You are caring for Polly, an 87-year-old female who resides in a local extended care nursing facility. In report, you are informed that Polly is a frail (85 pound), bed-bound, African American female with medical diagnoses of end-stage COPD, insulin dependent diabetes, and crippling arthritis. Polly is a G12P10 and has developed Stage IV uterine prolapse. Due to her complex medical conditions and fragility, Polly is not a surgical candidate for treating her prolapse nor does she have a pessary. Additionally, Polly is incontinent of bowel and bladder. (Learning Objectives 2 and 3)
A. What factors described above contributed to Polly’s development of pelvic organ prolapse?
B. What are the management and nursing interventions related to caring for Polly’s severe uterine prolapse?
C. Why do you think Polly is not a good candidate for a pessary?

1. age- weak pelvic floor muslces,muscles, Chronic Obsessive Pulmonary Disease, multiple pregnancies has in one way or the other contributed to factors leading to prolapse

2. pelvic floor stregthening exercises

-Usage of diapers or urinary devices.

-Avoiding constipation by taking high fibreFibre and drinking a lot of water.

-Proper treatment of COPD through medications, supplemental oxygen therapy, etc.

-Avoid bearing down to move your bowels

-Avoid heavy lifting of weight

-Control coughing

3. Low compliance by patient.

Explanation:

Pelvic organ prolapse happens occurs when the muscles and tissues supporting the pelvic organs (the uterus, bladder, or rectum) become weak or loose.

1. From the information given above, age- weak pelvic floor muslces,muscles, Chronic Obsessive Pulmonary Disease, multiple pregnancies has in one way or the other contributed to factors leading to prolapse.

2.pelvic floor stregthening exercises. For example, kegels,

-Usage of diapers or urinary devices.

-Avoiding constipation by taking high fibreFibre and drinking a lot of water.

-Proper treatment of COPD through medications, supplemental oxygen therapy, etc.

-Avoid bearing down to move your bowels

-Avoid heavy lifting of weight

-Control coughing

3. A pessary is a plastic device, that is similar to a vaginal contraceptive diaphragm. It is a low risk treatment which can either lifts the bladder or compresses the urethra during activities that can cause leakage.

Compliance is low by patient- Pessaries can fall out if you strain, multiparity.

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