NCP Impaired Urinary Elimination - Reflex Incontinence

Nursing Diagnosis: Impaired Urinary Elimination - Reflex 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: Involuntary loss of urine at somewhat predictable intervals when a specific bladder volume is reached

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: Loss of urine without warning

* Related Factors: Spinal cord injury
* Stimulation of perineum in presence of spinal cord injury

* Expected Outcomes Patient verbalizes or demonstrates management techniques.

Ongoing Assessment

* Ask whether patient feels urgency or sensation of voiding. Spinal cord-injured patients may have damaged sensory fibers, and may not have the sensation of the need to void.
* Document history of spinal cord injury, including level.

Therapeutic Interventions

* Consider use of external catheter.
* Use indwelling catheter as last resort. Although risk of infection is considerable with both external and indwelling catheters, indwelling catheters interfere with clothing, movement, and sexual activity and may result in odor or other embarrassing sensory phenomena.

Education/Continuity of Care

* Teach patient or caregiver (or perform for patient) intermittent (self-) catheterization. This empties bladder at specified intervals.