NURSING DIAGNOSIS: Altered urinary elimination: incontinence

related to:
  1. increased reflex activity of the bladder and loss of voluntary control of urinary elimination associated with upper motor neuron involvement if it has occurred;
  2. decreased ability to control urination associated with decreased level of consciousness or inability to recognize sensation of bladder fullness;
  3. inability to get to bedside commode or bathroom in a timely manner associated with:
    1. delay in obtaining assistance resulting from inability to communicate the urge to urinate
    2. impaired physical mobility.
Desired Outcome
The client will experience urinary continence.
Nursing Actions and Selected Purposes/Rationales
  1. Assess client's pattern of fluid intake and urination (e.g. times and amounts of fluid intake, types of fluids consumed, times and amounts of voluntary and involuntary voiding, reports of sensation of need to void, activities preceding incontinence).
  2. Implement measures to reduce the risk of urinary incontinence:
    1. offer bedpan or urinal or assist client to bedside commode or bathroom every 2-4 hours if indicated
    2. allow client to assume a normal position for voiding unless contraindicated in order to promote complete bladder emptying
    3. perform actions to reduce delays in toileting (e.g. have call signal within client's reach and respond promptly to requests for assistance; have bedpan, urinal, or bedside commode readily available to client; provide client with easy-to-remove clothing such as pajamas with Velcro closures or an elastic waistband)
    4. if client is aphasic, establish an effective method for him/her to communicate the urge to urinate
    5. instruct client to space fluids evenly throughout the day rather than drinking a large quantity at one time (rapid filling of bladder can result in incontinence if client has decreased urinary sphincter control)
    6. limit oral fluid intake in the evening to decrease possibility of nighttime incontinence
    7. instruct client to avoid drinking alcohol and beverages containing caffeine (alcohol and caffeine have a mild diuretic effect and act as irritants to the bladder; these factors may make urinary control more difficult).
  3. If urinary incontinence persists, consult physician about intermittent catheterization, insertion of indwelling catheter, or use of external catheter.