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Incontinence - Urinary and Fecal

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Incontinence - Urinary and Fecal NPN 200 Medical Surgical Nursing I Urinary Incontinence USA- 13 million (85% women) Stress incontinence - most common type Loss of ... – PowerPoint PPT presentation

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Title: Incontinence - Urinary and Fecal


1
Incontinence - Urinary and Fecal
  • NPN 200
  • Medical Surgical Nursing I

2
Urinary Incontinence
  • USA- 13 million (85 women)
  • Stress incontinence - most common type
  • Loss of urine when, sneezing, jogging or lifting
  • Common after childbirth and menopause
  • Urge incontinence
  • Inability to suppress the urge to void, may be
    caused by infection, stroke,, etc.
  • Overflow incontinence
  • Occurs when the muscles in the bladder do not
    contract and the bladder becomes distended over
    its capacity
  • Functional incontinence lack of awareness

3
Causes of Incontinence
  • Medications - CNS depressants, diuretics,
    multiple medications
  • Disease CVAs, arthritis, Parkinsons
  • Depression decreases energy to remain
    continent, decreasing self worth decreases desire
    to remain continent
  • Inadequate resources glasses, canes, may be
    afraid to ambulate, products to manage are
    costly, and no one available to help to bathroom

4
Assessment
  • Questions Do you leak urine when you cough or
    sneeze, on the way to the bathroom, or do you
    wear pads, tissue or use cloths to catch leaking
    urine?
  • Have patient describe the pattern and volume of
    urine, and any related symptoms
  • May observe a stale urine odor
  • Assess for distention, may need post void
    residual, have patient cough while wearing a pad
  • Clean catch urine, post void residual CBC
  • Voiding cystogram, cystoscope , cystometry,
    uroflowmetry

5
Medical Treatment
  • Surgery to improve the tone of the sphincter,
    artificial sphincters, repair cystocele (anterior
    vaginal repair), retropubic suspension,
    pubovaginal sling, or other means such as
    collagen injections
  • Non-surgical management
  • Drug interventions
  • Behavioral interventions
  • Intermittent catheterization
  • Indwelling catheter
  • Penile clamps
  • Pelvic organ support devices (pessary)

6
Interventions
  • Urinary bladder training
  • Improves bladder function by increasing the
    bladders ability to hold urine and the clients
    ability to hold urine and suppress urination
  • Urinary habit training
  • Establishes a predictable pattern of bladder
    emptying to prevent incontinence for patients who
    have urge, stress, or functional incontinence
  • Urinary catheterization intermittent regular
    periodic use of a catheter to empty bladder
  • Teach use of incontinent products

7
Potential Complications of Urinary Incontinence
  • Impaired skin integrity
  • Risk for infection
  • Social isolation
  • Low self esteem

8
Fecal Incontinence
  • Less common
  • Caused by trauma, sphincter dysfunction,
    childbirth, Crohns disease, or diabetic
    neuropathy
  • Severe diarrhea may cause temporary incontinence
  • May also be R/T impaction

9
Fecal Incontinence
  • Types
  • Symptomatic
  • Usually R/T colorectal disease/may have blood or
    mucus
  • Overflow
  • Caused by constipation, where the feces fills the
    entire colon
  • Patient passes semi-formed stool frequently
  • Can be seen in patients with long term laxative
    use
  • Treat by cleansing over 7-10 days, then work on
    constipation
  • Neurogenic
  • Patients who do not voluntarily delay defecation
  • Usually with dementia
  • Anorectal
  • Nerve damage which weakens muscles in the pelvic
    floor
  • Have several incontinent stools per day

10
Nursing Assessment
  • What is the problem?
  • Identify bowel patterns
  • Identify characteristics
  • Color
  • Clarity
  • Consistency
  • Past problems
  • Perform physical exam
  • Inspect rectal area

11
Treatment/Interventions
  • Provide for regular, scheduled bowel emptying
    (usually 30 min after eating)
  • Give ordered laxatives or enemas
  • Teach dietary and fluid requirements
  • Encourage ambulation or activity as tolerated
  • Cleanse and protect perineum after each BM
  • Use depends or fecal pouches when necessary
  • Always encourage patient and be prompt in
    attending to needs
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