STRESS CONTINENCE IN WOMEN

Introduction

Urinary incontinence is the accidental loss of urine. It is sometimes caused due to stress. Research has shown that the stress incontinence occurred when physical mobility or activity like laughing, coughing, sneezing, running as well as heavy lifting endorses pressure or stress over the bladder, leading to the leak in the urine (Lukacz, Santiago-Lastra, Albo, & Brubaker, 2017). Stress incontinence is not linked to psychological stress. According to Ostle, 2016, it was stated that the most common causes for this incontinence in women are childbirth and pregnancy and due to having several vaginal deliveries. Medical reports have shown that during childbirth or at time of pregnancy; sphincter as well as the pelvic muscles stretch out and gets weakened. At older age or specific health issues causes’ chronic cough leads to stress incontinence (Kim & Kwak, 2017). It was found that the stress incontinence along with mobility and activities like sneezing, coughing, and lifting, creates an abdominal pressure that further puts pressure over the bladder. Hence, leading to urine leakage (Mayo Clinic, 2020).

In this paper, the case study focusses on a Mrs A; aged 40 years. The women work in the supermarket, and she was facing difficulty in her work and serving customer due to her urinary incontinence issue. Hence, necessary measures are required to help Mrs A in overcoming the problem. The paper is structured to discuss the holistic nursing continence assessment over this patient, along with analysing the assessment processes besides detailing the nursing interventions. This paper also presents detailed analysis of nursing interventions and evaluating the effectiveness of given care and evaluating the knowledge of current research synthesis.

Discussion

Urinary incontinence occurs in both sexes, however more frequent in women. Research has shown that the pathophysiology for the stress incontinence occurs in every sexes (Urologyhealth.org, 2020). The incontinence among men showed a significance of prostatic widening or damage towards continence actions at the time of surgery or radiotherapy for prostate cancer. On the other hand, it was noted that the incontinence in women is characteristically linked to dysfunction of bladder along with pelvic floor muscles, with dysfunction arising at the time of pregnancy or childbirth, or during menopause (womenshealth.gov, 2020). The Primer focuses over female urinary incontinence on account of its advanced prevalence besides exceptional pathophysiology.

Holistic nursing continence assessment performed

Nursing assessment is one of the most crucial processes in terms of analysing the current health condition of a patient and determine his or her holistic needs. In case of Mrs A, nurses will use the Roper-Logan-Tierney model of assessment. As mentioned by Mcdonald, Boulton & Davis (2018), Roper-Logan-Tierney model of assessment is highly useful nursing assessment model which is widely used by the modern nursing professionals in terms of determining the holistic needs of patient. In case of Mrs A, this assessment model is expected to be highly useful in analysing in determining her regular activities of livings, which will assist both nurses and the doctors to determine her psychological, physical, sociocultural, economical and environmental needs. The assessment that is going to be done in case of Mrs A is as follows:

Maintain safe environment:

As stated by Giger and Haddad (2020), while it comes assess the overall health of a patient the first thing that health professionals need to consider is the; level of safe and secure environment that is provided to the patient in the care setting. In case of Mrs A, as she suffers from urinary incontinence, nurses need to maintain high level of hygiene while providing proper medicines to urinary track through vagina or attaching temporary catheter. Nurses will maintain proper hygrines while cleaning the vaginal part of Mrs A after applying any medicine or ointments. In addition to this, nurses need to be enough skilled in maintaining aseptic techniques while injecting any medicines through vagina of Mrs A. During urinary incontinence, nurses need to ensure that the dirty clothes of patient will be removed and washed regular wise ad they will be properly cleansed on regular basis to prevent the risk of any kind of infection at the vagina.

Communication:

Here in the case study, nurses as well as health professionals need to ensure that transparent communication has been conducted with Mrs A regarding her regular health updates, her neds and any issues or pain she faces during the care setting. Under NICE (2015), if patient is unable to maintain verbal communication with health professionals, then nurses and health professionals can use the non-verbal communication such as facial expression and body movement to analyse the health needs of patient [NICE, 2015]. Here Mrs A can make clear verbal communication with nurses and doctors, in which they need to ensure that right information will be transferred to the right person at right times to maintain the quality and systematic process of the care pathways.

Breathing:

Here nurses need to use the pulse oximeter in terms of determining the oxygen saturation level and the pulse of Mrs A. Here Mrs A does not show any sign of shortness of breath, chest tightness, wheezing or respiratory issues. Nurses need to check that Mrs A must have the breathing rate within 11-15 breaths per minute which is the normal range.

Drinking and eating:

As stated by McDonald, Boulton & Davis (2018), in nursing assessment the most important factors of assessments to analyse the food habits, drinking habit and the nutrients intake by the patients. In case of Mrs A, as she works in supermarket there is lots of workload and busy work schedule which have potential impact on her regular duet. Nurses need to check the regular diet, daily protein and fat intake, total; consumption of water and other liquids such as juice and soup, selection of foods, number of meal take and any cases of skipping of meals in case of Mrs A. As she suffers from urinary incontinence nurses needs to provide her limited fluids and water as per the recommendation of doctors, on the other hand, nurses also need to consult with the dieticians to provides such a meal to Mrs A tat will provide the essential nutrients through the solid foods that she loses each day high te uncontrolled urine.

Eliminating:

Here nurses need to check the overall excretion of Mrs A by checking how much urine she produces and eliminate from her body in each day. Based on this report, doctors can develop the effectives care plan in terms of improving her health condition.

Personal cleansing:

Here nurses need to ensure that Mrs A will be placed in a hygienic and clean environment in which she is free from any kind of infections. Here Mrs A needs two health staffs with her in all day and night which will check that whether there is a need to change her diaper or clothes. A temporary catheter can be used by the nurses for Mrs A which will be attached and remove as per the necessity by maintaining all level of hygiene and safety.

Control body temperature:

Mrs A has normal body temperature [98.7 0 F] and ter is nt sign of fever. Here nurses need to ensure that whether Mrs A feels uncomfortable with the temperature of AC in her room. In additional to this, nurses also check whether there is any sudden increase of temperate in Mrs A.

Sleeping:

Mrs A is reported to have insufficient and irregular sleep due to urinary incontinence.

Analyse the assessment process

Analysis of assessment is crucial for health professionals to determines the current health needs of the patients based in which they can develop the effective care plan. Here in case of Mrs A nurses will follow APIE pathways in gathering the information regarding patient’s health, premedical history, current health status, personal life and the ongoing medicines.

Assess:

This is first stage in which nurses carry out the necessary physical tests to gather the numerical or quantitative data and ask questions to patients and family members to collect the qualitative data. The qualitative data consists of personal life of patients, pre medical history and ongoing treatment and medicines.

Collecting quantitative information:

• Culture of urine specimen
• Identifying bladder infection
• Pelvic examination: here physicians will check the pelvic organ of Mrs A
• Rectal examination: here doctors will check whether there is any blockage in the rectum through inserting the lubricating finger covered by glove into rectum.
• Cystogram: this is the X ray of bladder that is done in case of Mrs A to check the bladder function
• Cystoscopy: doctors check the function of urethra through inserting the slender tube having a lens

Collecting qualitative information:

These information are gathered through asking questions to Mrs A regrading the following topics:

• Checking any medical condition that Mrs A had in the past
• Ongoing medicines of Mrs A
• The eating and drinking habits of Mrs A.
• Whether there are any difficulties in starting urine
• Is there any history of UTI (urinary tract infection)

Planning:

In this process proper care plan is developed for Mrs a based on the above-mentioned information

Implementation:

Her the care plan will be implemented into practices to meet the health neds of Mrs A.

Evaluation:

In this process nurses and physicians will evaluate whether the care plan developed for Mrs A is useful in improving her health condition.

All the information was gathered by asking specific questions to Mrs A. These questions were essential as it helped in understanding patient current scenario. Particular problems such as whether Mrs A had urine leakage in last three months if the answer was ‘yes’, further queries would be done regarding how many times visiting toilet was an emergency, what are the signs of urgency that was faced by Mrs A. This assessment process gave a broader idea about health. The urine leakage process is widespread among women, and hence, before prescribing any medication, history is required (McIntosh, Andersen, & Reekie, 2015). Therefore, this would help in determining patient episodes of incontinence that are necessary for measuring the cause for the urge of incontinence. It mainly occurs due to the abrupt contraction of bladder muscles. There are chances that a patient might report the feeling of the necessity for sudden urination and cannot get to the bathroom on time (Ford, Rogerson, Cody, Aluko, & Ogah, 2017). It is required to tell Mrs A as a nurse for keeping the daily diary for voiding pattern and frequency. The assessment tool would help in enabling the nurse for precise and quick identification of the voiding pattern. Therefore, the information given would help in generating individual plan.

Urine culture specimen taken for diagnosis helps in identifying the bladder infection that also leads to the cause of urinating urge. According to Troko, Bach & Toozs-Hobson (2016), a physical examination include practical assessment detecting the mental status as well as mobility along with body mass index of the patient. The assessment also included an abdominal study that can assess pelvic masses, palpable bladder besides costovertebral angle sensitivity. It was also obtained that the urogenital examination needed for urinary incontinence revealing vaginal atrophy in addition to incontinence-linked dermatitis, causing damage to the skin with exposure for urine (Bakan, Aslan, & Yıldız, 2020).

Detail and analyse the nursing interventions

Nursing intervention that was laid for Mrs A was to promote access towards toilet facilities in addition, instruct patient for making schedule trip to the bathroom. This helps in schedules voiding permitting frequent emptying of the bladder (Wiers & Keilman, 2017). The intervention was also to encourage and give the usage of medication such as tricyclic antidepressants and anticholinergic that lessens as well as blocks detrusor contraction by reducing manifestation towards incontinence. This tricyclic’s enhances the level of serotonin or norepinephrine, resulting in the relaxation in bladder wall as well as capacity of the bladder. This nursing intervention helps in educating the patient regarding the effect of extreme caffeine and alcohol intake where the chemical was known for bladder irritants and can increase the detrusor overactivity (Kehinde, 2016). Nursing intervention needs to aid Mrs A by developing a bladder training program comprising the increase in the capacity by regulation of fluid intake, pelvic exercise besides scheduled voiding. This regular void scheduling helps in decrease in the detrusor overactivity as well as an increase in the fluid volume capacity for the bladder (Jacobson & Ascher‐Walsh, 2020).

The nursing intervention management of urinary incontinence among women is an iterative procedure. It was found that the affected women, urinary incontinence sources bother besides intrusion to permit deliberation of treatment. Hence, the options towards the range of lifestyle modifications had shown invasive surgical interventions (Holtzer-Goor et al., 2015). In this case, Mrs A; might arrange resolution of urinary incontinence actively appealing pelvic floor rehabilitation, lifestyle variations comprising fluid optimisation, pharmacological action or surgery determination persistent symptoms. It was found that the women with severe health circumstances consider their urinary incontinence as chronic illness, with importance on declining symptom influence rather than full resolution (Bakan, Aslan, & Yıldız, 2020). This intervention had shown that the range of assignation in the treatment of urinary incontinence variations over woman’s lifetime, in addition, imitates changing health priorities in addition to preferences (Wiers & Keilman, 2017). Therefore, the goals and preferences likely to alteration with time, in addition, should be occasionally reconsidered in case of Mrs A.

Evaluate the effectiveness of the care given

This incontinence assessment tool helps in determining the problem as well as the treatment that is required. This also includes specifics of the individual’s signs in addition symptoms along with a physical examination that might be indicated. It was seen that the consent of the individual for an investigation was gained; to avoid further conflicts (Lukacz, Santiago-Lastra, Albo, & Brubaker, 2017). The assessment tools also avoid any doubts towards individual’s capacity along with intervention that was to be undertaken in an individual’s best interest. The assessment tool designed helps in coordinating and managing the UTI (Urinary tract infection), which might improve or reduce incontinence. The assessment data would help determine data for cystometry (Wiers & Keilman, 2017).

Several studies have shown that the conservative events would be tried first besides needs surgery for treating stress urinary incontinence highly operative in reducing symptoms. In the case of Mrs A, might have mixed incontinence and might be considered for surgery which is likely to be essential for adjunctive treatment in case of urgency incontinence. It was found from previous studies that the synthetic mid-urethral sling placement that is currently first-line surgical technique, with a cure rate above 80% and has a low morbidity rate (Bakan, Aslan, & Yıldız, 2020). It was found that the difficulties of vaginal mesh surgery became a cause of litigation, in addition to the risk of mid-urethral slings which are lower than mesh for prolapse, procedures requiring particular credentials of the consent process. The diagnostic testing assessment also defines a recognised way of persistent stress urinary incontinence after initial surgery would prompt rationalised diagnostic evaluation; succeeding stress incontinence surgery (O'Reilly et al., 2018). Hence, the likelihood for women initial surgery not successful in addition analysis remains stress urinary incontinence, however generally less successful than the primary procedure.

This diagnostic testing assessment is needed for measuring pressure in the bladder and fluid volume, storage as well as urination. Hence, the assessment data obtained states that Mrs A might be having some underlying issues that are related to urine incontinence but not have UTI. The nursing intervention for Kegel exercise is needed as it can strengthen muscles for the pelvic floor besides could be followed with recognised exertion (Jacobson & Ascher‐Walsh, 2020). Therefore, it was found that the repetitious relaxation or tightening of muscles aid the patient to regain continence.

According to Lukacz, Santiago-Lastra, Albo, & Brubaker, 2017, a medication that needs to be given to Mrs A, woman’s coexisting circumstances, usage of existing medication as well as the risk of antagonistic effects to be considered prior prescribing. Hence, it was found that the medicines, assistances might not be pragmatic for different weeks, significant to evaluate baseline symptoms to permit comparison with action effects consistently.

Recommendations

• Education of the caregivers, patient and family member’s essential. As knowledge would help in reducing risk factors and support in managing the complications faced by individuals. Psychological counselling is needed as it helps in making the patient believe that urinary incontinence id not shameful. It had been noticed that people undergo mental stress due to urinary issues (Jacobson & Ascher‐Walsh, 2020).
• It is also essential for Mrs A to change her feeding habit and reduce weight. She must be counselled regarding her weight and smoking habit. She must also be recommended to undergo a healthy diet and a healthy life besides treatment for urinary incontinence. It is also recommended that in case of future nursing, it needs that Mrs A must keep all her records and data and keep track of the change in urinary leakage (Lukacz, Santiago-Lastra, Albo, & Brubaker, 2017).

It is recommended that Mrs A must undergo regular exercises and be open to her difficulties to her families and even in her workplace. It is essential that all her family members, friends and colleagues must understand the situation and respond accordingly (Troko, Bach & Toozs-Hobson, 2016). She needs mental support from closed once; otherwise, she might also face mental health issues. It was found that the comprehensive assessment required to regulate intensifying factors, affecting woman’s quality of life in addition to desire treatment (Jacobson & Ascher‐Walsh, 2020). The distinctive diagnostic work-up includes medical history, physical inspection, urinalysis, assessment for post-void residual volume in addition exclusion of circumstances requiring specialist referral.

Conclusion

It can be concluded from the above study that the advancement in the incontinence research suggested that it might be at the point of a revolution in numerous research areas, particularly in accepting continence physiology, besides, primary prevention (Jacobson & Ascher‐Walsh, 2020). Past investigations have shown that in the past 130 years of research, the bladder, in addition, urethral sphincter dysfunction had discovered overlapping fundamental reasons of bladder dysfunction, comprising the myogenic, neurogenic as well as urotheliogenic hypotheses (Lukacz, Santiago-Lastra, Albo, & Brubaker, 2017). Moreover, it was seen that the development of new drugs was hampered by chronological focus over detrusor overactivity supposed unifying ‘reason for stress incontinence or urinary incontinence besides urinary urgency. Hence, the relationship between urgency and overactivity determined a remarkably complex of whether urinary emergency caused due to incontinence or significance of urgency incontinence that is unclear. This paper also explains the deficiency over the evidence involving stress incontinence towards urgency that has often been used as a surrogate endpoint towards clinical trials of interventions for every modality (Troko, Bach & Toozs-Hobson, 2016). Hence, different current treatment options were generated that includes anticholinergic medicines in addition to sacral neuromodulator, which diminishes detrusor overactivity. Therefore, it could be found that the presence of urinary/stress incontinence at the at baseline shown to be a poor prognostic factor of treatment consequence for a wide variety of incontinence interferences.

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