Alteration in Patterns of Urinary Elimination: Incontinence

Published on Saturday March 10th , 2007

Alteration in Patterns of Urinary Elimination: Incontinence

(_)Actual (_) Potential

**Related To:**
*[Check those that apply]*
(_) Congenital urinary tract anomalies: ________________________________ (_) Disorders of urinary tract:_________ ________________________________ (_) Drug therapy (_) Environmental barriers to bathroom (_) Estrogen deficiency (_) Inability to communicate needs	(_) Lack of privacy (_) Loss of perineal tissue tone (_) Neurogenic disorder or injury (_) Prostatic enlargement (_) Stress/fear (_) Other:__________________________ ____________________________________ ____________________________________

**As evidenced by:**
*[Check those that apply]*
Major: (Must be present)	(_) Urgency followed by incontinence. (_) Other:

Date &
Sign.

Plan and Outcome
[Check those that apply]

Target
Date:

Nursing Interventions
[Check those that apply]

Date
Achieved:

The patient will:

(_) Be continent at all times.

(_) Be continent during waking hours.

(_) Other:

(_) Montiro I & O, including patterns of urinary incontinence.

(_) Instruct to start and stop stream during urination.

(_) Ask physician for pelvic floor exercises. Order and teach as follows:
_________x__________ (# of times).

(_) Limit fluids 2-3 hours prior to bedtime.

(_) No fluids after:___________

(_) Awaken patient at night to void at:_______ or q___hours.

(_) Provide urinal/bedpan/bedside commode in easy access.

(_) Place call light within reach at all times.

(_) Provide comfort measures (sitz baths: warm perineal soaks as needed).

(_) Other:________________
________________________
________________________
________________________

__________________________
Patient/Significant other signature

__________________________
RN signature

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