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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.) 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 Focused history Diagnosis – Onset, provoking factors, associated conditions Physical assessment – General – Functional (mobility, dexterity, cognitive function), – Pelvic (including bladder innervation and muscle strength) Bladder/voiding record – Timing of voiding, incontinent episodes, nocturia Urinalysis – identify infection, diabetes Measure post-void residual urine Collaborative Care 80 % can be cured or improved significantly Pelvic muscle training (Kegel’s exercises) (See Box, pg. 1197) Biofeedback – vaginal sensors to help develop awareness and control of pelvic floor muscles Bladder training/habit training – rigid toileting schedule 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 Assessment Nursing Management – 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 Implementation Nursing Management – 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 assist, and provide positive feedback Remind, H ab i t training Nursing Management – 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 Risk Nursing Diagnoses(Belza, 2003) 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.
