Nurse's Pocket Guide

impaired URINARY ELIMINATION
incontinence; changes in size/force of urinary stream; problems
emptying bladder completely; nocturia/enuresis).
• Ascertain client’s/SO’s perception of problem/degree of disability
(e.g., client is restricting social/employment/travel
activities; having sexual/relationship difficulties; incurring
sleep deprivation; experiencing depression).
• Determine cultural factors impacting client’s self-image
regarding urinary problem (e.g., presence of urostomy and
need to empty bag at intervals; painful bladder that interferes
with daily activities/employment).
• Have client keep a voiding diary for three days to record fluid
intake, voiding times, precise urine output, and dietary intake.
Helps determine baseline symptoms, severity of frequency/
urgency, and whether diet is a factor (if symptoms worsen).
NURSING PRIORITY NO. 3.To assist in treating/preventing urinary
alteration:
• Refer to specific NDs Urinary Incontinence (specify); Urinary
Retention for additional related interventions.
• Encourage fluid intake up to 3000 or more mL/day (within
cardiac tolerance), including cranberry juice, to help maintain
renal function, prevent infection and formation of urinary
stones, avoid encrustation around catheter, or to flush
urinary diversion appliance.
• Discuss possible dietary restrictions (e.g., especially coffee,
alcohol, carbonated drinks, citrus, tomatoes, and chocolate)
based on individual symptoms.
• Assist with developing toileting routines (e.g., timed voiding,
bladder training, prompted voiding, habit retraining), as
appropriate. Note: Bladder retraining is not recommended for
clients with PBS.
• Encourage client to verbalize fears/concerns (e.g., disruption
in sexual activity, inability to work). Open expression allows
client to deal with feelings and begin problem solving.
• Implement/monitor interventions for specific elimination
problem (e.g., pelvic floor exercises/other bladder retraining
modalities; medication regimen, including antimicrobials
[single-dose is frequently being used for UTI], sulfonamides,
antispasmodics); and evaluate client’s response to modify
treatment, as needed.
• Discuss possible surgical procedures and medical regimen, as
indicated (e.g., client with benign prostatic hypertrophy
bladder/prostatic cancer, PBS/IC, and so forth). For example,
cystoscopy with bladder hydrodistention for PBS/IC,
or an electrical stimulator may be implanted to treat
Information in brackets added by the authors to clarify and enhance
the use of nursing diagnoses.
724 Cultural Collaborative Community/Home Care