第31回介護福祉士国家試験問題より
問題51
Cさん（81歳、女性）は、介護老人保健市施設に入所している。腹圧性尿失禁があり、トイレでの排泄や下着の交換には介護が必要だが、遠慮して下着の交換を申し出ないことがある。食堂で昼食をとっている最中に激しくむせこむんでいたので、背中をさすったところ、むせ込みは収まったが失禁をしたらしく、周囲に尿臭が漂った。
このときの介護福祉職の対応として、最も適切なものを１つ選びなさい。
1 尿臭がすることを伝える。
2 下着が濡れていないかと尋ねる。
3 むせた時に尿が漏れなかったかと尋ねる。
4 トイレに誘導して、下着を交換する。
5 Cさんが下着を替えてほしいと言うまで待つ。
正解は↓
答え ４
腹圧性尿失禁がある利用者への介護福祉職の対応に関する設問です。
１ × 昼食時で他の利用者がいるにもかかわらず、その中で尿臭がすることをCさんに伝えることは、遠慮しがちなCさん自身を精神的に追い詰め、自信を無くさせてしまう不適切な対応といえます。食堂で他の利用者もいるため、遠慮して下着の交換を言い出せないCさんの思いを考えた対応が介護福祉職には求められます。
２ × 「下着が濡れていないか」とCさんの羞恥心や自尊心に配慮しない安易な発言は不適切です。Cさんには腹圧性尿失禁があること、遠慮して下着の交換を申し出ないことなどの情報を介護福祉職は事前に把握したうえで、Cさんのプライバシーや羞恥心、自尊心に配慮した対応を行う必要があります。
３ × 腹圧性尿失禁は咳やくしゃみ等、腹部に力が入った時に尿が漏れてしまう状態で、骨盤底筋群が低下しやすい高齢の女性に多くみられます。Cさんの場合も、むせ込んだ際に失禁したと考えられるが、それをわざわざ尋ねる行為は、Cさんを精神的に追い込んでしまうおそれがあります。
４ 〇 昼食中で他の利用者もおり、Cさんは遠慮して下着の交換を申し出ることができない状況にあります。そうしたCさんの気持ちを理解した上で、さりげなくトイレに誘導して、下着を交換する必要があります。
５ × 尿が皮膚に接している時間が長くなればなるほど、尿かぶれが発生しやすくなります。尿かぶれになると皮膚が赤くなったり、かゆくなったりするため、失禁した場合には、できるだけ早く交換する必要があります。
英訳
From the 31st National Examination Question for Care Workers
Problem 51
Ms. C (81 years old, female) is admitted to a long-term care health city facility. She has stress urinary incontinence and needs care to excrete in the toilet and change her underwear, but she may be reluctant to offer to change her underwear. She was squeezing hard while she was having lunch in the cafeteria, so when she rubbed her back, the swelling subsided, but she seemed to be incontinent, and there was a urine odor around her. rice field.
Please select the most appropriate one for the care and welfare staff at this time.
1 Tell them that you have urine odor.
2 Ask if your underwear is wet.
3 She asks if urine leaked when she was sick.
4 Guide to the toilet and change underwear.
5 Wait until Ms. C asks you to change your underwear.
The correct answer is ↓
Answer 4
This is a question regarding the response of long-term care welfare workers to users with stress urinary incontinence.
1 × Telling Ms. C that he has a urine odor even though there are other users at lunch will mentally hunt down Mr. C himself, who tends to be reluctant, and lose his confidence. It can be said that it is an inappropriate response. Since there are other users in the cafeteria, long-term care and welfare workers are required to take into consideration the thoughts of Ms. C, who cannot hesitate to change his underwear.
2 × It is inappropriate to make a simple statement, “Is your underwear wet?” Without considering Ms. C’s shame and self-esteem. The long-term care welfare worker should be aware of information such as that Ms. C has stress urinary incontinence and that he should refrain from offering to change his underwear, and then take measures in consideration of Ms. C’s privacy, shame, and self-esteem. You need to do.
3 × Stress urinary incontinence is often seen in elderly women whose pelvic floor muscles tend to decline, with urine leaking when the abdomen is stressed, such as coughing or sneezing. In the case of Ms. C, it is thought that he was incontinent when he was incontinent, but the act of asking for it may push him mentally.
4 〇 There are other users during lunch, and Ms. C is in a situation where he cannot offer to change his underwear. After understanding Ms. C’s feelings, it is necessary to casually guide him to the bathroom and change his underwear.
5 × The longer the urine is in contact with the skin, the more likely it is that urine rash will occur. If you have an incontinence, you should replace it as soon as possible, as urinary rashes can cause your skin to become red and itchy.
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