Nursing diagnosis – OVERFLOW URINARY INCONTINENCE

OVERFLOW  URINARY  INCONTINENCE

DEFINITION

Involuntary loss of urine associated with overdistention of the bladder

DEFINING CHARACTERISTICS

• Bladder distention

• High postvoid residual volume

• Nocturia

• Reported and observed involuntary leakage of small volumes of

urine

RELATED FACTORS

• Bladder outlet obstruction

• Severe pelvic prolapse

• Detrusor external sphincter

• Side effects of anticholinergic,

dyssynergia

calcium channel blocker, or

• Detrusor hypocontractility

decongestant medications

• Fecal impaction

• Urethral obstruction

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Activity/exercise

• Fluid and electrolytes

• Behavior

• Physical regulation

• Elimination

• Self-care

EXPECTED OUTCOMES

The patient will

• Void 200–300 mL of clear, yellow urine every 3–4 hr while

awake.

• Have postvoid residual of less than 50 ml.

• Have reduction in urinary incontinence episodes or complete

absence of urinary incontinence.

• Experience relief of most bothersome aspect of urinary

incontinence.

• Remain clean and dry without urine odor.

• Express understanding of condition and activities to prevent/reduce

overflow incontinence.

• Express improvement in quality of life.

SUGGESTED NOC OUTCOMES

Knowledge: Treatment Regimen; Urinary Continence

INTERVENTIONS AND RATIONALES

Determine: Monitor and record patient’s voiding patterns to

determine existence and extent of overflow incontinence.

Monitor and record patient’s intake and output to determine fluid

balance.

Perform: Ask patient to keep a bladder diary of continent and incon-

tinent voids to promote understanding of the extent of the problem

of overflow incontinence. Discuss voiding and fluid intake patterns.

Accurate understanding of patient’s pattern provides a baseline for

introducing new activities.

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Provide privacy and adequate time to void to decrease anxiety

and promote relaxation of sphincter.

Assist patient to assume usual position for voiding. Some patients

are unable to void while lying in bed and may develop urinary

retention and overflow incontinence.

Massage (credé) the bladder area during urination to increase

pressure in the pelvic area to encourage drainage of urine from the

bladder.

Institute indwelling or intermittent catheterization, as ordered.

Catheterization is used as a last resort to empty the bladder prevent-

ing overflow incontinence.

Assist with application of pads and protective garments (used only

as a last resort) to prevent skin breakdown and odor and to

promote social acceptance.

Inform: Teach patient and/or family to catheterize patient with

chronic overflow incontinence related to urinary retention using

clean technique to manage long-term overflow incontinence.

Teach stress management and relaxation techniques. Stress and

anxiety interfere with sphincter relaxation, causing urinary retention

and overflow incontinence.

Attend: Encourage patient to share feelings related to incontinence to

reduce anxiety.

Encourage patient to drink six to eight glasses of noncaffeinated,

nonalcoholic, and noncarbonated liquid, preferably water, per day

(unless contraindicated). 1,500–2000 mL/day promotes optimal renal

function and flushes bacteria and solutes from the urinary tract.

Caffeine and alcohol promote diuresis and may contribute to excess

fluid loss and irritation of the bladder wall.

Encourage patient to respond to the urge to void in a timely man-

ner. Ignoring the urge to urinate may cause incontinence.

Encourage patient to participate in regular exercise, including

walking and modified sit-ups (unless contraindicated). Weak abdomi-

nal and perineal muscles weaken bladder and sphincter control.

Encourage patient to avoid anticholinergics, opioids, psychotrop-

ics,    -adrenergic agonists,    -adrenergic agonists, and calcium-

channel blockers (unless contraindicated), which inhibit relaxation of

the urinary sphincter and cause urinary retention.

Manage: Provide referrals for physical therapy or psychological

counseling as necessary to enhance success.

SUGGESTED NIC INTERVENTIONS

Urinary Incontinence Care; Urinary Retention Care

Reference

DuBeau, C. (2006). Clinical presentation and diagnosis of urinary

incontinence. Retrieved December 12, 2006, from http://www.uptodate.com

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