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The Case Study of Mr. Brian

   

Added on  2020-03-16

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Running Head: Nursing assignmentNursing assignmentName of the StudentName of the University Author Note

1NURSING ASSIGNMENTIntroductionThe aim of the report is to respond to the case study of Mr. Brian experiencingincontinence. The contributing factors to the incontinence and the continence issues arediscussed. To promote continence in Brian, health promotion involves the process of increasinghis control over and improves the health. For this purpose two-research articles on one initiativeor innovation program is critically analysed and based on the evidence obtained the reportrecommends how registered nurses can improve personal practice and the practice of others. Contributing factors to Brian’s continence problems Incontinence and the problems related to continence are the indicators of the bladder andbowel dysfunction. It is the most common problem occurring in the old age but is never normal.Thus, age is not causative e but contributing factor for incontinence, which is also found in caseof Brian (Watt et al. 2014). He is 82 years old man and his age may be considered contributingfactors for his continence problems. According to Johnson and Chang (2014), urinary and faecal incontinence in elderlypatients is caused by strokes. From the patient history, it can be interpreted that the ischemicheart diseases and heart failure is the contributing factor of Brian’s faecal and urinaryincontinence. Bladder dysfunction also results from the spinal disorders and osteoarthritis(Bedretdinova et al. 2016). In neurogenic bladder disorder there is damage to the nerve tissuesthat control the functioning of the bladder and the muscles involved in urination and bowelmovement. Brian’s, spondylitis may be the other contributing factor (Panicker et al. 2015). Thepossible complications of spondylitis are the urinary and faecal continence (Bagnola et al. 2017).

2NURSING ASSIGNMENTNot drinking enough water is the contributing factor for inflamed bladder wall. In case ofBrian, it was seen he consumed more of wine and coffee and less of water. Drinking tea orcoffee aggravates the bladder, which makes the incontinence a likely occurrence (Watt et al.2014). Wine acts as a bladder stimulant (Johnson and Chang 2014). Faecal incontinence can becaused by constipation. Brian opens his bowel every 2-3 days. Thus, constipation may be thecontributing factor for the continence issues observed in Brian. According to Loening‐Bauckeand Swidsinski (2015) faecal impaction causes difficult bowel moment and is the cause of thelower gastrointestinal tract obstruction. It is commonly found in elderly people with theconstipation. The same may be the causative factor of Brian bowel problems and it was foundfrom the case study that his abdominal examination showed lower left abdominal faecal masses. Since, Brian is undergoing treatment and medication for his ailments; the side effects ofthe medicines are having adverse effects on his bladder function. Brian is taking frusemide andspiractin, which is diuretic that increases urine volume. Amiodorone taken by him shows the betablocker-like and calcium channel blocker-like actions and is known for urinary incontinence andconstipation. Brian also takes tramadol which is the opioid that causes the reduce bladdercontractions, constipation (Hussain and Gill 2016). Main continence issues The main urinary incontinence issues faced by Brian is the voiding of urine 9-12 times aday and 2-3 times overnight, he feels the urgency to void on most occasions. Sometimes Brian isnot aware of leakage. He opens his bowel every 2-3 days and each bowel action is associatedwith straining and urgency. These issues can be categorised as urge continence in Brian. Urgecontinence refresh to the condition where the loss of urine is accompanied with the urgent need

3NURSING ASSIGNMENTto urinate. This mainly occurs due to involuntary actions of the bladder after stroke (Johnson andChang 2014). Brian condition can also be related to the overflow continence. It is the conditionwhere the bladder never completely empties. It is due to this reason that Brian voids urine 3-4times a day with small volume of urine loss. Brian’s functional incontinence that is unable tomake up to the bathroom at night. It can be caused by the stroke complications and theneurological disorder that he is having. His mind cannot carry or plan the trip to bathroom (Wattet al. 2014). Incontinence in elderly patients is difficult to treat, as they are reluctant to seek help dueto embarrassment. Lack of awareness and effective communication with the health careproviders is the other major cause of poor services (Watt et al. 2014). It can be concluded thatBrian needs comprehensive health care plan because he is having chronic heart illness along withseveral comorbidities that result in interrelated complications. This demands the multifacetedapproach. Thus, the nursing care plan must address the health issues using evidence-basedpractice. There is a need of joint approach and strategies for achieving the best outcome forBrian considering his age, coronary heart disease, spondylitis, incontinence, walking disabilityand overall weakness (De Gagne et al. 2015). Critical analysis research articles Article 1In the article by De Gagne et al. (2015), the aim of the pilot study is to develop,implement and determine the effectiveness of the self-management program that is evidencebased for community-dwelling older women (aged 55 years) with urinary incontinence in SouthKorea. The rational for conducting this study is evident from the succinct background provided

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