NCP Impaired Urinary Elimination - Total Incontinence

Nursing Diagnosis: Impaired Urinary Elimination - Total 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: Continuous and unpredictable loss of urine

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.

* Defining Characteristics: Continual involuntary loss of urine

* Related Factors: Pelvic surgery
* Fistulas (iatrogenic, postoperative, and postradiation)
* Trauma
* Exstrophy of bladder

* Expected Outcomes Patient remains dry and comfortable.
* Perineal skin remains intact.

Ongoing Assessment

* Assess amount of urine loss.
* Assess perineal skin condition. The urea in urine converts to ammonia in a short time and is caustic to skin.

Therapeutic Interventions

* Encourage use of diapers or external collection devices. Most of these patients are women with fistulas; in-dwelling catheters are useless in the presence of vesi-covaginal or urethrovaginal fistulas because there is a communication between the bladder or urethra and the vagina.
* Prepare patient for surgical correction as indicated.