Disease Management. Incontinence Care. Chan Sau Kuen Continence Nurse Consultant United Christian Hospital 14/11/09
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1 Disease Management in Incontinence Care Chan Sau Kuen Continence Nurse Consultant United Christian Hospital 14/11/09
2
3 What is incontinence? Definition of Incontinence - Is the compliant of any involuntary leaking of urine or bowel (ICS 2002)
4
5 People at risk Elderly Women (Mother) Disable people Person in the institution
6 Prevalence of Urinary Incontinence (APCAB 1998) Country Prev. :Overall (%) Prev. :Female (%) Prev. :Males (%) China Hong Kong India Indonesia Korea Malaysia Pakistan Philippines Singapore Tai Wan Thailand Overall
7 Compare the epidemiology of incontinence among Hong Kong and Western Country Pang 2005 Bringer 1996 Stress Incontinence 33.9% 21% Urge Incontinence 15.5% 15% Frequency of Micturation 19.3% 19% Voiding difficulties 7.6% 13%
8 Consequence of Incontinence Physical Aspect Discomfort Smelly Skin rash Bed sore Fall Dehydration
9 Consequence of Incontinence Psychological aspect Lost of self-esteem and self confidence Independent Worry Embarrass Depression
10 Consequence of Incontinence Social aspect Avoid social life Isolation
11 Philosophy of Continence Care Everybody has the night to be continence When true continence is not achievable, people have the right to the highest standards of continence care and incontinence management.
12 Objectives of Nursing Management Independence continence Dependence continence Social continence
13 Levels of Care Primary and Community Care Promotion of public awareness Preventive measures Identification of people at risk Secondary Care Reduction of severity of the incontinence Tertiary Care Preventing and managing complication Maintain social continence after secondary care
14 Management in Incontinence Assessment Explaining of the problem Psychological support Strategies of bladder / bowel management
15 The Goal of Assessment Confirm the presence of incontinence Identify the risk factors and causes of incontinence Make an accurate diagnosis Decide on need for further evaluation
16 ASSESSMENT 1.Social Background Living condition Toilet distance Toilet facilities
17 2.Health History Medical :DM Stroke Parkinson Surgical :Urethral dilatation TURP Bladder neck surgery Radical Prostatectomy Gynaecological : Hysterectomy Pelvic floor repair Obstetric : No. of pregnancy Types of deliveries Child birth weights
18 3. Medications - Diuretics -Sediatives - Anticholingerics - Antidepressants - Narcotics Analgesics - Calcium Channel Blockers - Alpha-adrenergic Blockers
19 4. Urinary signs and symptom - Duration - Frequency of voiding - Voiding amount - Frequency of incontinence - Amount lost - Urgency - Hesitancy -Stream -Dysuria -Haematuria - Smell of urine
20 5. Bowel Symptoms - Frequency - Normal Pattern - Character - Constipation - PR bleeding - Control 6. Continence Aids 7. Fluid and diet intake
21 8. Physical Assessment - Mobility - Functional activity - Mental state - Communication 9. Attitude towards incontinence
22 10. Physical exam. - Abdominal - Skin condition - PR: anal tone faecal loading prostate size mass - PV:pelvic floor muscle grading prolapse atrophic vaginitis
23 11. Ix - Frequency volume chart - Urinalysis -MSU - Post voiding Residual Urine - X ray Abd - Urodynamic study - Cystoscopy 12. Psychosocial Aspect 13. Economical Aspect
24 Explaining the problem Better understanding Better motivation Make decisions on treatment options
25 Psychological Support Trusting relationship Sympathetic ear
26 Strategies of bladder / bowel management Treat the reversible causes : D Delirium I Infection A Atrophic P Pharmacologic P Psychological E Excessive urine output R Restricted Mobility S Stool Impaction
27 Stress incontinence Pelvic floor exercise Prevent constipation Appropriate aids Lifestyle modification Surgery
28 Urge incontinence Lifestyle modification Bladder training Biofeedback Appropriate aids Skin care Medication Surgery
29 Absorbent products
30 Overflow incontinence Empty the bowel Intermittent catheterization Indwelling catheter
31 Nelaton Catheter
32 Functional incontinence Toilet training Appropriate aids Life-style modification
33
34 Constipation Lifestyle modification Bowel training Medication
35 Faecal incontinence Anal sphincter exercise Treat constipation Appropriate aids Skin care Surgery
36 Anal plug
37 Lower Urinary Tract Syndrome Lifestyle modification Pelvic floor exercise Bladder training Urethral massage Medication Surgery
38 Enuresis Lifestyle modification Prevent constipation Bladder training medication
39 Bed protection
40 Refer to related specialtist for further investigations / interventions Urologist Colorectal Surgeon Urogynaecologist Geriatrician Occupational Therapist Physiotherapist Medical Social Worker
41 Management Process Evaluation Assessment Management Plan
42
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