NCP Impaired Urinary Elimination - Stress Incontinence

Nursing Diagnosis: Impaired Urinary Elimination - Stress 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: Loss of less than 50 ml of urine occurring with increased abdominal pressure

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: Leakage of urine during exercise
* Leakage of urine during coughing, sneezing, laughing, or lifting

* Related Factors: Multiple vaginal deliveries
* Pelvic surgery
* Hypoestrogenism (aging, menopause)
* Diabetic neuropathy
* Trauma to pelvic area
* Obesity
* Radial prostatectomy
* Myelomeningocele
* Infection

* Expected Outcomes Patient is continent of urine or verbalizes satisfactory management.

Ongoing Assessment

* Ask whether urine is lost involuntarily during coughing, laughing, sneezing, lifting, or exercising. Whenever intraabdominal pressure increases, a weak sphincter and/or relaxed pelvic floor muscles allow urine to escape involuntarily.
* Examine perineal area for evidence of pelvic relaxation:
o Cystourethrocele (sagging bladder or urethra)
o Rectocele (relaxed, sagging rectal mucosa)
o Uterine prolapse (relaxed uterus)
* Determine parity. Childbirth trauma weakens pelvic muscles.
* Explore menstrual history. Postmenopausal hypoestrogenism causes relaxation of the urethra.
* Ask about previous surgical procedures. In men, transurethral resection of the prostate gland can result in urinary incontinence.
* Weigh patient. Obesity contributes to increased intraabdominal pressure.
* Culture urine. Infection can cause incontinence.

Therapeutic Interventions

* Prepare patient for surgery as indicated. Many types of procedures are used to control stress incontinence; the most commonly performed are Marshall-Marchetti, Burch’s colposuspension, and sling procedures.
* Prepare patient for the implantation of an artificial urinary sphincter. This uses a subcutaneous pumping device to deflate or inflate a cuff that controls micturition.
* Encourage weight loss if obese.

Education/Continuity of Care

* Teach patient to perform Kegel exercises. Kegel exercises are used to strengthen the muscles of the pelvic floor, and can be practiced with a minimum of exertion. The repetitious tightening and relaxation of these muscles (10 repetitions, four or five times per day) helps some patients regain continence. Kegel exercises may be used in combination with biofeedback to enhance outcome.