9. Loss of urinary control - neurological mechanism controlling bladder emptying does not work effectively and results in incontinence; a symptom, not a diagnosis.
1. Assessment. Risk factors:
1. Immobility.
2. Cognitive and functional impairments - Parkinson’s disease, Alzheimer’s disease, multiple sclerosis, alcoholism, stroke, vitamin B deficiency, inability to walk and transfer to toilet.
3. Medications.
4. Institutionalization.
5. Pathological conditions - men: hyperplasia leading to infection, incomplete emptying, urgency, and frequency; women: weakening of pelvic floor postmenopause,
6. leading to residual urine and infection; atrophy of vaginal and trigonal tissue, leading to frequency, urgency, and incontinence.
7. Childbirth.
2. Incontinence - possible symptom of urinary tract infection, impaction, chronic constipation, dementia, inability to walk and transfer by self to toilet, dehydration.
3. Nursing goal/implementation: minimize incontinence episodes and reduce urinary tract infections.
1. Regular toileting schedule - every 2 hr, with some exceptions at night; or personalize regimen based on assessment.
2. Modify environment - location of toilet, good lighting, prompt response to calls for assistance, use of Velcro closures on clothing, raised toilet seats with safety bars.
3. Monitor fluid intake; adequate hydration - 1-2 L during day; avoid alcohol and caffeine and restrict fluids at bedtime.
4. Avoid medications contributing to incontinence.
5. Avoid use of indwelling catheters if possible.
6. Use usual undergarments; be positive about continence; use absorbent pads to improve perineal hygiene if other measures fail.
7. Treat constipation.