care of patient with urinary elimination

1. URINARY
INCONTINENCE
Mr.Veerabhadra.B.Badiger
Asst Professor
Dept of Medical Surgical Nsg

2. URINARY INCONTINENCE
Urinary incontinence is involuntary or
uncontrolled loss of urine from the bladder
sufficient to cause a social or hygienic problem.
 It is estimated that at least one third of older
adults living in the community and one half of
older clients in institutions suffer from incontinence

3. ETIOLOGY & RISK FACTORS
 Pregnancy: vaginal delivery, episiotomy
 Menopause
 Genitourinary surgery
 Pelvic muscle weakness
 Incompetent urethra due to trauma or sphincter relaxation
 Immobility
 Diabetes mellitus
 Stroke
 Age-related changes in the urinary tract
 Cognitive disturbances: dementia, Parkinson’s disease
 Medications: diuretics, sedatives, hypnotics, opioids

4. TYPES OF INCONTINENCE
 Stress incontinence is the involuntary loss of
urine through an intact urethra as a result of a
sudden increase in intra-abdominal pressure
(sneezing, coughing, or changing position).
 It predominately affects women who have had
vaginal deliveries.
 Functional incontinence refers to those
instances in which lower urinary tract function is
intact but other factors, such as severe cognitive
impairment (eg, Alzheimer’s dementia), physical
impairments make it involuntary urine passage.

5. CONTINUED….
 Urge incontinence is the involuntary loss of urine
associated with a strong urge to void that cannot be
suppressed.
 Reflex incontinence is the involuntary loss of urine
due to hyperreflexia in the absence of normal
sensations usually associated with voiding. This
commonly occurs in patients with spinal cord injury.
 Overflow incontinence is the involuntary loss of urine
associated with overdistention of the bladder

6.  Iatrogenic incontinence refers to the
involuntary loss of urine due to medical factors &
medications.

7. MANAGEMENT
1. Anticholinergic agents :-
 Oxybutynin chloride
 Phenoxybenzamine hydrochloride
inhibit bladder contraction. may be useful in treating
problems with sphincter control
2. Several tricyclic antidepressant medications
Imipramine, Doxepin, Desipramine, & Nortriptyline also
decrease bladder contractions as well as increase
bladder neck resistance.

8. CONTINUED..
3. Estrogen may be useful in restoring mucosal,
vascular, and muscular integrity of the urethra for
postmenopausal incontinence
Bladder Training
Prompted voiding which combines scheduled voiding
with prompting and praising. It is used for cognitively
impaired clients
Surgical correction of anatomic problems
 Urethroplasty—surgery to repair structures damaged
by trauma

9. SURGICAL MANAGEMENT
Surgeries to improve urinary control include:
 Bladder augmentation (increases the storage
capacity of the bladder)

10.  Periurethral bulking
placement of small
amounts of collagen in
urethral walls to aid the
closing pressure
 Implantation of an
artificial sphincter.

11. Surgeries to provide better support for urinary
structures, such as:
 Retropubic suspension: Retropubic suspension
surgery is used to treat urinary incontinence by lifting
the sagging bladder neck and urethra that have
dropped abnormally low in the pelvic area
 Transvaginal needle suspension
 Sling procedures: A sling is a piece tissue or a
synthetic tape that a placed to support the bladder
neck and urethra.
 Sacral nerve stimulator implantation.

12. Sacral nerve
stimulator
implantation.
Retropubic
suspension

13. SLING PROCEDURES

14. TRANS-VAGINAL NEEDLE SUSPENSION

15. Nursing Management
Main goal is to :-
 Maintaining continence as much as possible
 Preventing skin breakdown around groin.
 Reducing anxiety.
 Initiating a bladder-training program.
 Exercises to increase muscle tone &
voluntary control (Kegel exercises).

16. URINARY RETENTION

17. URINARY RETENTION
 Urinary retention is the inability to empty the
bladder completely during attempts to void.
 The most common clinical features is bladder
fullness

18. ETIOLOGY
Urinary retention can occur
 Postoperatively in any patient(general
anesthesia )
 Surgery of the perineal or anal regions
 Reflex spasm of the sphincters.
 General anesthesia
 Bladder muscle innervation
 Urethral pathology (infection, tumor, calculus),
trauma
 Pelvic injuries
 Pregnancy
 BPH (Benign prostatic hyperplasia)

19. CONTINUED…
 Neurologic disorders such as Stroke ,
spinal cord injury, multiple sclerosis, or
Parkinson’s disease..
 Medications:
 Anticholinergic agents (atropine sulfate,
dicyclomine hydrochloride.
 Antispasmodic agents.
 Beta-adrenergic blockers (Propranolol)
 Estrogens.

20. COMPLICATION OF URINARY RETENTION
 Urine leakage can lead to perineal skin
 Calculi (Due to urinary stasis)
 Pyelonephritis
 Sepsis.
 Injury to kidney.

21. MANAGEMENT
 Urinary Catheterization
 Removal urethral mass
 Repair / surgical correction of urethral injury.
 Removal of prostate gland in case of BPH
 Insertion of a suprapubic catheter (in case of
urethral injury)

22. NURSING CARE
 Reassure the patient
 Monitor Intake & output chart.
 Applying warm application ( hot water bag) below
abdomen to relax the sphincters .
 Trigger techniques:
 Turning on the water faucet while the patient is
trying to void.
 Dipping the patient’s hands in warm water.
 Stroking the abdomen or inner thighs
 Tapping above the pubic area

23. CONTINUED…
 The patient cannot void, catheterization is used.
 Providing catheter care.
 Check for blood in urine .
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