Complex care

Question 1

What are the risk factors for a pressure ulcer?

Answer 1

• Limited mobility
• Loss of sensation
• Previous/current ulcer
• Nutritional deficiency
• Inability to reposition themselves
• Cognitive impairment

Question 2

What is the Waterlow score?

Answer 2

Screens patients at risk of developing pressure ulcers

Question 3

What are the grades of pressure ulcers?

Answer 3

1 - erythema, discolouration, warmth or hardness of intact skin
2 - loss of epidermis, dermis or both
3 - damage to or necrosis of subcutaneous tissue
4 - tissue necrosis or damage to muscle, bone or supporting structures

Question 4

How do you prevent pressure ulcers?

Answer 4

SSKIN

1. Support surface
2. Skin inspection
3. Keep moving
4. Incontinence and increased moisture
5. Nutrition and hydration

Question 5

What is the management for pressure ulcers?

Answer 5

•	Analgesia
•	Hydrocolloid dressing
•	Antibiotics only if: Sepsis, Cellulitis
 or Osteomyelitis 
•	Referral to tissue viability

Question 6

What is an overactive bladder?

Answer 6

o Detrusor overactivity

Question 7

What is stress incontinence?

Answer 7

o Leaking small amounts of urine when coughing/laughing

Question 8

What is overflow incontinence?

Answer 8

o Involuntary leakage associated with constantly dribbling or continuing to dribble for some time after passing urine

Question 9

How do you investigate urinary incontinence?

Answer 9

• Bladder diaries for 3 days
• Pelvic and rectal examination searching for:
• Urine dipstick
• Urodynamic studies

Question 10

What is the general management for urinary incontinence?

Answer 10

• Reduce caffeine

- Weight loss if >30kg/m2

Question 11

What is the management for urge incontinence?

Answer 11

o Bladder retraining 6 weeks

o Antimuscarinics - Oxybutynin

Question 12

What is the management for stress incontinence?

Answer 12

o Pelvic floor muscle training 3 months
o Surgery
o Duloxetine

Question 13

What is given if concerned about anticholinergic SE in older people for urge incontinence?

Answer 13

Mirabegron

Question 14

How do you manage faecal incontinence?

Answer 14

Advise:

• Food and fluid diary
• Modify one food at a time to treat cause
• Screen for malnutrition
• Wear easily removable clothing
• Continence products
• Bowel emptying after meals
• Sitting/squatting when emptying bowel to avoid straining

Pharmacological:

• Loperamide
• Cannot tolerate: codeine phosphate or co-phentrope