care plan help

[Theresa Presley]

I turned in a care plan for maternal child on a postpartum multi para. In the assessment she complained of urinary incontinence throughout her pregnancy and was very interested in learning what to do to improve her control. My nursing diagnosis was "Stress urinary incontinence r/t multiparity" I got an email from my instructor that stated "stress urinary incontinence (SUI) is a medical diagnosis, not a nursing diagnosis" and then a whole lot of going on about what a nursing diagnosis is. She stated that I will have to do another complete care plan. I spent at least two hours on this complete care plan, based on SUI being a nursing diagnosis. According to the 2012 Nanda SUI, IS a nursing diagnosis. So now I'm confused. My question is, is "urinary incontinence; stress," a nursing diagnosis? If no then why is it in the approved diagnosis list for Nanda? If yes, then what do I do now? Thanks in advance for any suggestions.

[smf0903]

SUI comes straight from the NANDA list. If it were me, I'd ask to meet with the instructor and bring my nursing dx book with me, that way she can look at the book and give you an explanation as to why she says it's not a nursing dx. I understand the it using medical diagnoses in the care plan, but as far as I know (unless something changed since 2013...which is the nursing dx book I have) SUI is still a nursing diagnosis. But I would go straight to the source (instructor) to get this cleared up. Good luck!! :)

[Esme12, ASN, BSN, RN]

According to NANDA I Stress urinary Incontinence: Sudden leakage of urine with activities that increase intraabdominal pressure

Defining Characteristics

Observed urine loss with physical exertion (sign of stress incontinence); reported loss of urine associated with physical exertion or activity (symptom of stress incontinence); urine loss associated with increased abdominal pressure (urodynamic stress urinary incontinence) (Abrams et al, 2002)

Related Factors (r/t)

Urethral hypermobility/pelvic organ prolapse (genetic factors/familial predisposition, multiple lady partsl deliveries, delivery of infant large for gestational age, forceps-assisted or breech delivery, obesity, changes in estrogen levels at climacteric, extensive abdominopelvic, or pelvic surgery); urethral sphincter mechanism incompetence (multiple urethral suspensions in women, radical prostatectomy in men, uncommon complication of transurethral prostatectomy or cryosurgery of prostate, spinal lesion affecting sacral segments 2 to 4 or cauda equina, pelvic fracture)

I would have a meeting with her and ask that question... it is on the list maybe she objects to your reference to multiparity and wants you to go more for the increased intraabdominla pressure due to gravid uterus or multiple lady partsl deliveries

[nurseprnRN, BSN, RN]

Page 196, NANDA-I 2012-2014. Your instructor may be working from an old edition or from a nursing diagnosis "handbook" which does not include this very appropriate nursing diagnosis. Bring your NANDA-I 2012-2014 along with you to an appt with her. Show her the related factors and defining characteristics you assessed in this patient that made it possible for you to make this diagnosis because they match the ones in the diagnosis as given.

FWIW, the current list includes only 4 related factors:

*degenerative changes in pelvic muscles

*high intra-abdominal pressure

*intrinsic urinary sphincter insufficiency (as you might see post prostatectomy)

*weak pelvic muscles (this last likely to be the one for a postpartum patient).

Also, in case she trots out that old "you can't use a medical diagnosis as a related factor" inaccuracy, bookmark half a dozen of them in different chapters that do exactly that. You can start with "Pain" and ""Chronic pain." :)