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Urinary incontinence is an underdiagnosed and underreported problem that increases with age, affecting 38-55% of women older than 60 years and 50-84% of the elderly in long-term care facilities. It is estimated that around 423 million people (20 years and older) worldwide experience some form of urinary incontinence. Approximately 13 million Americans experience urinary incontinence. 24% to 45% of women report some degree of urinary incontinence. In general, the prevalence of men is about half that of women. The International Continence Society defines urinary incontinence as the involuntary loss of urine that represents a hygienic or social problem to the individual. Urinary incontinence can be thought of as a symptom as reported by the client, as a sign that is demonstrable on examination, and as a disorder. Four types of urinary incontinence are defined in the Clinical Practice Guideline issued by the Agency for Health Care Policy and Research. Some authors include functional incontinence as a fifth type of incontinence.
Urinary incontinence may have multiple etiologies, with varying degrees of contribution.
Urinary IncontinenceIncontinence occurs when micturition physiology, functional toileting ability, or both have been disrupted. During episodes of stress incontinence, an increase in intra-abdominal pressure raises pressure within the bladder to the point where it exceeds the urethra’s resistance to urinary flow. Leakage ceases when bladder pressure again falls below urethral pressure. In urge incontinence, some researchers believe that detrusor overactivity represents the premature initiation of the normal micturition reflex. Relative cholinergic denervation may also explain some of these findings. Subtle obstruction and the effects of aging on smooth muscle and the autonomic nervous system are two possible contributors. Nurses need to have different communicative resources to effectively assist the client diagnosed with urinary incontinence in order to successfully implement nursing interventions. The focus of the approaches for nursing interventions for urinary incontinence varies among educational, behavioral, and physical. The following are nursing diagnoses associated with urinary incontinence.
Urinary Incontinence Nursing Care PlanBelow are sample nursing care plans for the problems identified above. Impaired Urinary EliminationUrinary incontinence has been identified as a World Health Organization health priority. It has many physical, mental, and social effects on the client’s life. Age-related changes in the lower urinary tract include decreased bladder capacity and a feeling of fullness, decreased detrusor muscle contraction rate, decreased pelvic floor muscle strength, and increased residual urine volume. Urinary incontinence has a great impact on daily and social activities such as work, travel, physical exercise, and sexual function, and thus reduces the quality of life. Nursing Diagnosis
Evidenced by
Desired OutcomesAfter implementation of nursing interventions, the client is expected to:
Nursing Interventions
Acute Urinary RetentionThe major contributing factor to overflow incontinence is incomplete bladder emptying secondary to impaired detrusor contractility or bladder outlet obstruction. Impaired detrusor contractility is typically neurogenic in nature. The maximal storage capacity of the bladder is reached, oftentimes without the client realizing that this has occurred. Incontinence occurs off the top of a chronically over-filled bladder. Effective emptying is not possible because of an acontractile detrusor muscle. Nursing Diagnosis
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Desired OutcomesAfter implementation of nursing interventions, the client is expected to:
Nursing Interventions
Risk for Impaired Skin IntegrityIncontinence and skin breakdown related to incontinence have a considerable effect on clients’ physical and psychological well-being. When the skin is exposed to moisture (urine, feces, double incontinence, or frequent cleansing), its permeability increases and the barrier function reduces. The skin is not only exposed to chemical irritation but also to physical irritation (friction). Friction increases when perineal skin rubs over containment materials, clothing, and bed or chair surfaces. The combination of chemical and physical irritation results in a weakened skin status. If these mechanisms affect the integrity of the skin recurrently, further skin breakdown will develop. Nursing Diagnosis
Risk Factors
Evidenced by
Desired Outcomes After implementation of nursing interventions, the client is expected to:
Nursing Interventions
References
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