Question

1. Give examples of management and treatment strategies of incontinence.

2. what can a nurse say to a patient that they are teaching to do coughing and deep breathing exercises before the patient goes to surgery. Include in your instructions an explanation to the patient the purpose of the instructions and the risks of not doing the exercises after surgery.

3. Give an example of a patient scenario where you might suspect early hypoxia. Include a cause, symptoms and influence on vital signs.

4. If you suspect a patient has fluid volume excess, what might you find in the following areas of assessment?

a. Blood pressure

b. Weight

c. Respiratory status

d. Jugular veins

e. Pulse quality

Answer 1

1. Incontinence: Unable to control excreta or urine is termed incontinence.Urinary incontinence may result from urinary tract infections, detrusor instability, bladder outlet obstruction or incompetence,neurologic impairment , bladder spasm or contracture and inability to reach toilet in time.

Management:

• Previous and current fluid intake and voiding patterns should be noted. Defecation time, character of stool, nutritional intake are noted.
• The ability to get to bathroom should be assessed.
• Assess bowel sounds, reflex and tone .
• Physiologic risk factors for elimination problems , defecation cues and functional toileting ability should be taken into account.
• Privacy is provided

Treatment:

• Ensure adequate fluid intake is taken by the client
• Voiding and toileting schedule is formulated.
• Bladder training should be taught to client and encourage scheduled toilet trips .
• Pelvic floor exercises are taught to strengthen the muscles in pelvic area.
• Condom catheters in male is provided . Intermittent self catheterization is made .
• Psychological support is provided .
• Incontinence pads are used to manage.
• Rectal suppositories and glycerin are provided in constipation.
• Anticholinergics like darifenacin (Enablex), fesoterodine (Toviaz) can calm an overactive bladder.
• In women topical estrogen is provided to rejuvenate tissues in the urethra and vaginal areas.
• If a uterine prolapse is causing incontinence then pessary can be used.

2.A goal of preoperative nursing care is to teach patient how to promote optimal lung expansion and consequent blood oxygenation after anesthesia. The patient should be in sitting position to promote lung expansion. Also inform patient that coughing and breathing exercises are stress relieving techniques . Goal for coughing exercise is to mobilize secretions , so that can be removed.

These exercises can reduce the postoperative stress , promote lung expansion and provide necessary amount of oxygen to tissues. Most surgeries use anesthesia. When client is in passive state during surgery breathing is slower. The breaths taken is not deep as normal breaths that was took during active state. Alveoli needs adequate oxygen to withstand. Postoperatively, these air sacs can flatten and stick together. It is neccessary to inflate the alveoli. Breathing exercises can help in this scenario. Taking deep breaths and holding breath makes the alveoli function as usual and let the oxygen in. If coughing and breathing exercises are not done postoperatively may sometimes lead to pneumonia, and lack of oxygen in tissues , fatigue.

3.Hypoxia is decrease in the oxygen supply to tissues and cells.Shortness of breath , tachypnea , anxiety, restlessness are some early signs to predict hypoxia. Causes may be change in altitude, any trauma, any infection or chronic diseases , any obstruction

Rapid breathing doesnot provide adequate oxygen to tissues which may be interpreted while measuring SPO2. Rapid breathing may occur.(Tachypnea) > 28 breaths/min.

4.Fluid volume excess is an isotonic expansion of the extracellular fluid caused by abnormal retention of water and sodium than they normally exist in ECF.

a.Blood pressure : Increased

b. Weight: Increase in body water leading to increased weight

c.Respiratory status: Shortness of breath ,wheezing and rapid breathing can be noted.

d.Jugular veins:Distended neck veins

e.Pulse quality: Bounding pulse can be noted.