A 66-year-old woman, who resides in a nursing home following a stroke, is hospitalized because of loose stools and confusion. On the second hospital day, the patient has two episodes of urinary incontinence. Neither the nursing-home staff nor family members report previous problems with incontinence. Medical history is significant for a cerebrovascular accident with severe aphasia and left hemiparesis, hypertension, and type 2 diabetes mellitus. Current medications are aspirin, dipyridamole, lisinopril, and glipizide.
On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 164/96 mm Hg, pulse rate is 92/min, and respiration rate is 18/min. Arterial oxygen saturation is 98% on ambient air. Results of cardiopulmonary, abdominal, and rectal examinations are normal. On neurologic examination, the patient is not oriented to place or date and she keeps trying to climb out of bed. There is expressive aphasia and moderate weakness of the left arm and leg.
| Laboratory studies: | |
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Complete blood count
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Normal
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Calcium
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8.6 mg/dL (2.15 mmol/L)
|
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Creatinine
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1.2 mg/dL (106.1 µmol/L)
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Glucose
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100 mg/dL (5.55 mmol/L)
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Electrolytes
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Normal
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Urinalysis
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2+ glucose, moderate protein, 10-20 leukocytes and 3-5 erythrocytes/hpf
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Results of urine and blood cultures are pending. An electrocardiogram and chest radiograph are normal.
Which of the following is the best management for this patient’s incontinence?
