Caring for an Ageing Population

Topics: Urinary incontinence, Urinary bladder, Risk Pages: 6 (2069 words) Published: August 28, 2013
Lucille Mckenzie, a 72 year old female accompanied by her stepdaughter/ sole carer Marjorie Wilson was admitted to the ward on the 17th January via Accident and Emergency (A&E), following a fall at home. X-rays revealed healing fractures of several ribs and arthritic changes, but no bony injury of her right hip. Presenting features included, a recent history of unexplained falls spanning over 9 months, mild confusion, a productive cough with yellow sputum, dyspnoea, indigestion and acute urinary incontinence over the last 3 days. Abnormal observations included an increased respiration rate of 24 per minute and mild pyrexia of 37.8 degrees Celsius (Kozier et al., 2008). A Modified Early Warning Score was charted as 2 and hourly observations scheduled. I n addition lying and standing blood pressure were taken as postural hypotension is an intrinsic risk factor for falls (DOH 2001). Baseline urinalysis confirmed the presence of Leukocytes, protein and keotones, which could indicate possible infection, dehydration or malnutrition. Nazarko (2009) believes Urinary tract infections (UTI’s) may be a transient cause of incontinence and confusion additionally, yellow sputum could indicate infection. A midstream urine sample (MSU) and sputum sample were sent for microbiological culture and antibiotic sensitivities’ NICE (2006a). The results were discussed with the doctor and appropriate treatment started. As multiple aetiologies can cause confusion a blood sugar was taken to exclude hypoglycaemia (NICE 2010). To prevent further falls and injury to patient or staff, a falls and manual handling risk assessment were completed within 6 hours of admission. This assignment will discuss Lucille’s holistic care through to discharge based on best practice, including critical analysis of a continence assessment tool. Lucille Mckenzie is a pseudonym, therefore confidentiality is maintained in accordance with the NMC (2008). In particular I will be focussing on Lucille’s continence. On admission Lucille was placed in a hi/low bed due to her acute confusion and fear of falling without bed rails. MHRA (2007) found that older adults with confusion have a greater risk of entrapment in bed rails. In contradiction Healey et al., (2008) argues that bedrails do not result in an inherent risk of fatal entrapment. The latter uses weak evidence, meeting only 4 out of 10 quality criteria with no randomised controlled trials. As light problems can affect balance, mobility, and as incontinence is an intrinsic risk factor for falls Lucille was placed in a well lit single sex bay, near to the nurses’ station and the toilet to promote continence, facilitate mobility, observation, and dignity (RCP 2009), (DOH 2001). Dignity is promoted when individuals are enabled to do the best within their capabilities and is an important aspect of spiritual care (Moore 2010). In order to build rapport and trust and set the foundation for the relationship, the author introduced herself to both Lucille and Marjorie on arrival and explained that she would be responsible for Lucille’s care.(Kennedy-Sheldon 2009). Lucille was orientated to the ward ensuring that she knew the location of the toilet. The call bell, walking aid and a jug of water were placed within reach. To reduce confusion an orientation to the ward care plan was implemented which included 24 hour reality orientation. This ensured staff introduced, re-orientated and reminded Lucille of the date and time with the aid of a clock at each visit (NICE 2010). To promote comfort Lucille was offered the services of the hospital chaplain. Marjorie was asked to retrieve Lucille’s spare glasses and items which Lucille had requested. Hampton (2005) argues that pressure damage may occur from 30 minutes to 2 hours in the vulnerable patient. Lucille was assessed for risk using the Waterlow score and combined with clinical judgement pressure relieving equipment was ordered for both her bed and chair (NICE...
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