Assignment
HJ is a 68-year-old female who works full time as lawyer for women's rights. She works a 50-hour week and is constantly on the move from meetings with clients to representing other women in court. She is coming into her Primary Care Provider's (PCP) office today as she has noticed that she cannot hold her urine anymore. Once she feels the urge to urinate, she must go at that time or wet her underwear. She also notices that when she coughs, laughs or sneezes she leaks urine.
Subjective Data:
Patient states that she is up to date with vaccinations and her last visit for an annual was 6 months ago. Elimination problems started three months ago and have not improved. She denies any problems with cognition, ability to concentrate or follow orders. She denies any balance or ambulation problems but walks with a cane. She denies any new problems with HEENT, musculoskeletal, neuro, cardiac, respiratory, GI or skin systems. GU: She denies itch, pain, discomfort, urgency, frequency, or blood in the urine. Skin is cool to touch and intact. She feels safe at home and is Christian and attends services every Sunday.
PMH: Hypertension, DM II, 6 vaginal births
PSH: Right hip replacement 4 years ago
Family history: mother died of a stroke and father died from cardiac disease
Social history: She has a glass of wine with dinner each night, never smoked but smoked marijuana while in college but never after the age of 21
Allergies: NKDA and no food or environmental allergies
Activity: Patient walks 2 miles each evening after work with her husband
Medications: Norvasc 50 mg po q am and Metformin 500 mg po BID, MVI 1-tab po q am, Calcium 2.000 mg po qd at 1000 taken separately from other medications, Vitamin D 400 IU PO q am
Objective data:
Vital signs: T 98, P: 70, R 18, BP 116/70, Pulse Ox 99% on R/A and patient denies any pain
Neuro and mental status: Alert and oriented x4 and she follows commands well. Pleasant and cooperative.
Musculoskeletal and Neuro: Ambulates without difficulty even with cane supporting the right leg. She is 160 lbs. and 67 inches tall. No scoliosis noted and posture is straight. Upper and lower extremity strength is 4/5 bilaterally to upper and lower extremities.
HEENT: Eyes, eye brows, ears, nose and mouth are symmetrical. No drainage noted to ears or nose. Cranial nerves II-XII are grossly intact.
Cardiac: S1 and S2 are noted without ectopy.
Respiratory: Lung sounds are clear to all lung fields
GI: abdomen is symmetrical, rounded and without scars. Positive bowel sounds to all four quadrants, abdomen is soft, non-tender and non-distended.
GU: Urine sample obtained and urine is clear yellow with aromatic odor
The nurse takes her to the examination room and is obtaining patient data when HJ states: "I hope this is nothing serious, I still have a lot of work to do before I give up my cause and retire."
A. What statement by the nurse will be appropriate at this time?
B. What cues can the nurse get from the subjective and objective data that will clue her in to what is going on with the patient.
C. If the patient is having urinary incontinence what nursing interventions are needed for an outpatient.
D. Develop a teaching plan for this patient.