Alteration in Patterns of Urinary Elimination: Incontinence
Alteration in Patterns of Urinary Elimination: Incontinence
(_)Actual (_) Potential
| (_)
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:__________________________ ____________________________________ ____________________________________ |
| 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: (_) 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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