1. Have the Courage to be a Continence Lion
Kimberly K Kopp
BSN, RN, CWOCN, CFCN

2. LEARNING OUTCOMES
Participants will be able to:

3. Facts Financial burden – 25 million women affected by incontinence
Year 2000 estimated at $19.5 billion
$14.2 billion incurred by community residents
$5.3 billion by institutional residents .
$900 annually paid privately for pads
25 million women affected by incontinence
1 in 4 women over 18 report episodes of incontinence
On average, women wait 6.5 years from the first time they experience symptoms until they obtain a diagnosis for their incontinence
80% of those affected can be improved or cured with treatment
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics , Vital and Health Statistics, Prevalence of Incontinence Among Older Americans, Series 3, Number 36, June 2014
National Association for Continence website

4. Fears / Misconceptions / Excuses
Need to be a Nurse Practitioner
Need expensive high tech equipment
Need to be able to do Urodynamics
Continence exam is too hard to pass
Already to busy don’t have time for Continence
I already take care of IAD so I am taking care of the
incontinence issue

5. Ways I use my “C” Direct Patient Care – many opportunities
Bring new products to the facility to use
Resource person for staff
Help develop new protocols
Education of the staff and the public

6. Acute Care CAUTI prevention
Prevention and Management of Incontinence Associated Dermatitis
High volume fecal output
Urinary incontinence
Staff education
Develop protocols for product usage
Product review
Teaching how to self catheterize
Assist patients with obtaining supplies for home

7. Home Health Care Assist with management of foley catheters
Suprapubic vs Urethral
Removal vs Long term placement
Obtaining UA’s
Develop simple management and education for staff as well as patient and families
Toileting programs
Chronic constipation
Dietary modifications
Containment products
Skin care

8. Long Term Care CMS mandates that facilities address
Avoidance of inappropriate catheter usage
Avoid inappropriate treatment of nonsymptomatic bacteriuria
Continence program for residents that have some ability to respond to cues to urinate
Bowel management regime to prevent constipation and impactions

9. Out patient Clinic Continence nurse can
Do basic baseline assessment of urinary / bowel system
Provide basic counseling to patients for
Dietary modifications
Pelvic floor exercises
Toileting programs
Clean intermittent catheterization procedure
Bladder control strategies
Containment options
Determine need for further referral

10. Educational Opportunities in my practice
Women’s Health Events
Healthy U hospital educational event for public
Nursing staff
Always new nurses that need education
Education impacts the direct patient care
Primary care physicians
When to do a UA in long term catheterized patients
Management of those patients in the nursing homes
Treatment of women with chronic UTI’s
Antibiotics vs Vaginal estrogen

11. Case Study #1 Inpatient Report at huddle
81 y/o male admitted to our Swing bed with CHF
Recent catheter placement in city due to acute renal failure and retention
Local physician wanted catheter changed to obtain urine specimen as WBC remained elevated
Urine had been bloody & bloody drainage around meatus
Nursing reports that catheter draining well

12. impact:
Suggested use of a double balloon catheter to decrease irritation of bladder
Nurse not familiar with new double balloon catheter so offered to assist
400cc urine in bag at time of change but patient was uncomfortable and looked distended
Double balloon catheter inserted and immediately drained 1300cc urine
Renal function improved, WBC normalized

13. Case Study #2 Outpatient
48 y/o female Physical therapy aide at CCMH
Complaint of frequency and urgency
Heard we had new incontinence equipment so got referral for treatment

14. assessment Normal anatomy Voiding every 30 -60 minutes during day
Up 4-6 times a night
Had separate bedrooms at home
Didn’t want to take medication or have surgery

15. Treatment Initiated the biofeedback and electrical stimulation
Good pelvic floor strength
Education
Basic voiding anatomy and physiology
Urge suppression
Bladder retraining

16. Impact In 6 weeks she was sleeping all night
Going 3 hours without voiding at work
Felt the best she had in years

17. Social Effects of Incontinence
Impacts responsibilities at work
Fear of leaving home due to leakage
Embarrassment
Isolation
Stress in relationships
Depression
Desperate for help

18. Case Study #3 desperation
36 y/o female
Long standing urinary incontinence
2 urologist, 2 surgeries, several urodynamic studies, medications
Willing to private pay for biofeedback and e stim due to desperation

19. Assessment Solution Amazing pelvic floor strength
No consistent pattern to the incontinence
Wasn’t typical urge or stress
“normal” bowel routine
Had never been discussed with her
Solution
Added fiber to improve her normal bowel routine

20. Case Study #4 Isolation
84 y/o female walks into office c/o incontinence
Totally incontinent
Never walked to bathroom to void
Rarely left home
Initial treatment
Bladder diary
Bladder retraining
Return appointment
Voiding every 2 hours
Going to visit grandchildren

21. Case Study #5 depression
44 y/o female quad lived at home with assistance of home health care and private care givers
Repeated UTI’s and was receiving IV antibiotics every 6 weeks
Was so depressed and tired of feeling terrible she drove wheelchair down flight of stairs in suicide attempt

22. Impact
Introduced her to the option of the double balloon catheter by having her watch the video about the catheter
Has been using the double balloon catheter for 3 years now and has had only 1-2 UTI’s/year that have been treated with oral antibiotics

23. Take the time to listen and educate
Diet and fluid intake
Bladder routine
Bowel routine

24. Take the time to look and feel
Prolapse
Fragile vaginal tissue
Squeeze fingers
Bladder distention
scan

25. Patients aren’t asking for a miracle cure
They want someone to make their life more manageable
It really isn’t complicated or technical

26. Final Case Study 83 y/o active male
New indwelling catheter due to hematuria postop polyp removal couple days prior
Presented to the admissions department with complaints about the catheter

27. Bilateral arm amputee of 50 years

28. assessment Response I don’t want to bother you I know you are busy
Tubing taped too tight was pulling
Are you having any other problems that I can help you with today?
Response
I don’t want to bother you I know you are busy
I am having a little trouble emptying
the leg bag

29. Cant get hook behind clamp to open drain
Need an extension on green handle

30. Resourceful WOC nurse

32. References
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics , Vital and Health Statistics, Prevalence of Incontinence Among Older Americans, Series 3, Number 36, June 2014
National Association for Continence website

33. Have the Courage to be a Continence Nurse