Ms. Franklin, 68 years old, is seen in the clinic for urinary incontinence. Her history includes hypertension, type 2 diabetes, and osteoarthritis, treated with lisinopril/hydrochlorothiazide 20 mg/25 mg daily, glipizide/metformin 2.5 mg/500 mg twice a day, and celecoxib 200 mg daily. She states that she delayed seeking care because she felt uncomfortable talking to her health care provider about the issue and thought all women experienced incontinence. The problem has worsened; she leaks through her incontinence liner pads at times. Two of her daughters convinced her to come to the clinic for treatment. Upon further questioning by the nurse, it is revealed that Ms. Franklin has reduced her caffeine intake to one cup of coffee per day but has also decreased her overall fluid intake to reduce her incontinence. When asked to describe her incontinence, she states that she loses urine before she can make it to the bathroom, and she needs to urinate frequently. She also gets up to use the bathroom several times each night. She states that her last bowel movement was this morning after breakfast; she normally has a soft bowel movement each day. Ms. Franklin's vital signs are blood pressure 125/82 mm Hg, heart rate 88 beats/minute, respirations 14 breaths/minute, temperature 97.9°F. She is 5'4" and weighs 200 pounds. Her laboratory results include: BUN/creatinine is 22 mg/dL and 1.6 mg/dL. Na/Cl is 145 mmol/L and 105 mmol/L. Glucose is 115 mg/dL. Urine is amber and clear, pH 5.0, nitrite negative and leukocyte esterase negative, red blood cells (RBCs) 2/hpf, WBC 2/hpf, and bacteria negative. Use an X to indicate which actions listed that would be included in the plan of care. (Select all that apply) Actions Plan of Care:
Explanation & Rationale
A. Teach client pelvic floor muscle exercises. Pelvic floor muscle (Kegel) exercises strengthen the muscles involved in urinary control and are a first-line intervention for urge or stress incontinence. B. Reduce weight by 10% Obesity increases intra-abdominal pressure, contributing to urinary incontinence. A modest weight loss can significantly improve symptoms. C. Encourage fluid restriction throughout the day. Restricting fluids can lead to concentrated urine, bladder irritation, and increased risk of urinary tract infections. Maintaining adequate hydration is important. D. Initiate a bladder training schedule. Bladder training (gradually increasing intervals between voiding) helps reduce urgency and frequency and improves bladder control. E. Refer for physical therapy evaluation. Pelvic floor physical therapists can provide tailored exercise programs and biofeedback to improve continence.