- Monitor and record patient's voiding patterns to ensure correct fluid replacement therapy.
Assist with specific bladder elimination procedures, such as the following: - Bladder training. Place patient on commode or toilet every 2 hours while awake and once during night. Successful bladder training revolves around adequate fluid intake, muscle-strengthening exercises, and carefully scheduled voiding times.
- Rigid toilet regimen. Place patient on toilet at specific intervals (every 2 hours or after meals). Note whether patient was wet or dry and whether voiding occurred at each interval. This helps patient adapt to routine physiologic function.
- Behavior modification. Reward continence or voiding in lavatory. Don't punish unwanted behavior such as voiding in wrong place. Reinforce behavior consistently, using social or material rewards. This helps patient learn alternatives to maladaptive behaviors.
- Use of external catheter. Apply according to established procedure and maintain patency. Observe condition of perineal skin and clean with soap and water at least twice daily. This ensures effective therapy and prevents infection and skin breakdown.
- Application of protective pads and garments. Use only when interventions have failed to prevent infection and skin breakdown and promote social acceptance. Allow at least 4 to 6 weeks for trial period. Establishing continence requires prolonged effort.
Maintain continence based on patient's voiding patterns and limitations. - Use reminders. Reminders help limit amount of information patient must retain in memory.
- Orient patient to toileting environment: time, place, and activity. A structured environment offers security and helps patient with elimination problems.
- Stimulate patient's voiding reflexes (give patient water to drink while on toilet, stroke area over bladder, or pour water over perineum). External stimulation triggers bladder's spastic reflex.
- Provide hyperactive patient with distraction, such as a magazine, to occupy attention while on toilet. This reduces anxiety and eases voiding.
- Provide privacy and adequate time to void to allow patient to void easily without anxiety.
- Praise successful performance to give patient a sense of control and to encourage compliance.
- Change wet clothes to accustom patient to dry clothes.
- Teach family members and support personnel to assist, thus reducing anxiety that results from noninvolvement and increasing chances for successful treatment.
- Respond to patient's call light promptly to avoid delays in voiding routine.
- Choose patient's clothing to promote easy dressing and undressing (e.g., use Velcro fasteners and gowns instead of pajamas). This reduces patient's frustration with voiding routine.
- Schedule patient's fluid intake to encourage voiding at convenient times. Maintain adequate hydration up to 3,000 mL daily, unless contraindicated. Scheduling fluid intake promotes regular bladder distention and optimal time intervals between voidings. Limit fluid intake to 150 mL after dinner to reduce need to void at night.
- Instruct patient and family members in continence techniques to use at home to increase chances of successful bladder retraining.
- Encourage patient and family members to share feelings related to incontinence. This allows specific problems to be identified and resolved. Attentive listening conveys recognition and respect.
Refer patient and family members to psychiatric liaison nurse, home health care agency, or support group to provide access to additional community resources.
Suggested NIC Interventions
Environmental Management; Pelvic Muscle Exercise; Prompted Voiding; Self-Care Assistance; Urinary Elimination Management; Urinary Habit Training |