Case Scenario: Mrs.
P is an 80-year-old retired school teacher who receives visits from a nursing agency for
congestive heart failure. Mrs. P was diagnosed with dementia 4 years ago. She lives with her daughter, who is
also her caregiver. In addition to dementia. Mrs. P has macular degeneration. She is blind at her left eye and has
significantly impaired vision in her right, she fell and fractured her left hip 1 year ago. She walks with the
assistance of a walker. She has a moderate amount of ankle and foot edema bilaterally. She always suffered
from frequent constipation. Her current medication include; hydrochlorothiazide, a calcium channel blocker and
a stool softener, Mrs. P is able to get in and out bed by herself but requires assistance with all other ADLs. She
has been incontinent of urine for 2 years.
Mrs. P voids but leaks urine before she gets to the bathroom.
Mrs. P wears incontinence undergarments. She also has enuresis and usually wet in the morning
1. Enumerate and describe each different types of urinary incontinence.
Stress- UI due to increased intra-abdominal pressure, associated with coughing, exertion, etc.
Urge- Leakage of urine associated with sudden urge to void, frequency of micturition.
Mixed-Both stress and urge symptoms.
Overflow- Symptoms sometimes comparable to those of stress and urge UI, but may have a sensation of bladder
fullness, a weak stream, straining to void, dribbling UI or post void dribble.
Functional- Inability to reach/ use/ request an appropriate receptacle to void intro.
Passive- May be unaware of UI occurring
Reflex- UI as a result of detrusor contractions with no voluntary inhibition.
2. Make a drug study of hydrochlorothiazide and stool softener
Name Indication Pharmaco contraindication Side effect Nursing consideration
dynamics
hydrochlorothiazide HCTZ Contraindicated in anorexia, Elderly and debilitated
Adults: Initially increases patients with anuria, nausea, patients need close
, 25 to 200 mg urinary hepatic coma, or observation and may
P.O. daily for excretion of hypersensitivity to pancreatitis need reduced dosages.
several days or sodium and other thiazides or epigastric They’re more sensitive
until dry weight water by other sulfonamide distress, to excess diuresis
is attained. inhibiting derivatives. Use because of age-related
Maintenance sodium cautiously in changes in CV and
dosage is 25 to reabsorption in patients with renal function. Excess
100 mg P.O. the cortical severely impaired diuresis promotes
daily or diluting tubule renal or hepatic orthostatic
intermittently. of the nephron, function or hypotension,
A few thus relieving progressive hepatic dehydration,
refractory cases edema. disease. Drug isn’t hypovolemia,
may require up effective if hyponatremia,
to 200 mg daily. creatinine clearance hypomagnesemia, and
is less than 50 hypokalemia.
ml/minute.
3. What is the common cause of urinary incontinence of Mrs.P?
She suffered from frequent constipation. Also Ms. P has Dementia and macular degeneration.
4. How can you stop incontinence in older adult?
Pelvic muscle exercises (also known as Kegel exercises) work the muscles that you use to stop urinating.
Timed voiding may help you control your bladder. In timed voiding, you urinate on a set schedule, for example,
every hour. You can slowly extend the time between bathroom trips.
Lifestyle changes may help with incontinence. Losing weight, quitting smoking, saying “no” to alcohol,
drinking less caffeine (found in coffee, tea, and many sodas), preventing constipation and avoiding lifting heavy
objects may help with incontinence.
5. Is incontinence a normal part of aging, explain?
Urinary incontinence in the elderly is a prevalent, bothersome and costly problem, and is not necessarily
a normal part of aging. Structural changes in the aging bladder and urethra may predispose the elderly to the
development of urinary incontinence.
