Urinary Incontinence Nursing Diagnosis

Topic: Incontinence Nursing Diagnosis: Impaired skin integrity r/t functional incontinence aeb urinary leakage and excoriation of the perineal skin. Interventions: 1. Set a toileting schedule. 2. Use incontinence pads and plastic liners to trap the moisture. 3. Apply vitamin-enriched moisturizer to perineal skin after cleaning. Rationales for interventions 1a. Designates time for voiding. 1b. Reduces episodes of incontinence by promoting a patterned urge response to the pelvic parasympathetic nerves, lumbar sympathetic nerves, and pudendal nerves of the smooth muscles of the urinary tract. 2a. The use of pads and plastic catch liners reduces the amount of urine that reaches the patient's skin, and allows for a reduction in moisture on the skin, which can cause skin breakdown within minutes due to the levels of ammonia in the urine. 2b. Ammonia and moisture from ursin can cause skin maceration in addition to the pressure on the surface breaking skin down quickly, the skin becomes thin and friable. 3a. Provides a protective barrier for the perineal skin from the urine. 3b. Promotes skin healing by delivering moisture to the dermis, thereby repelling water from the environment to the skin layer. Meds for urinary incontinence: oxybutynin (Ditropan XL) tolterodine (Detrol) darifenacin (Enablex) fesoterodine (Toviaz) solifenacin (Vesicare) trospium chloride Mirabegron (Myrbetriq) Meds for fecal incontinence: loperamide hydrochloride (Imodium A-D) Diphenoxylate atropine sulfate (Lomotil) Medications side effects oxybutynin (Ditropan XL)- Dry mouth, drowsiness, headache, dizziness, nausea, vomiting, upset stomach, stomach pain, constipation, diarrhea, blurred vision, dry eyes, unusual taste in mouth, dry/flushed skin, stuffy nose, and cough. tolterodine (Detrol)- Dry mouth, dry eyes, headache, constipation, stomach upset/pain, dizziness, drowsiness, tiredness, or blurred vision. darifenacin (Enablex)- Dry mouth, constipation, nausea, stomach upset, stomach pain, blurred vision, dry eyes, dizziness, or weakness. fesoterodine (Toviaz)- Bladder pain, bloating, swelling, dysuria, difficulty breathing. solifenacin (Vesicare)- Dry mouth, constipation, stomach pain, upset stomach, vomiting, heartburn, dry eyes, blurred vision. trospium chloride- Dry mouth, dry throat, constipation, upset stomach, gas, headache, dry eyes, dizziness, blurred vision. Mirabegron (Myrbetriq)- Nausea, constipation, UTI, headache, dizziness, tachycardia. loperamide hydrochloride (Imodium A-D)- Constipation, dizziness, drowsiness, nausea, stomach cramps. Diphenoxylate- Drowsiness, dizziness, headache, malaise, confusion, dry mouth, nauseous, vomiting, upset stomach. atropine sulfate (Lomotil)- Dry mouth, blurred vision, photosensitivity, dizziness, nausea, skin rash. Signs and symptoms -leaking urine when coughing, sneezing, laughing or exercising -feeling sudden uncontrollable urges to urinate -frequent urination -waking up many times at night to urinate -urinating during sleep Lab values/Diagnostics: **no specific lab values** -Urinalysis can help identify factors contributing to transient UI -Postvoid residual (PVR): this is obtained by asking the patient to void, followed by catheterization or use of a bladder ultrasound; this amount will show the urine left over in the bladder after urination -Bladder stress test -Ultrasound or x-rays Patient outcomes: - Patients will have a reduction in skin breakdown and pressure injuries. - Patient will remain dry and clean from urine - Patient will establish a routine bathroom schedule and change pads within 10 minutes of being soiled. - Patient will have understanding of teaching related to the use of pads, fluid intake during the day and reduction of fluids before bed. Patient will understand the related factors that can contribute to incontinence.