- Observe voiding pattern; document intake and output. This ensures correct fluid replacement therapy and provides information about patient's ability to void adequately.
Provide appropriate care for patient's urologic condition, monitor progress, and report patient's responses to treatment. Patient should receive adequate care and take part in decisions about care as much as possible.- Provide supportive measures:
- Administer pain medication and monitor effectiveness. Patient's knowledge that pain can be alleviated reduces tension and anxiety.
- Prepare pleasant toilet environment that's warm, clean, and free from odors to promote continence.
- Place commode next to bed, or assign patient bed next to bathroom. A bedside commode or convenient bathroom requires less energy expenditure than bedpan.
- Keep bed and commode at same level to facilitate patient's movements.
- Provide good lighting from bed to bathroom to reduce sensory misinterpretation.
- Remove all obstacles between bed and bathroom to reduce chance of falling.
- Provide clock to help patient maintain voiding schedule through self-monitoring.
- Unless contraindicated, maintain fluids to 3,000 mL daily to moisten mucous membranes and ensure hydration; limit patient to 150 mL after dinner to reduce need to void at night.
- Have patient wear easily removable clothes (gown instead of pajamas and Velcro fasteners instead of buttons or zippers) to reduce frustration and delay in voiding routine.
- If patient loses control on way to bathroom, instruct patient to stop and take a deep breath. Anxiety and rushing may strengthen bladder contractions.
Assist with specific bladder elimination procedures, such as the following: - Bladder training. Place patient on commode every 2 hours while awake and once during night. Provide privacy. Gradually increase intervals between toileting. These measures aim to restore a regular voiding pattern.
- Rigid toilet regimen. Place patient on toilet at specific times. This aids adaptation to routine physiologic function. Keep baseline micturition record for 3 to 7 days to monitor toileting effectiveness.
- Encourage patient to express feelings and concerns about the urologic problem to identify patient's fears.
- Explain urologic condition to patient and family members; include instructions on preventive measures and established bladder schedule. Patient education begins with educational assessment and depends on establishing a therapeutic relationship with patient and family. Prepare patient for discharge according to individual needs to allow patient to practice under supervision.
- Instruct patient and family members in continence techniques for home use. This reduces fear and anxiety resulting from lack of knowledge of patient's condition, and reassures patient of continuing care.
Refer patient and family members to psychiatric liaison nurse, support group, or other resources, as appropriate. Community resources typically provide health care not available from other health agencies.
Suggested NIC Interventions
Bathing; Environmental Management; Fluid Monitoring; Perineal Care; Self-Care Assistance: Toileting; Urinary Elimination Management; Urinary Habit Training; Urinary Incontinence Care |