NCP Impaired Urinary Elimination - All Types of Incontinence

Nursing Diagnosis: Impaired Urinary Elimination - All Types of Incontinence
Stress Incontinence; Urge Incontinence; Reflex Incontinence; Functional Incontinence; Total Incontinence
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels

* Urinary Continence
* Urinary Elimination
* Self-Care: Toileting

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels

* Urinary Catheterization
* Urinary Catheterization: Intermittent
* Urinary Habit Training: Urinary
* Incontinence Care

NANDA Definition:

There are several types of urinary incontinence; all are characterized by the involuntary passage of urine. Urinary incontinence is not a disease but rather a symptom. Incontinence occurs more among women, and the incidence increases with age, although urinary incontinence is not a given with aging. An estimated 10 million people are incontinent; billions are spent annually in the management of urinary incontinence. Micturition (urination) is a complex physiological function that relies on proper function of the bladder muscles and sphincters responding to spinal nerve impulses (S2, S3, and S4). Urinary incontinence occurs whenever the bladder, sphincter, or the nerves involved in micturition are diseased or damaged. Relaxed pelvic musculature following childbirth, postmenopausal urethral atrophy, central nervous system (CNS) diseases (e.g., Parkinson’s and cerebrovascular accident [CVA]), spinal cord lesions or injury, and postoperative injuries can result in urinary incontinence. Careful diagnosis, including urodynamic studies, should precede treatment decisions, although empiric management is common. Urinary incontinence can lead to altered skin integrity, as well as severe psychological disturbances. Incontinent individuals often withdraw from social contact, and urinary incontinence is a major determinant in the institutionalization of elderly patients. This care plan addresses five types of urinary incontinence: stress, urge, reflex, functional, and total. Education and continuity of care are addressed for each type, as well as for the problem of urinary incontinence as an entity.
Ongoing Assessment

Therapeutic Interventions

Education/Continuity of Care

* Teach patient or caregiver normal anatomy of genitourinary tract and factors that normally control micturition and maintain continence.
* Assist patient in recognizing that any episodes of incontinence that pose a social or hygienic problem deserve investigation so that appropriate therapy can be implemented. Many people accept urinary incontinence as an inevitable consequence of aging and may be unaware that therapeutic measures can improve incontinence.
* Inform patient of the high incidence of urinary incontinence. This information may decrease feelings of hopelessness and isolation that often accompany urinary incontinence.
* Assist patients, through careful interview, to identify possible causes for urinary incontinence.
* Teach patients the necessity, purpose, and expected results of urodynamic diagnostic evaluation. Urodynamic studies evaluate bladder filling and sphincter activity and are particularly useful in differentiating stress and urge incontinence.
* Provide information regarding all available methods of managing urinary incontinence. Methods include the following:
o Use of absorbent pads or undergarments that accommodate absorbent pads
o Diapers
o Linen protectors for bedridden patient
o External collection devices such as male external catheters and female external catheters
o Indwelling catheters
o Intermittent catheterization
o Surgical procedures
o Electrical nerve stimulators
o Pharmacotherapeutic agents Patients need information on drugs used to treat urinary incontinence as well as those used for other problems that may precipitate or worsen incontinence.
o Drugs that may precipitate or worsen incontinence: diuretics, sedatives, hypnotics, anticholinergics, and alcohol
o Drugs that may be used to treat urinary incontinence:
+ Alpha-Blockers These increase bladder pressures and decrease outlet pressures.
+ Beta-Blockers These increase outlet resistance.
+ Cholinergics These increase bladder pressures.
+ Anticholinergics These depress smooth muscle activity in hypertonic bladder.
+ Alpha-Adrenergics These increase sphincter tone.
This enables patient to make an informed decision.
* Provide information on odor control. Vinegar and commercially prepared solutions are useful in neutralizing urinary odor.
* Familiarize patient with potential risk of skin break-down. Urea contained in urine metabolizes to ammonia within minutes and is responsible for "urine burns" or "scalding." Spray or wipe preparations such as Skin Prep and Bard Barrier Film to protect skin from urine.
* Refer to Help for Incontinent People (HIP), PO Box 544, Union, SC 29379.