Functional Urinary Incontinence

Selasa, 06 Agustus 2013

Inability of usually continent person to reach toilet in time to avoid unintentional loss of urine

Defining Characteristics: The relationship between functional limitations and urinary incontinence remains controversial (Hunskaar et al, 1999). While functional impairment clearly exacerbates the severity of urinary incontinence, the underlying factors that contribute to these functional limitations themselves contribute to abnormal lower urinary tract function and impaired continence.

Related Factors:

  • Cognitive disorders (delirium, dementias, severe or profound retardation); 
  • neuromuscular limitations impairing mobility or dexterity; 
  • impaired vision; 
  • psychological factors; 
  • weakened supporting pelvic structures; 
  • environmental barriers to toileting.

NOC Outcomes (Nursing Outcomes Classification)

Suggested NOC Labels
  • Urinary Continence
  • Urinary Elimination
Client Outcomes
  • Eliminates or reduces incontinent episodes
  • Eliminates or overcomes environmental barriers to toileting
  • Uses adaptive equipment to reduce or eliminate incontinence related to impaired mobility or dexterity
  • Uses portable urinary collection devices or urine containment devices when access to the toilet is not feasible

NIC Interventions (Nursing Interventions Classification)

Suggested NIC Labels
  • Urinary Incontinence Care

Nursing Interventions and Rationales

1. Perform a focused history of the incontinence including duration, frequency and severity of leakage episodes, and alleviating and aggravating factors.
The history provides clues to the causes, the severity of the condition, and its management.

2. Complete a bladder log of diurnal and nocturnal urine elimination patterns and patterns of urinary leakage.
The bladder log provides a more objective verification of urine elimination patterns as compared with the history (Resnick et al, 1994) and a baseline against which the results of management can be evaluated.

3. Assess client for potentially reversible causes of acute/transient urinary incontinence (e.g., urinary tract infection [UTI], atrophic urethritis, constipation or impaction, sedatives or narcotics interfering with the ability to reach the toilet in a timely fashion, antidepressants or psychotropic medications interfering with efficient detrusor contractions, parasympatholytics, alpha adrenergic antagonists, polyuria caused by uncontrolled diabetes mellitus, or insipidus).
Transient or acute incontinence can be eliminated by reversing the underlying cause (Urinary Incontinence Guideline Panel, 1996).

4. Assess client for established/chronic incontinence: stress urinary incontinence, urge urinary incontinence, reflex, or extraurethral ("total") urinary incontinence. If present, begin treatment for these forms of urine loss.
Functional incontinence often coexists with another form of urinary leakage, particularly among the elderly (Gray, 1992).

5. Assess the home, acute care, or long-term care environment for accessibility to toileting facilities, paying particular attention to the following:
  • Distance of toilet from bed, chair, living quarters
  • Characteristics of the bed, including presence of side rails and distance of bed from the floor
  • Characteristics of the pathway to the toilet, including barriers such as stairs, loose rugs on the floor, and inadequate lighting
  • Characteristics of the bathroom, including patterns of use; lighting; height of toilet from floor; presence of hand rails to assist transfers to toilet; and breadth of door and its accessibility for wheelchair, walker, or other assistive device
Functional continence requires access to the toilet; environmental barriers blocking this access can produce functional incontinence (Wells, 1992).

6. Assess client for mobility, including ability to rise from chair and bed; ability to transfer to toilet and ambulate; and need for physical assistive devices such as a cane, walker, or wheel chair.
Functional continence requires the ability to gain access to a toilet facility, either independently or with the assistance of devices to increase mobility (Jirovec, Wells, 1990; Wells, 1992).

7. Assess client for dexterity, including the ability to manipulate buttons, hooks, snaps, Velcro, and zippers needed to remove clothing. Consult physical or occupational therapist to promote optimal toilet access as indicated.
Functional continence requires the ability to remove clothing to urinate (Maloney, Cafiero, 1999; Wells, 1992).

8. Evaluate cognitive status with a NEECHAM confusion scale (Neelan et al, 1992) for acute cognitive changes, a Folstein Mini-Mental Status Examination (Folstein, Folstein, McHugh, 1975), or other tool as indicated.
Functional continence requires sufficient mental acuity to respond to sensory input from a filling urinary bladder by locating the toilet, moving to it, and emptying the bladder (Maloney, Cafiero, 1999; Colling et al, 1992).

9. Remove environmental barriers to toileting in the acute care, long-term care or home setting. Help the client remove loose rugs from the floor and improve lighting in hallways and bathrooms.

10. Provide an appropriate, safe urinary receptacle such as a 3-in-1 commode, female or male hand-held urinal, no-spill urinal, or containment device when toileting access is limited by immobility or environmental barriers.
These receptacles provide access to a substitute toilet and enhance the potential for functional continence (Rabin, 1998; Wells, 1992).

11. Assist the client with limited mobility to obtain evaluation for a physical therapist and to obtain assistive devices as indicated (Maloney, Cafiero, 1999); assist the client to select shoes with a nonskid sole to maximize traction when arising from a chair and transferring to the toilet.

12. Assist the person to alter their wardrobe to maximize toileting access. Select loose-fitting clothing with stretch waist bands rather than buttoned or zippered waist; minimize buttons, snaps, and multilayered clothing; and substitute Velcro or other easily loosened systems for buttons, hooks, and zippers in existing clothing.

13. Begin a prompted voiding program or patterned urge response toileting program for the elderly client with functional incontinence and dementia in the home or long-term care facility:
  • Determine the frequency of current urination using an alarm system or check and change device
  • Record urinary elimination and incontinent patterns on a bladder log to use as a baseline for assessment and evaluation of treatment efficacy
  • Begin a prompted toileting program based on the results of this program; toileting frequency may vary from every 1.5 to 2 hours, to every 4 hours
  • Praise the client when toileting occurs with prompting
  • Refrain from any socialization when incontinent episodes occur; change the client and make her or him comfortable 
Prompted voiding or patterned urge response toileting have been shown to markedly reduce or eliminate functional incontinence in selected clients in the long-term care facility and in the community setting (Colling et al, 1992; Eustice, Roe, Patterson, 2000).
Geriatric

1. Institute aggressive continence management programs for the community-dwelling client in consultation with the patient and family.
Uncontrolled incontinence can lead to institutionalization in an elderly person who prefers to remain in a home care setting (O'Donnell et al, 1992).

2. Monitor elderly clients for dehydration in the long-term care facility, acute care facility, or home. Dehydration can exacerbate urine loss, produce acute confusion, and increase the risk of morbidity and morality, particularly in the frail elderly client (Colling, Owen, McCreedy, 1994).

Home Care Interventions

1. Assess current strategies used to reduce urinary incontinence, including fluid intake, restriction of bladder irritants, prompted or scheduled toileting, and use of containment devices.
Many elders and care providers use a variety of self-management techniques to manage urinary incontinence such as fluid limitation, avoidance of social contacts, and absorptive materials that may or may not be effective for reducing urinary leakage or beneficial to general health (Johnson et al, 2000).

2. Teach the family general principles of bladder health, including avoidance of bladder irritants, adequate fluid intake, and a routine schedule of toileting (refer to care plan for Impaired Urinary elimination).

3. Teach prompted voiding to the family and patient with mild to moderate dementia (refer to previous description) (Colling, 1996; McDowell et al, 1994).

4. Advise the patient about the advantages of using disposable or reusable insert pads, pad-pant systems, or replacement briefs specifically designed for urinary incontinence (or double urinary and fecal incontinence) as indicated. Many absorptive products used by community-dwelling elders are not designed to absorb urine, prevent odor, and protect the perineal skin. Substitution of disposable or reusable absorptive devices specifically designed to contain urine or double incontinence are more effective than household products, particularly in moderate to severe cases (Shirran, Brazelli, 2000; Gallo, Staskin, 1997).

5. Assist the family with arranging care in a way that allows the patient to participate in family or favorite activities without embarrassment. Careful planning can retain the dignity and integrity of family patterns.

6. Teach principles of perineal skin care, including routine cleansing following incontinent episodes, daily cleaning and drying of perineal skin, and use of moisture barriers as indicated. Routine cleansing and daily cleaning with appropriate products help maintain integrity of perineal skin and prevent secondary cutaneous infections (Fiers, Thayer, 2000).

7. Refer to occupational therapy for help in obtaining assistive devices and adapting the home for optimal toilet accessibility.

8. Consider use of an indwelling catheter for continuous drainage in the patient who is both homebound and bed-bound and receiving palliative or end of life care (requires physician order). An indwelling catheter may increase patient comfort, ease care provider burden, and prevent urinary incontinence in bed-bound patients receiving end of life care.

9. When an indwelling catheter is in place, follow prescribed maintenance protocols for managing the catheter, drainage bag, perineal skin, and urethral meatus. Teach infection control measures adapted to the home care setting. Proper care reduces the risk of catheter-associated UTI.

Client/Family Teaching

1. Work with the client, family, and their extended support systems to assist with needed changes in the environment and wardrobe and other alterations needed to maximize toileting access.

2. Work with the client and family to establish a reasonable, manageable prompted voiding program using environmental and verbal cues, such as television programs, meals, and bedtime, to remind caregivers of voiding intervals.

3. Teach the family to use an alarm system for toileting or to perform a check and change program and to maintain an accurate log of voiding and incontinent episodes.

30 komentar:

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Unknown mengatakan...

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Am Richard, I am here to testify about a great herbalist  man who cured my wife of breast cancer. His name is Dr Imoloa. My wife went through this pain for 3 years, i almost spent all i had, until i saw some testimonies online on how Dr. Imoloa cure them from their diseases, immediately i contacted him through. then he told me the necessary things to do before he will send  the herbal medicine. Wish he did through DHL courier service, And he instructed us on how to apply or drink the medicine for good two weeks. and to greatest surprise before the upper third week my wife was relief from all the pains, Believe me, that was how my wife was cured from breast cancer by this great man. He also have powerful herbal medicine to cure diseases like: Alzheimer's disease, parkinson's disease, vaginal cancer, epilepsy Anxiety Disorders, Autoimmune Disease, Back Pain, Back Sprain, Bipolar Disorder, Brain Tumor, Malignant, Bruxism, Bulimia, Cervical Disc Disease, Cardiovascular Disease, Neoplasms , chronic respiratory disease, mental and behavioral disorder, Cystic Fibrosis, Hypertension, Diabetes, Asthma, Autoimmune inflammatory media arthritis ed. chronic kidney disease, inflammatory joint disease, impotence, alcohol spectrum feta, dysthymic disorder, eczema, tuberculosis, chronic fatigue syndrome, constipation, inflammatory bowel disease, lupus disease, mouth ulcer, mouth cancer, body pain, fever, hepatitis ABC, syphilis, diarrhea, HIV / AIDS, Huntington's disease, back acne, chronic kidney failure, addison's disease, chronic pain, Crohn's pain, cystic fibrosis, fibromyalgia, inflammatory Bowel disease, fungal nail disease, Lyme disease, Celia disease, Lymphoma, Major depression, Malignant melanoma, Mania, Melorheostosis, Meniere's disease, Mucopolysaccharidosis, Multiple sclerosis, Muscular dystrophy, Rheumatoid arthritis. You can reach him Email Via drimolaherbalmademedicine@gmail.com / whatsapp +2347081986098

Richard William mengatakan...

Am Richard, I am here to testify about a great herbalist  man who cured my wife of breast cancer. His name is Dr Imoloa. My wife went through this pain for 3 years, i almost spent all i had, until i saw some testimonies online on how Dr. Imoloa cure them from their diseases, immediately i contacted him through. then he told me the necessary things to do before he will send  the herbal medicine. Wish he did through DHL courier service, And he instructed us on how to apply or drink the medicine for good two weeks. and to greatest surprise before the upper third week my wife was relief from all the pains, Believe me, that was how my wife was cured from breast cancer by this great man. He also have powerful herbal medicine to cure diseases like: Alzheimer's disease, parkinson's disease, vaginal cancer, epilepsy Anxiety Disorders, Autoimmune Disease, Back Pain, Back Sprain, Bipolar Disorder, Brain Tumor, Malignant, Bruxism, Bulimia, Cervical Disc Disease, Cardiovascular Disease, Neoplasms , chronic respiratory disease, mental and behavioral disorder, Cystic Fibrosis, Hypertension, Diabetes, Asthma, Autoimmune inflammatory media arthritis ed. chronic kidney disease, inflammatory joint disease, impotence, alcohol spectrum feta, dysthymic disorder, eczema, tuberculosis, chronic fatigue syndrome, constipation, inflammatory bowel disease, lupus disease, mouth ulcer, mouth cancer, body pain, fever, hepatitis ABC, syphilis, diarrhea, HIV / AIDS, Huntington's disease, back acne, chronic kidney failure, addison's disease, chronic pain, Crohn's pain, cystic fibrosis, fibromyalgia, inflammatory Bowel disease, fungal nail disease, Lyme disease, Celia disease, Lymphoma, Major depression, Malignant melanoma, Mania, Melorheostosis, Meniere's disease, Mucopolysaccharidosis, Multiple sclerosis, Muscular dystrophy, Rheumatoid arthritis. You can reach him Email Via drimolaherbalmademedicine@gmail.com / whatsapp +2347081986098

Oscar mengatakan...



I would like to thank Ultimate Health Home for reversing my father's Amyotrophic Lateral Sclerosis (ALS). My father’s ALS condition was fast deteriorating before he started on the ALS Herbal medicine treatment from Ultimate Health Home. He was on the treatment for just 6 months and we never thought my father will recover so soon. He has gained some weight in the past months and he is able to walk with no support. You can contact them at ultimatehealthhome@gmail.com

Florence mengatakan...


I started on COPD Herbal treatment from Ultimate Health Home, the treatment worked incredibly for my lungs condition. I used the herbal treatment for almost 4 months, it reversed my COPD. My severe shortness of breath, dry cough, chest tightness gradually disappeared. Reach Ultimate Health Home via their email at ultimatehealthhome@gmail.com . I can breath much better and It feels comfortable!

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We realize that picking a home medical services office can be overpowering. Also, doing so requires basic dynamics. For your family or for somebody you love, you need all the data you can get and near the information that will help you settle on a cool-headed choice. Pacific Health Systems is set up with Professional Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) who convey quality medical care administrations to both grown-up and paediatric patients in the solace of their homes.

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I was diagnosed as HEPATITIS B carrier in 2013 with fibrosis of the
liver already present. I started on antiviral medications which
reduced the viral load initially. After a couple of years the virus
became resistant. I started on HEPATITIS B Herbal treatment from
ULTIMATE LIFE CLINIC (www.ultimatelifeclinic.com) in March, 2020. Their
treatment totally reversed the virus. I did another blood test after
the 6 months long treatment and tested negative to the virus. Amazing
treatment! This treatment is a breakthrough for all HBV carriers.

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Tom Neil mengatakan...

Hi, there. I am Tom Neil and I want to describe how life had been for my younger brother living with schizophrenia and how he had been permanently able to overcome this debilitating disease via a naturopathic, herbal method.

Maicon - my kid brother was twenty years old when he was brought to the emergency room by the campus police of the college from which he had been suspended several months ago. A professor had called and reported that he had walked into his classroom, accused him of taking his tuition money, and refused to leave.

Although he had much academic success as a teenager, his behavior had become increasingly odd during the past year. He quit seeing his friends and no longer seemed to care about his appearance or social pursuits. He began wearing the same clothes each day and seldom bathed. He lived with several family members but rarely spoke to any of them. When he did talk to them, he said he had found clues that his college was just a front for an organized crime operation. He had been suspended from college because of missing many classes. My sister said that she had often seen him mumbling quietly to himself and at times he seemed to be talking to people who were not there. He would emerge from my room and ask my family to be quiet even when they were not making any noise.

My father and sister told the staff that Maicon's great-grandmother had had a serious illness and had lived for 30 years in a state hospital, which they believed was a mental hospital. Our mother left the family when Maicon was very young. She has been out of touch with us, and they thought she might have been treated for mental health problems.

Maicon agreed to sign himself into the psychiatric unit for treatment. The whole family except I had agreed to have Maicon transferred to a mental asylum. I knew inwardly there was still some plausible means by which my kid brother could overcome this condition. I knew botanical means of treatment will be more favorable than any other type of treatment, and as such, I had taken a keen interest in the research of naturopathic alternative measures suitable for the treatment of schizophrenia. I had pleaded for some little patience from the family in the delay of the transfer, I was looking forward to proving a point to the entire family, of a positive botanical remedy for this condition.

It was during my ceaseless search on the internet I had been fortunate enough to come across Dr. Utu Herbal Cure: an African herbalist and witch doctor whose professional works had majored on the eradication of certain viral conditions, especially schizophrenia, ( improving the memory capacity positively), via a traditional, naturopathic process and distinguished diet plan. It was by the administration of this herbal specialist that my brother had been able to improve his condition for better.

Before the naturopathic remedy - Maicon's story had reflected a common case, in which a high-functioning young adult goes through a major decline in day-to-day skills. Although family and friends may feel this is a loss of the person they knew, the illness can be treated and a good outcome is possible.

My brother Maicon is just like many other patients out there suffering from this disease. Although he was able to overcome this condition via a naturopathic herbal remedy administered by this African herbal physician and saved completely thus, rekindling the lost joy which had been experienced by the family members.

I wish to use this opportunity to reach across to anyone who may happen to be diagnosed with this disastrous condition to spread the hope of an everlasting herbal remedy that is capable of imposing a permanent end to this disease.

For more information concerning this naturopathic herbal remedy, feel free to contact this African herbal practitioner via email:
drutuherbalcure@gmail.com

Anonim mengatakan...

was diagnose April 17,2015 and find out I'm HIV positive.I was scared because there is no cure for HIV/AIDS but today some people still don't believe that there is cure for HIV, it can only be cured through Africans root and herbs,and our doctor's here in USA few of them know about the African herbal medicine can cure Hiv but they chooses to hide it from us just to make a sales of medical expertise. I did a research online finding way to get rid of my disease,I saw a comment about a herbal doctor on internet Name Dr itua ,who has cured several disease with his powerful herbal medicine, I contacted him on whats-app, chat with him explain my self to him.He said he can cure hiv perfectly well , he gave me his request which i send to him. within 5 days he sent me the herbal medicine through ups courier delivering service And told me how to take the medicine for 2 weeks to get cured,I did for 2 weeks, within this 7 days i notice a very big change in my health and i new some thing great has happened then i went to confirm my result after finishing the herbal medicine for two weeks it was absolutely negative.The doctor who new i was hiv positive was asking me how come i am negative, what did it took to get cure and were did i get this medicine from and how did i get rid of it I told him every thing about the herbal medicine that cure me. imagine doctor telling me not to let anyone know about it,I wasn't shock though i knew they know about the herbal cure but chose to hide it in other to make sales on medicals expertise,if you are HIV positive Or other disease such
Cancer,Hiv,Herpes,Shingles, Hepatitis B,Liver Inflammatory,Diabetes,Fibroid,Parkinson's,Alzheimer’s disease.contact Dr Itua for any kind of herbal product and remedies through Email Or Website.. drituaherbalcenter@gmail.com www.drituaherbalcenter.com

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