Nursing diagnosis – URGE URINARY INCONTINENCE

URGE  URINARY  INCONTINENCE

DEFINITION

Involuntary passage of urine occurring shortly after a strong sense

of urgency to void

DEFINING CHARACTERISTICS

• Bladder contraction or spasm

• Increased or decreased volume

• Frequency

• Nocturia

• Inability to reach toilet in time

• Urgency

RELATED FACTORS

• Alcohol intake

• Decreased bladder capacity

• Atrophic urethritis

• Detrusor hyperactivity with

• Atrophic vaginitis

impaired bladder contractility

• Bladder infection

• Fecal impaction

• Caffeine intake

• Use of diuretics

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Activity/exercise

• Fluid and electrolytes

• Behavior

• Physical regulation

• Elimination

• Self-care

EXPECTED OUTCOMES

The patient will

• Have fewer episodes of incontinence.

• State increased comfort.

• State understanding of treatment.

• Have minimal, if any, complications.

• Discuss impact of disorder on himself and family members.

• Demonstrate skill in managing incontinence.

SUGGESTED NOC OUTCOMES

Tissue Integrity: Skin & Mucous Membranes; Urinary Continence;

Urinary Elimination

INTERVENTIONS AND RATIONALES

Determine: Observe voiding pattern; document intake and output.

This ensures correct fluid replacement therapy and provides informa-

tion about patient’s ability to void adequately.

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

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

Patient should receive adequate care and take part in decisions

about care as much as possible.

Assist with specific bladder elimination procedures, such as the

following:

bladder training—place patient on commode every 2 hr while

awake and once during night, provide privacy, and gradually

increase intervals between toileting (these measures aim to restore a

regular voiding pattern). As well as rigid toilet regimen—place

patient on toilet at specific times (to aid adaptation to routine

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physiologic function), and keep baseline micturition record for

3–7 days (to monitor toileting effectiveness).

Administer pain medication; discuss effectiveness with patient to

reinforce that pain can be alleviated, which reduces tension and anxiety.

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

bathroom. A bedside commode or convenient bathroom requires less

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.

Provide a clock to help patient maintain voiding schedule through

self-monitoring.

Unless contraindicated, maintain fluids to 3,000 ml daily to mois-

ten mucous membranes and ensure hydration; limit patient to 150

ml after dinner to reduce need to void at night.

Have patient wear easily removable clothes (gown instead of paja-

mas and Velcro fasteners instead of buttons or zippers) to reduce

frustration and delay in voiding routine.

If patient loses control on way to bathroom, instruct patient to

stop and take a deep breath. Anxiety and rushing may strengthen

bladder contractions.

Inform: Explain urologic condition to patient and family members;

include instructions on preventive measures and established bladder

schedule. Patient education begins with educational assessment and

depends on establishing a therapeutic relationship with patient and

family. Prepare patient for discharge according to individual needs to

allow patient to practice under supervision.

Instruct patient and family members on continence techniques for

home use. This reduces fear and anxiety resulting from lack of knowl-

edge of patient’s condition and reassures patient of continuing care.

Attend: Encourage patient to express feelings and concerns related to

his or her urologic problem to identify patient’s fears.

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

Fluid Monitoring; Perineal Care; Self-Care Assistance: Toileting; Uri-

nary 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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