Urge urinary incontinence - etiology help??

[marjibme]

I could really use some help. I'm a first semester student & we're been assigned a case study (from the Evolve website - based on the Ackley Nursing Diagnosis Handbook). Outside of a mention of the nursing process during the 2nd weeks lecture in Fundamentals, this is the first (and apparently only, since the semester ends in 3 weeks) exposure to this we've had and the only instructions provided are those written on the assignment itself.

We're supposed to write at least 2 nursing diagnosis, prioritize them according to Maslow, and prepare a care plan, providing rational when appropriate, etc. I've completed much of the assignment but I'm having some trouble figuring out the etiology/related to factors for one of my possible diagnosis.

I'm pasting the scenario/assessment provided to us below and follow that with the diagnosis, related to and AEB that I've come up with. Ive underlined what I consider to be the significant symptoms:

Case Scenario

“Oh, this is awful,” Jenny muttered to herself. She was sitting on the toilet with a pair of very wet panties and slacks around her ankles. Jenny said that she never knew when it would hit, this need to urinate quickly. She would find herself running to the bathroom like a woman possessed and then usually not making it in time. “It also seems like I’m ‘peeing’ all the time,” she said. “This is getting old and is not fun at all.”

Nursing Assessment

Jenny Hill is an 82-year-old woman who lives in a home for elderly women. She has trouble controlling urination. She finds that when she has to urinate, she has to get to the bathroom quickly or she will wet her panties. She has started wearing incontinence pads, but she hates them because they are uncomfortable, and she’s afraid they show when she wears pants. Also they cost a lot of money.

She finds herself getting up to urinate two to three times per night. Sometimes she finds she really smells of urine in the morning, and her sheets are wet with urine. She is limiting her usual social activities because of the possible embarrassment of smelling like urine. Mrs. Hill makes an appointment to talk her nice nurse practitioner to see if anything can be done about the situation.

The instructions tell us to list the symptoms that indicate a health problem, group the symptoms that are similar and then select at least two possible nursing diagnosis. I selected:

urge urinary incontinence r/t (???) aeb urinary frequency, urgency, nocturia & enuresis

imparied social interaction r/t inability to control passage of urine aeb limiting normal social activities

I'm not having any trouble prioritizing (elimination is primary/physiological need according to Maslow) or coming up with my NOC and NIC. I can not, however, for the life of me figure out the etiology for the urge incontinence (idiopathic causes???). especially since the instructions indicate we should use those provided in the book and none of them seem to "fit."

I realize this has been long - so if you've read through to this point I am grateful. If you can point me in the right direction here - you will be my new best friend forever!

[Isitpossible, LPN, LVN]

hi!! im in fundamentals now, and also trying to get the hang of nursing care plan...its seems that you got it except for the r/t part? since we dont have results of diagnostic testing it difficult to know exactly whats causing the incontinence...but i reviewed my fundamentals book to determine what causes urinary incontinence:

according to my books and notes:

infection (probably not your patient b/c no reporting of pain)

loss of muscle control (especially older adults!)

weakened pelvic musculature

a nursing diagnosis that is my book states: urge yincontience r/t weakended pelvic musculature AEB (all your evidence listed)

in reviewing my medsurge book i see that there is more than one type of incontinence!! (i didnt realize)

stress incontinence -

urge incontinence

overflow incontinence

reflex incontinence

functional incontinence

sounds like your patient has the urge incontinence:

condition is caused by uncontrolled contraction or overactivity of detrusor muscle...

i hope this helps, and hope daytonite sees this...shes the best....!

[marjibme]

Thanks for the reply. I went with idopathic causes since there wasn't any information in the data provided to suggest any concrete reason/cause. My brain has been at th epint of Information Saturation for a while now - but there's 2 weeks left in the semester. Then we get an entire 2 1/2 weeks breaks before the fun begins again. I'm thinking a semi-deserted tropical island (someone else has to be around to bring me drinks and feed me grapes) sounds REAL good about now.

[sharpeimom]

just a quick thought ...

she's 82 years old. might she possibly have had a very slight stroke that perhaps went unnoticed? even a very very slight stroke could cause urinary incontinence of the type you describe. bladder training programs exist to retrain the bladder to help her realize when she needs to void. sometimes poststroke, people don't get a strong -- or any signal that their bladder is full enough that they should

go. sometimes just reminding yourself that you need to get up and go every ___ minutes or q __ hours can be all it takes.

kathy

shar pei mom:paw::paw:

[Daytonite, BSN, RN]

This is Impaired Urinary Elimination R/T sensory motor impairment AEB dysuria, frequency, incontinence, nocturia and urgency.

That, or she has an undiagnosed UTI.

Another potential diagnosis is Ineffective Health Maintenance R/T lack of material resources AEB limited use of incontinence pads because of their cost.

[marjibme]

Daytonite (and all),

Thanks again for your responses. Based on the requirements for the assignment, I felt that impaired urinary elimination was too broad a diagnosis. I did speculate on possible causes, but again, since we were limited to the data provided, I felt that "idopathic causes" was the best etiology to use.

The idea of the 2nd diagnosis you mentioned had never crossed my mind, and while the assignment has already been submitted, I really appreciate the insight. Apparently there is more to the nursing diagnosis than what first meets the eye. I am really looking forward to the time when this "new language" isn't quite so foreign to me.