63-273

1. 63-273 Urinary Incontinence

2. 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

3. 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

4. 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

5. Diagnosis • Focused history • 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. Nursing Diagnoses(Belza, 2003) • Risk for impaired skin integrity • Risk for infection • Social isolation • Fluid volume deficit

12. 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.