Nursing diagnosis – STRESS URINARY INCONTINENCE

STRESS  URINARY  INCONTINENCE

DEFINITION

Sudden leakage of urine with activities that increase intra-abdominal

pressure

DEFINING CHARACTERISTICS

• Dribbling with increased abdominal pressure

• Frequency

• Urgency

RELATED FACTORS

• Degenerative changes in pelvic

• Intrinsic urethral sphincter

muscles

deficiency

• High intra-abdominal pressure

• Weak pelvic muscles

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Activity/exercise

• Fluid and electrolytes

• Behavior

• Physical regulation

• Elimination

• Self-care

EXPECTED OUTCOMES

The patient will

• Maintain continence.

• State increased comfort.

• State understanding of treatment.

• State understanding of surgical procedure.

• Demonstrate skill in managing urinary elimination problems.

• Identify resources to assist with care following discharge.

SUGGESTED NOC OUTCOMES

Tissue Integrity: Skin & Mucous Membranes; Urinary Continence;

Urinary Elimination

INTERVENTIONS AND RATIONALES

Determine: Observe patient’s voiding patterns, time of voiding,

amount voided, and whether voiding is provoked by stimuli. Accu-

rate, thorough assessment forms basis of an effective treatment plan.

Perform: Provide appropriate care for patient’s urologic condition,

monitor progress, and report patient’s responses to treatment.

Patient expects to receive adequate care and to participate in

decisions regarding care.

Help patient to strengthen pelvic floor muscles by Kegel exercises

for sphincter control. Exercises increase muscle tone and restore cor-

tical control.

Promote patient’s awareness of condition through education to

help patient understand illness as well as treatment.

Help patient reduce intra-abdominal pressure by losing weight,

avoiding heavy lifting, and avoiding chairs or beds that are too high

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or too low. These measures reduce intra-abdominal pressure and

bladder pressure.

Provide supportive measures:
– Respond to call bell quickly, assign patient to bed next to bath-

room, put night-light in bathroom, and have patient wear easily

removable clothing (gown rather than pajamas and Velcro fasteners

rather than buttons or zippers). Early recognition of problems pro-

motes continence; easily removed clothing reduces patient frustration

and helps achieve continence.

– Provide privacy during toileting to reduce anxiety and promote

elimination.

– Have patient empty bladder before meals, at bedtime, and

before leaving accessible bathroom area to promote elimination,

avoid accidents, and help relieve intra-abdominal pressure.

– Limit fluids to 150 ml after dinner to reduce need to void at

night.

– Encourage high fluid intake, unless contraindicated, to moisten

mucous membranes and maintain hydration.

– Suggest patient eat increased amount of salty food before going

on a long trip (unless contraindicated). Increased sodium decreases

urine production.

– Make protective pads available for patient’s undergarments, if

needed, to absorb urine, protect skin, and control odors.

If surgery is scheduled, give attentive, appropriate preoperative

and postoperative instructions and care to reduce patient’s anxiety

and build trust in caregivers.

Inform: Alert patient and family members about need for toilet

schedule. Prepare for discharge according to individual needs to

ensure that patient will receive proper care.

Attend: Encourage patient to express feelings and concerns related to

urologic problems. This helps patient focus on specific problem.

Manage: Refer patient and family members to psychiatric liaison

nurse, support group, or other resources, as appropriate.

Community resources typically provide healthcare not available from

other healthcare agencies.

SUGGESTED NIC INTERVENTIONS

Pelvic Muscle Exercise; Teaching: Individual; Urinary Elimination

Management; Urinary Habit Training; Urinary Incontinence Care

Reference

Anders, K. (2006, May). Recent developments in stress urinary incontinence in

women. Nursing Standard, 20(35), 48–54.

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