Transcript 63-273Incontinence04f

63-273
Urinary Incontinence
Definition of Urinary Incontinence
 Uncontrolled
loss of urine that is of
sufficient magnitude to be a problem
 Affects 13 million people in the U.S.
 Prevalance in working women
exceeds 50 %
 2 to 9% of working men
 Not a natural consequence of aging
Causes
Anything that interferes with bladder or
urethral sphincter control
 May be transient – caused by confusion,
depression, infection, drugs, restricted
mobility or stool impaction – identify
reversible causes using the DRIP
anacronym
– Delerium/Drugs, Restricted mobility,
Infection & Polyuria
 Congenital

Types of Acquired Incontinence
(See Table 44-16 p. 1196 Lewis 6th ed.)

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Stress Incontinence – sudden increase in intra abdominal
pressure causes involuntary passage of urine
Urge incontinence – occurs randomly preceded by warning
of a few seconds to minutes, leakage is periodic but
frequent, nocturnal frequency
Overflow incontinence – when the pressure of urine in the
bladder overcomes sphincter control - urination is frequent
and in small amounts
Reflex incontinence – occurs with no warning or stress,
equally in the day or night
Functional incontinence- loss of urine resulting from
problems of patient mobility or environmental factors
Incontinence after trauma or surgery – post TURP or post
bladder repair
Diagnosis

Focused history
– Onset, provoking factors, associated conditions

Physical assessment
– General
– Functional (mobility, dexterity, cognitive
function),
– Pelvic (including bladder innervation and
muscle strength)
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Bladder/voiding record
– Timing of voiding, incontinent episodes,
nocturia
Urinalysis – identify infection, diabetes
 Measure post-void residual urine
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Collaborative Care
80 % can be cured or improved
significantly
 Pelvic muscle training (Kegel’s exercises)
(See Box, pg. 1197)
 Biofeedback
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– vaginal sensors to help develop awareness and
control of pelvic floor muscles
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Bladder training/habit training
– rigid toileting schedule
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Prompted voiding
– Reminders, assistance and positive feedback
for functional UI
Collaborative Care
 Drug
therapy – limited role
 Surgery
– Marshall-Marchetti procedure: elevation
of urethra and bladder neck with
sutures that are secured and anchored
in nearby cartilage.
 Suburethral
sling or ring surgery
Nursing Management
 Assessment
– Obtain a history of the client’s
incontinence
– Type, time of daily fluid intake,
frequency of BM’s
– Relevant medical history, including
medications taken
– Functional and cognitive ability
Nursing Management

Implementation
– Ensure adequate fluid intake of 1500-2000 ml.
per day and eliminate caffeine and alcohol
– Manage constipation
– Provide info regarding most effect incontinence
products
– Initiate prompted voiding for people with
altered cognitive function and functional UI
 Use
three day voiding record determine schedule
 Remind, assist, and provide positive feedback
Nursing Management
 Habit
training
– Use voiding record to determine voiding
patterns
– Establish goal for voiding frequency
(usually Q 2-3 hrs) – increase interval
over time
– Urinate as usual at night if awakened
with need to void
– May combine with pelvic muscle training
Nursing Diagnoses(Belza, 2003)
 Risk
for impaired skin integrity
 Risk for infection
 Social isolation
 Fluid volume deficit
Expected Outcomes (Belza, 2003)
The client will maintain perineal skin that
is intact and free from excoriation.
 The client will maintain stable vital signs
with no signs or symptoms of infection.
 The patient will verbalize feelings of
positive self-esteem.
 The patient will take an active role in care.
 The patient will demonstrate effective
coping strategies.
 The patient will maintain adequate
hydration of 1500-2000 ml. daily.
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