Nursing diagnosis – RISK FOR URGE URINARY INCONTINENCE

RISK  FOR  URGE  URINARY  INCONTINENCE

DEFINITION

At risk for involuntary loss of urine associated with a sudden,

strong sensation or urinary urgency

RISK FACTORS

• Effects of medication, caffeine,

• Detrusor muscle instability

or alcohol

with impaired contractility

• Detrusor hyperreflexia from

• Ineffective toileting habits

cystitis, urethritis, tumors,
renal calculi, central nervous
system disorders above
pontine micturation center

• Involuntary sphincter
relaxation
• Small bladder capacity

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Activity/exercise

• Fluid and electrolytes

• Behavior

• Physical regulation

• Elimination

• Self-care

EXPECTED OUTCOMES

The patient will

• State ability to anticipate if incontinence is likely to occur.

• State understanding of potential causes of urge incontinence and

its treatment.

• Avoid or minimize complications of urge incontinence.

• Discuss potential effects of urologic dysfunction on self and family

members.

• Demonstrate skill in managing incontinence.

• Identify community resources to cope with alterations in urinary

status.

SUGGESTED NOC OUTCOMES

Knowledge: Treatment Regimen; Urinary Continence; Urinary Elimi-

nation

INTERVENTIONS AND RATIONALES

Determine:  Observe patient’s voiding pattern, and document intake

and output to ensure correct fluid replacement therapy and provide

information about the patient’s ability to void adequately.

Determine patient’s premorbid elimination status to ensure that inter-

ventions are realistic and based on the patient’s health status and goals.

Assess patient’s ability to sense and communicate elimination

needs to maximize self-care.

Perform:  Unless contraindicated, provide 21⁄2 to 3 qt (2.5–3 L) of

fluid daily to moisten mucous membranes and ensure adequate

hydration. Space out fluid intake through the day and limit it to

150 ml after supper to reduce the need to void at night.

Place commode next to bed, or assign patient bed next to

bathroom. A bedside commode or convenient bathroom requires less

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energy expenditure than bedpan. If using commode, keep bed and

commode at same level to facilitate patient’s movements. If using

bathroom, provide good lighting from bed to bathroom to reduce

sensory misinterpretation; remove all obstacles between bed and bath-

room to reduce chance of falling. Prepare pleasant toilet environment

that is warm, clean, and free from odors to promote continence.

Have patient wear easily removed articles of clothing (a gown

instead of pajamas, Velcro fasteners instead of buttons or zippers)

to facilitate the removal of clothing and foster independence.

Have patient keep a diary recording episodes of incontinence to

use as a basis for planning bladder training interventions; interven-

tions may include voiding every 2 hr, avoiding high fluid intake,

maintaining proper hygiene, or notifying a healthcare professional if

urge incontinence occurs frequently. Individualized interventions help

promote self-care, foster motivation, and avoid incontinence.

Incorporate patient’s suggestions for managing incontinent

episodes into a care plan to foster motivation.

Inform:  Explain urge incontinence to patient and family members,

especially preventive measures and potential underlying causes, to

foster compliance.

Instruct patient to stop and take a deep breath if he or she expe-

riences an intense urge to urinate before he can reach a bathroom.

Anxiety and rushing may increase bladder contraction.

Attend:  Encourage patient to express feelings about incontinence to

provide emotional support and identify needed areas for further

patient teaching.

Manage:  Use an interdisciplinary approach to caring for incontinence.

Incorporate recommendations from a urologist, urology nurse special-

ist, other healthcare providers, and the patient. Monitor progress and

report the patient’s response to interventions. An interdisciplinary

approach helps ensure that the patient receives adequate care. Encour-

aging patient participation on the team will help foster motivation.

Note if patient expresses concern about the effect of incontinence

on sexuality. If appropriate, refer him to a sex therapist to promote

sexual health.

Refer patient and family members to community resources such as

support groups, as appropriate, to help ensure continuity of care.

SUGGESTED NIC INTERVENTIONS

Fluid Monitoring; Urinary Elimination Management; Urinary Habit

Training; Urinary Incontinence Care

Reference

Dingwall, L., & McLafferty, E. (2006, October). Do nurses promote urinary

continence in hospitalized older people? An exploratory study. Journal of
Clinical Nursing, 15(10), 1276–1286.

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