Foundations Health And Wellbeing

Client Profile

A case study regarding a patient suffering from urinary tract infection (URI) is developed as part of the essay. The confidentiality of the patient is ensured by referring all the information about the individual in an unidentified manner as per the suggested code of conduct by the Nursing and Midwifery Council (NMC). The consent is taken from the patient regarding whom the case study is framed prior to mentioning the facts by informing the individual regarding the way the shared information is to be used. In the case study, the patient will be named as P and the nurse mentor will be indicated as NM. P is an 80-year-old woman who is admitted to the Elderly Ward in the hospital as she was facing problem of urinary tract infection which includes cystitis, urinary incontinence, urethritis and cystocele. The cystitis is referred to the infection of the bladder and urethritis is infection of urethra which is common form of UTIs. They commonly affect the women urinary system due to its anatomical structure which allows the bacteria and microorganisms to thrive easily to infect the tract (Lapidus et al. 2017).

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The Cystocele is referred to the condition in which the supportive tissues holding the bladder as well as the vaginal wall weakness resulting the bladder to bulge in the vagina (Jameel& Mahmud, 2016). The treatment of cystocele is repair surgery where the surgeon fixes the tissues but the surgery often leads to urine leakage, injury to bladder, narrowing of vagina and others (Vitale et al. 2016).
P has a long history of burning sensation, pain and irritation in the urinary tract; infrequent urine passage; uncontrolled bladder condition and stomach pain which is the key cause of her many admission to the hospital. Furthermore, P has history of diabetes mellitus along with various allergies with food and gastroesophageal reflux disease. The patient named

P is seen to currently live in a rural area within an attached household where she is to share a single washroom with five of her family members. The washroom conditions are informed to be unhygienic in nature as reported by P during communication with the nurse in the hospital. The UTIs often arise among women who use washroom that is in unhygienic condition as bacteria and fungi responsible for causing the UTIs are found in such condition. Also, suppressed immune system as a result of diabetes results to raise risk of causing UTIs (Nitzan et al. 2015). The UTIs are often treated by using antibiotics to avoid the infection to be spread into the blood and other parts of the body. This is because such condition may lead to kidney damage and blood in the urine (Bryce et al. 2016).

Body System

The client P’s health condition has hindered her normal functioning of the urinary system which is further raising complication to her health. The key function of the urinary system is to remove liquid waste materials in the form of urine from the blood to keep proper salt balance as well as maintain normal content of other substances in the blood (Abraham & Miao, 2015). This is because increased build-up of waste in the blood causes damage to the body as they are harmful substances and they are to be removed for effective functioning of the body. The urinary system also acts to maintain proper fluid content in the body and they are involved in production of erythropoietin (produced in kidney) which is a hormone that helps in formation of red blood cells that transfers oxygen from the lungs to rest of the body (Rehfeld, Nylander & Karnov, 2017). In the urinary system, the Kidneys are the primary organs which filter waste from the blood. They are also involved in maintaining concentration of salts such as sodium, calcium, potassium and others. The filtered waste by the kidney is transported through the ureter to the urinary bladder and when the bladder is filled up with urine they realises it through the urethra to the outside in females (Chung, Cheng, & Tse, 2016).

In case of client P, it is seen that her condition of cystitis, cystocele and urethritis has led her to feel difficulty to completely remove urine from the bladder. This is evident as improper positioning of the bladder as a result of cystocele causes urine retention in acute cases along with feeling of pain due to cystitis and urethritis causes urine incontinence (Borys et al. 2019). This has led P to develop infection in the urinary tract that has spread to the entire urinary system because the incomplete removal of urine has led bacteria to grow in the bladder which has spread to the kidney through the ureter. The urinary tract infection damages the cells present in the ureter as well as in the kidney which lower the proper filtering efficiency of the kidney. This leads to development of wastes and salt imbalance in the blood which damages the proper functioning of the body (Hibbing, Conover & Hultgren, 2016). Further, as a result of P’s different urinary tract complication that has infected her urinary tract, the infection may spread into the blood through the kidney. This would lead to presence of harmful microorganisms in the circulatory system which may further damage her different organs (Sokolski et al. 2017).

Activities of Living

The Roper-Logan-Tierney model is a nursing model that focuses on the activity of living for the patient (Williams, 2015). One of the key activities of living to be considered for the patient P is her elimination of wastes outside the body. The elimination is done by the individuals through breathing, urinating and faecal release through the urinary system. The elimination is required by the body so that the harmful waste produced in the body does not affect the internal parts (Lamb et al. 2016). However, the presence of urinary tract infection (UTI) in P in the form of cystocele, urethritis and cystitis would result her activity of elimination to be altered. This is because in cystocele the bladder that stores the urine get bulged out into the vagina as the muscles and tissues that support the bladder and vagina is stretched and weakened making the bladder to sag from its normal position. This bulging out of the bladder put pressure on the bladder that results in urinary incontinence (Lamblin et al. 2016). The urinary incontinence is already found to be faced by P which is making her experience issues with proper elimination as she cannot keep proper control of her bladder during urination.

The urethritis is referred to inflammation of the urethra which is the key tube that carries urine outside the body. This condition leads individuals to face pain during urination (Horner et al. 2016). Thus, the condition also has an effect in altering the elimination activity of P as due to pain as result of urethritis she may be avoiding to properly urinate resulting to store urine in the bladder helping the bacteria to grow inside the urinary bladder as a result of storage of urine. Moreover, in cystitis, the bladder gets inflamed as result of entry of bacteria through the urethra in the body. This results in creating burning sensation as well as develop frequent urge to pass urine (Katz et al. 2017). This is going to interfere with the elimination process of P as due to frequent urge to urinate she is going to face urinary incontinence. Further, the burning sensation would make her feel uneasy to eliminate properly leading to storage of urine in the bladder that would adversely affect her health.

The UTIs are often controlled and treated through medication and surgery and the surgical process are nowadays invasive in nature (Schaeffer & Nicolle, 2016). However, the patients require discussing the side-effects of the surgery and medication so that they are able to take proper precautions and measures to lead a healthy life through effective planning. Therefore, the elimination process of P would now be altered in the sense that it would be coordinated through use of medication along with use of urinary catheter and implication of surgery to resolve cystocele for ensuring proper release of urine from the body to maintain homeostasis.

The other key activity of living that would alter as a result of UTI in P is way to maintain safe environment. The bacteria usually enter the body through the urethra that causes rise of urinary infection in the urinary tract (Mody et al. 2015). Thus, the presence of UTI would lead P alter her habits of maintaining safe environment by cleaning her urinary region after elimination so that no bacteria enter the body due to unhygienic condition of not washing after elimination. As mentioned by Maki et al. (2016), women are more prone to get infected by UTI as the ureter is smaller in length. The small length of the ureter leads bacteria present in the bladder in women to travel much shorter distance to reach the kidney for raising infection over the enter urinary tract. Since P is a woman, thus she requires to alter her activity of maintaining a safe environment by compulsory using soap after elimination so that hygienic environment may be maintained to avoid growth as well as the entry of bacteria into the body due to unhygienic environment.

The other activity that would be altered in P as a result of UTI is her eating and drinking habits. This is because often food and fluids that are taken in acts to control as well as prevent rise of UTI. As asserted by Huttner et al. (2018), UTI is able to be managed by drinking proper amount of fluids. This is because increased fluid intake causes hydration of the body as a result of which the wastes and microorganisms present in the body are tried to be eliminated out through diluted urine by urinating frequently. Therefore, P's diet would be changed to include foods that hydrate the body, as well as her nature of drinking fluids, would also be altered so that proper hydration of the body is maintained. The rise of UTI is dependent on the pH of the urine as the pH indicates how much hospitable the environment would be let bacteria thrive in the urinary tract to affect the system (Mambatta et al. 2015). The increased intake of fluid in the body through eating and drinking helps to maintain the pH of the urine in normal condition where the bacteria cannot thrive. Thus, the eating habits and drinking nature would be altered in P as a result of UTI to help her resolve the health condition.

The Bio-psycho-social model informs the biological, psychological and social factors and their interactions that responsible in causing the disease or illness for gaining understanding regarding the cause and prevention of the health issue. The biological factors are the genetic vulnerabilities and physiological pathology related to the disease whereas the psychological factors are psychological stress, coping methods, attribution and others of the patient regarding the illness. The social factors are the work environment, family circumstances and relationships (Van de Velde et al. 2016). The women are more prone to urinary tract infection because of their anatomy which shows that they have a shorter urethra in comparison to the men that shortness the travelling distance of the bacteria to infect the bladder (Aydin et al. 2015). Therefore, women are more prone to get infected easily through microorganisms during elimination under unhygienic condition.

The psychological stress, for example, anxiety, confusion, depression and others act in a potential way in causing urinary incontinence and bladder problems. This mainly occurs because during psychological stress serotonin and norepinephrine are activated which indicates the body to respond in different unusual ways out of which bladder leakage may be one (de Jesus et al. 2016). In elderly individuals, it is seen that rise of UTI causes them to experience delirium which is a sudden change in the brain that leads to emotional disruption and mental confusion (Chae & Miller, 2015). This mainly arises as a result of uneasy feeling and unable to properly urinate due to the condition. The rise of delirium as a result of UTI makes them face inability to think properly, sleep, pay attention and others.

The study of Ahmed et al. (2018), informed that out of the total number of patients they surveyed in the UK during 2004 to 2014 it is found that 21% of adults who are above the age of 65 are at least once diagnosed with UTI during the period. The study also informed that women are more prone to get UTI in comparison to men and the complication of UTI also increases with age. This is because with ageing different functions of the body is hindered leading to the development of UTI (Ahmed et al. 2018). The lower social status leads individuals towards getting infected with UTI as they are unable to manage effective living conditions (Wagenlehneret al. 2018).

Overview of Health and Social Care Delivery Plan The Health and Social Care Delivery Plan has the key aim to offer quality healthcare services to the people of Scotland with a focus on preventing health issues among individuals by providing them early intervention as supporting them through self-management (www.gov.scot, 2016). The patient who requires care at the hospital as per the Plan has the aim to offer them the facility of day surgery as well as ensure they are discharged swiftly after healthcare at the hospital if it is safe to do so (www.gov.scot, 2016). This is required so that the authorities who have the bad intention to raise the health bill for the patients by keeping them unnecessarily admitted at the hospital are not fulfilled. It would be effective for the patients to pay low amount of bill at the hospital making avoid experiencing financial constraints in availing care at the hospital. Moreover, the swift release from the hospital of the patient is the aim so that beds for the other deserving patients who need attention at the hospital can be made effectively. The Health and Social Care Delivery Plan has the aim to provide guidance on the way people of Scotland would be able to live healthier and longer lives in homely settings or within homes (www.gov.scot, 2016). In order to execute this purpose,

the Plan would have focus on anticipation, prevention and support self-management of the patients. Moreover, to fulfil the aim the Plan has the will to make day-case treatment as the norm in condition where the hospital treatment though required but cannot be provided. The aim of the Plan to fulfil the purpose also has the focus to deliver highest standard services to the service users and the patients are to be kept in the middle when deciding the treatment. Further, the focus is to ensure patients to be brought back to live a normal life in the community with having minimum risk to get readmitted for the health disorder in the hospital. In order to accomplish the aims, the Scottish government has decided towards evolving their health and care services through the Plan for meeting new demands and opportunities of care as well as develop proficiency in using updated healthcare technology (www.gov.scot, 2016). This is required for the patients to be offered high standard care through advanced use of technology and improved medication for early diagnosis and recovery from health issues. Implement the Health and Social Care Delivery Plan for P
The content mentioned in the Health and Social Care Delivery Plan could be applied to the client named P to improve her condition. The early intervention is one of the key focuses of fulfilling the aim of providing effective healthcare as mentioned in the Plan (www.gov.scot, 2016). This aspect of the Plan can be applied for the client P whereby taking early intervention the diagnosis of her health condition could be made at the earliest. It would be effective for the health practitioner to understand the nature of treatment required by P to resolve her complicated UTI condition to help her live a normal life. Moreover, the early intervention could be able to help P manage delirium as she would have been offered care to resolve UTI at the earliest. The Plan informs that self-management by the patients is an effective method to control their health situation (www.gov.scot, 2016). The aspect can be applied for client P by offering her information by NM regarding the way she is to maintain proper hygiene so that her UTI remains controlled.
The Plan indicates that the patients are to be involved in taking decision regarding their care (www.gov.scot, 2016). This is to be implemented in case of P by NM who is the nurse-in-charge for her care by asking permission from her regarding finalising any care services to be offered to P. As asserted by Petrino, Tua & Salvi (2018), putting patients in the centre to take decision regarding their

care helps to show dignity and respect towards them. This is because in this case the opinion of the service users is taken and based on their opinion the care is provided. In order to resolve cystocoele experienced by P, the repair surgery is the treatment option for the patient. In the Health and Social Care Delivery Plan, it is informed that they have the focus to provide day surgery option for the patients (www.gov.scot, 2016). Thus, this part of the plan can be applied in case of P where she would be offered Repair Surgery for resolving cystocoele during day time. It would help her to feel less stressed and have opportunity to recover through proper sleeping during night.

The two health promotion campaigns that could be helpful for the patient P to control and prevent UTI are Chronic Urinary Tract Infection Campaign and National Hydration Campaign. The National Hydration Campaign is being launched in April 2018 by the Scottish urinary tract Infection Network with the key aim to offer knowledge to the public about the health benefits they can gain by remaining hydrated in terms of preventing UTI (www.hps.scot.nhs.uk, 2018). This campaign would be effective for P to understand the way she is required to manage her drinking habits so that further relapse of UTI does not occur in future. The National Hydration Campaign also informs about the facts to be remembered regarding good personal hygiene so that UTI can be prevented (www.hps.scot.nhs.uk, 2018). These facts would be helpful for P to understand regarding the way she requires to maintain hygiene so that her condition regarding UTI remains controlled and do not relapse. The Campaign offers information regarding the way women need to manage hygiene and wash after elimination to avoid presence of bacteria that give rise to UTI (www.hps.scot.nhs.uk, 2018). This would be helpful for P to manage hygiene while and after elimination, in turn, assisting her to reduce risks of UTI.

The National Hydration Campaign is seen to provide a visible urine colour chart to indicate individuals which colour of urine indicate they require to drink more and which colour means they are having healthy urine (www.hps.scot.nhs.uk, 2018). This would be helpful for P to understand when to drink more fluid to remain hydrated so that she can have healthy urine and avoid being at risk to develop UTI as a result of lower hydration. The Camping provides indication to the individuals about the guidelines to be followed to avoid UTI (www.hps.scot.nhs.uk, 2018). This information would be helpful for P to understand the way she requires to manage her daily activities so that she can avoid the risk of UTI. The Campaign informs that a single individual requires to take in 6-8 glasses of water to remain hydrated to avoid risk of UTI (www.hps.scot.nhs.uk, 2018). This information would help P to have knowledge regarding how much amount of fluid to be taken in so that she remains hydrated which is one of the ways to avoid risk of UTI.

The Chronic Urinary Tract Infection Campaign was launched in 2015 by the UTI suffers and parents of children who suffer UTI. The key aim of the campaign is to raise awareness regarding urinary tract infection (UTI) so that individuals have knowledge when and where to avail intervention and way to prevent UTI (www.cutic.co.uk, 2015). This aim of the campaign would be effective for client P to develop understanding by identifying symptoms at the earliest whether or not she is suffering from UTI and what steps are to be taken next to control further spread of UTI. The Campaign offers information about the most effective ways in which UTI can be diagnosed accurately (www.cutic.co.uk, 2015). This information can be used by P to understand the nature of test she requires to perform to be ensured that whether or not she is suffering from UTI. It would help her to arrange early intervention for her UTI condition.

The Chronic Urinary Tract Infection Campaign offers guidelines about the treatment to be availed by patients who are suffering from chronic UTI (www.cutic.co.uk, 2015). This service of the campaign would be effective for P to understand the nature of treatment she requires to avail to control her UTI condition. Moreover, this information is going to help P to identify whether or not the GP and the nurse NM are providing her proper treatment or not and it also helps her to take informed decision regarding her care in the hospital. The Campaign is seen to provide service by making available specialist treatment for all patients suffering from chronic UTI (www.cutic.co.uk, 2015). This service is going to help P to be able to avail special treatment required to control her UTI. The Campaign provides information in details about the way UTI develops and the way they become chronic in nature (www.cutic.co.uk, 2015). This information could be used by P to understand the activities she requires to avoid so that risk of developing further deteriorated UTI can be avoided. Further, the Campaign informs that taking short-course of medication in case of UTI leads to its relapse (www.cutic.co.uk, 2015). This information would be helpful for P to remain alert that she completes full course of her medication to control UTI.

Conclusion

The above discussion informs that P is suffering from different nature of urinary tract infection (UTI) that has rendered her to face pain during urination, urine incontinence and sometimes retention. The urinary tract in normal condition is seen to be involved in removing wastes from the body. As a result of UTI, the elimination, eating and drinking along with maintaining safe environment of client P would be alerted. The Health and Social Care Delivery Plan is going to offer P be able to self-manage and attain early intervention to resolve her health issue. The health campaign named Chronic Urinary Tract Infection Campaign and National Hydration Campaign would be effective for client P to control her UTI condition.

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References

  • Abraham, S. N., & Miao, Y. (2015). The nature of immune responses to urinary tract infections. Nature Reviews Immunology, 15(10), 655. Retrieved on 30 March 2019 from:
  • Ahmed, H., Farewell, D., Jones, H. M., Francis, N. A., Paranjothy, S., & Butler, C. C. (2018). Incidence and antibiotic prescribing for clinically diagnosed urinary tract infection in older adults in UK primary care, 2004-2014. PloS one, 13(1), e0190521.
  • Aydin, A., Ahmed, K., Zaman, I., Khan, M. S., & Dasgupta, P. (2015). Recurrent urinary tract infections in women. International urogynecology journal, 26(6), 795-804.
  • Borys, M. A., Hulsebosch, S. E., Mohr, F. C., Watson, K. D., Sykes, J. E., Simpson, K. W., & Westropp, J. L. (2019). Clinical, histopathologic, cystoscopic, and fluorescence in situ hybridization analysis of proliferative urethritis in 22 dogs. Journal of veterinary internal medicine, 33(1), 184-191. Retrieved on 29 March 2019 from:
  • Bryce, A., Hay, A. D., Lane, I. F., Thornton, H. V., Wootton, M., & Costelloe, C. (2016). Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis. bmj, 352, i939.
  • Bryce, A., Hay, A. D., Lane, I. F., Thornton, H. V., Wootton, M., & Costelloe, C. (2016). Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis. bmj, 352, i939.
  • Chung, A. S., Cheng, J. N., & Tse, V. (2016). Psychotropic drugs and their effects on lower urinary tract function: an update. Current Bladder Dysfunction Reports, 11(3), 258-265. Retrieved on 30 March 2019 from:
  • de Jesus, L. E., Tomé, A., Cobe, D., & Camelier, P. (2016). Psychosocial and respiratory disease related to severe bladder dysfunction and non-monosymptomatic enuresis. Journal of pediatric urology, 12(2), 126-e
  • Hibbing, M. E., Conover, M. S., & Hultgren, S. J. (2016). The unexplored relationship between urinary tract infections and the autonomic nervous system. Autonomic Neuroscience, 200, 29-34. Retrieved on 31 March 2019 from:
  • Horner, P., Blee, K., O’Mahony, C., Muir, P., Evans, C., & Radcliffe, K. (2016). 2015 UK National Guideline on the management of non-gonococcal urethritis. International journal of STD & AIDS, 27(2), 85-96. Retrieved on 31 March 2019 from:
  • Lapides, J., Diokno, A. C., Silber, S. J., & Lowe, B. S. (2017). Clean, intermittent self-catheterization in the treatment of urinary tract disease. The Journal of urology, 197(2s), S122-S124.
  • Mody, L., Meddings, J., Edson, B. S., McNamara, S. E., Trautner, B. W., Stone, N. D., ... & Saint, S. (2015). Enhancing resident safety by preventing healthcare-associated infection: a national initiative to reduce catheter-associated urinary tract infections in nursing homes. Clinical Infectious Diseases, 61(1), 86-94. Retrieved on 23 March 2019 from:
  • www.cutic.co.uk (2015), Chronic Urinary Tract Infection Campaign, Retrieved on 30 March 2019 from: www.gov.scot 2016, Health and Social Care Delivery Plan, Retrieved on 21 March 2019

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