NCP Impaired Urinary Elimination - Functional Incontinence

Nursing Diagnosis: Impaired Urinary Elimination - Functional 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: Inability of usually continent person to reach toilet in time to avoid unintentional 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: Recognizes need to urinate, but is unable to access toileting facility

* Related Factors: Unavailability of toileting facility
* Inability to reach toileting facility
* Untimely responses to requests for toileting
* Limited physical mobility

* Expected Outcomes Patient experiences fewer episodes (or no episodes) of incontinence.

Ongoing Assessment

* Assess patient’s recognition of need to urinate. Patients with functional incontinence are incontinent because they cannot get to an appropriate place to void. Institutionalized patients are often labeled "incontinent" because their requests for toileting are unmet. Elderly patients with cognitive impairment may recognize need to void, but may be unable to express the need.
* Assess availability of functional toileting facilities (working toilet, bedside commode).
* Assess patient’s ability to reach toileting facility, both independently and with help.
* Assess frequency of patient’s need to toilet. This is the basis for an individualized toileting program.

Therapeutic Interventions

* Establish a toileting schedule. A toileting schedule assures the patient of a specified time for voiding, and reduces episodes of functional incontinence.
* Explore the benefit of placing a bedside commode near the patient’s bed.
* Encourage use of clothing that can be easily and quickly removed. Prophylactically care for perineal skin. Moisture-barrier ointments are useful in protecting perineal skin from urine scalds.
* Treat any existing perineal skin excoriation with a vitamin-enriched cream, followed by a moisture barrier.

Education/Continuity of Care

* Teach patient or caregiver the rationale behind and implementation of a toileting program.