.html?
fbclid=IwAR2IDNt0YMRiw9WSvJHt61ste3uJBT5CAu5nxQ-
obPa4qVE3iA39PVN8PzM