A nursing care plan for urinary retention is a condition in which a person cannot empty their bladder of urine. It can be an acute, sudden change or a chronic condition in which the individual gradually loses the ability to empty their bladder over time completely. As a nursing student, you can use this blog to help you have a clear picture of what it entails and take home a lot of information on the same.
Four types of a nursing care plan for urinary retention
They are defined in the Agency for Health Care Policy and Research’s Clinical Practice Guideline. According to some authors, functional incontinence is a fifth type of incontinence.
• Urinary retention during stress
Increases in intraabdominal pressure cause involuntary urine leakage (e.g., exertion, effort, sneezing, or coughing). This is driven by urethral sphincter and pelvic floor dysfunction.
• Severe urinary retention
Due to detrusor overactivity, involuntary urine leakage may be preceded or accompanied by a sense of urinary urgency. Contraction symptoms could be caused by bladder irritation or a loss of neurologic control.
• Urinary retention mixed
Urine incontinence is caused by a combination of stress and urges urinary incontinence, as described above.
• Urinary retention with overflow
Involuntary urine leakage from an overstretched bladder is caused by impaired detrusor contractility and bladder outlet obstruction. Benign prostatic hyperplasia is a common cause in men.
• Retention of urinary function
Environmental or physical toileting barriers cause involuntary urine leakage. This type of incontinence is also known as toileting difficulty. Urinary incontinence can be caused by various factors, each of which contributes to varying degrees.
• Disorders or diseases that are underlying
Urinary incontinence can be caused by structural and functional problems with the bladder, urethra, ureters, and surrounding connective tissue. Furthermore, a spinal cord or central nervous system disorder could be a major etiologic factor. Medical comorbidities can also be significant.
• Inadequate anatomic pelvic support
Urethral hypermobility caused by poor anatomic pelvic support is women’s most common cause of stress incontinence. Postmenopausal estrogen loss, childbirth, surgery, or specific disease states that affect tissue strength can cause women to lose this pelvic support.
• Inadequate intrinsic sphincter function
Intrinsic sphincter deficiency, which can result from the aging process, pelvic trauma, surgery, or neurologic dysfunction, is a less common cause of stress incontinence. Radiation prostatectomy for prostate cancer or transurethral resection of the prostate for benign prostatic hyperplasia is the most common cause of intrinsic sphincter deficiency in men.
• Pharmacologic reasons
Many medications, either directly or indirectly, contribute to urinary incontinence. Medications must always be considered the cause of new-onset urinary incontinence, especially in the elderly, who frequently have polypharmacy. Incontinence can be caused by medications such as anticholinergics, alpha-adrenergic agonists, alpha-antagonists, diuretics, calcium channel blockers, sedative-hypnotics, angiotensin-converting enzyme (ACE) inhibitors, and anti-parkinson medications.
Nursing Care Plan For Urinary Retention
Incontinence occurs when the physiology of micturition, functional toileting ability, or both are disrupted. During stress incontinence episodes, an increase in intra-abdominal pressure causes pressure within the bladder to exceed the urethra’s resistance to urinary flow. When bladder pressure drops below urethral pressure, leakage stops. Some researchers believe that detrusor overactivity represents the premature initiation of the normal micturition reflex in urge incontinence. Some of these findings could also be explained by relative cholinergic denervation. Two possible contributors are subtle obstruction and the effects of aging on smooth muscle and the autonomic nervous system.
Nurses must have various communicative resources to effectively assist a client diagnosed with urinary incontinence and successfully implement nursing interventions. Nursing interventions for urinary incontinence are divided into educational, behavioral, and physical. The nursing diagnoses associated with urinary incontinence are as follows.
- Impaired Urinary Elimination
- Urinary Retention
- Skin Integrity Risk
Below is a sample of retention nursing care plans for the problems identified above:
Impaired Urinary Elimination
The World Health Organization has designated urinary incontinence as a public health priority. It has numerous physical, mental, and social consequences on the client’s life. Lower urinary tract age-related changes include decreased bladder capacity and fullness, decreased detrusor muscle contraction rate, decreased pelvic floor muscle strength, and increased residual urine volume. Urinary incontinence interferes with daily and social activities such as work, travel, physical activity, and sexual function, lowering one’s quality of life.
Nursing Diagnosis
- Impaired Urinary Elimination
Related Factors
- Urethral hypermobility
- Damage to pelvic floor nerves, muscle, and connective tissue
- Surgical procedures
- Loss of bladder tone
- Increased intra-abdominal pressure
Evidenced by
- Urgency, hesitancy, dysuria, and incontinence
- Bladder fullness
- Suprapubic discomfort
- Changes in the amount and character of urine
Desired Outcomes
After implementation of nursing interventions, the client is expected to:
- Demonstrate a continuous flow of urine.
- Demonstrate adequate urine output for the situation.
- Exhibit behaviors that will help you regain bladder and urinary control.
Nursing care plan for acute urinary retention
Typically, men with prostatic hypertrophy (enlarged prostate) experience acute urinary retention, and when obstruction occurs, the patient experiences pain and may become agitated. The symptoms can be relieved by inserting a urinary catheter into the bladder.
• Constipation
An impacted sigmoid colon or rectum can pressure the lower urinary tract, preventing the bladder from emptying. The nurse or doctor will need to use a catheter to drain the urine from the bladder. Once the patient is comfortable, it is critical to ask about bowel function and perform a rectal examination to look for fecal impaction.
If there is evidence of constipation, enemas and laxatives should be administered, and the catheter should be removed once constipation has been resolved. To prevent the problem from recurring, the patient should be advised on diet and fluid intake, and regular laxatives should be considered.
• Bladder outflow obstruction
An enlarged prostate in men can cause bladder outflow obstruction because the enlarged gland can occlude the urethra. The man may complain about urinary flow issues, including increased frequency, nocturia, hesitancy, urgency, and poor flow. Acute painful urinary retention can occur when a man with these problems drinks excessively or fails to empty his bladder for an extended period. In this case, the detrusor muscle becomes stretched, and poor detrusor muscle function and outflow obstruction may result in acute urinary retention.
For two weeks before removing the catheter, an alpha-blocker with or without a five alpha-reductase inhibitor may help shrink the size of the prostate gland in some men. If the patient had a significant residual volume of urine in his bladder when catheterized, surgery to resect the prostate gland might be a better option.
• Infection
The bladder mucosa becomes inflamed and oedematous as a result of infection. This ‘thinning’ can result in urinary retention. Once the infection is treated with antibiotics, this should go away.
• Recent surgery or immobility
Anaesthetics paralyze the detrusor muscle, and it may take some time to recover, particularly if it has been overstretched due to any of the issues listed in Box 1. It is therefore critical to monitor the urine output of all patients the following anesthesia.
• Urethral strictures
Urethral strictures can develop spontaneously or as a result of trauma, surgery, or infection. A stricture usually causes an intermittent, poor urine stream and may require straining to push urine through the narrowed urethra. Urinary retention may occur if the stricture tightens. A urethral catheter may be difficult, if not impossible, to pass in this situation, necessitating the insertion of a suprapubic catheter.
A flexible cystoscope is used to confirm the presence of a structure. Following the incision, a urethral catheter is inserted to act as a stent and keep the new passage open. The patient may be discharged with two catheters: a urethral catheter for urine drainage and a suprapubic catheter. The urethral catheter is removed about a week later, depending on the density of the stricture. The suprapubic catheter remains in place if the patient does not urinate through the urethra. When an excellent urethral flow of urine has been established, it can be removed from the bladder.
To prevent a recurrence of urinary retention caused by urethral stricture, most patients will need to learn self-dilatation using an intermittent catheter. One of the many causes of haematuria (blood in the urine) is bladder cancer. Blood clots in the bladder can obstruct urine flow, resulting in clot retention, and the patient may require catheterization with a three-way catheter. This allows the bladder to be irrigated continuously, preventing blood accumulation and clot formation.
• Painless acute retention
A neurological condition typically causes acute painless urinary retention. A catheter can relieve the retention, but if there is no known cause, an urgent neurological opinion should be sought.
Signs and Symptoms
The signs and symptoms of urinary retention can differ depending on whether the urinary retention is acute or chronic. Both types’ signs and symptoms are listed below.
Urinary Retention Acute
- Urinary incontinence
- Lower abdominal pain (usually severe)
- Urgent need to urinate
- Lower abdominal swelling
Urinary Retention that is Chronic
- Inability to empty the bladder while urinating
- Frequent, small amounts of urination
- Hesitancy (difficulty initiating urination)
- Slow urine stream
- Urge to urinate with little success
- Need to urinate immediately after urinating
It’s also worth noting that some people with chronic urinary retention don’t show any signs or symptoms.
Causes
Urinary retention can be caused by a variety of factors, including:
- Urethral blockage or narrowing
- Medications (e.g., antihistamines, opiates, antispasmodics)
- Nerve diseases/conditions (e.g., stroke, diabetes, multiple sclerosis, spine or pelvic trauma) Infections
- Surgery
- Weakening bladder muscles
Complications
Urinary retention, if left untreated, can lead to other complications for the individual. Among the possible complications are:
- Increased risk of urinary tract infections
- Bladder damage is caused by stretching the bladder too far or for too long periods
- Renal damage
- Urinary incontinence
Expected Outcomes
- The patient will be able to urinate adequately and free of any palpable bladder distention.
- The patient will be free of any post-void residuals greater than 100mL and any abdominal discomfort caused by urinary retention.
Nursing Care Plan Evaluation For Urinary Retention Nursing
- Determine the patient’s individual nursing care plan risk for urinary retention
Reviewing the patient’s chart and medical history will assist the nurse in determining whether the patient is at risk of urinary retention due to other medical conditions, recent surgery, or medications.
- Diagnosis of a nursing care plan for urinary retention
If the patient is frequently urinating in small amounts, this could indicate urinary retention.
- Perform an abdominal examination
Palpating the bladder may help the nurse determine whether there is abdominal tenderness or bladder distention.
- Examine the characteristics of urine
Noting urine color, clarity, and odor can help determine the presence of an infection that may cause urinary retention.
- Determine post-void residuals
If patients are not completely emptying their bladder while urinating, they may feel the need to empty it frequently. The amount of urine left in the bladder after excretion will tell the nurse if urinary retention is present and, if so, how severe it is.
- Examine/review the medication list
Some medications have the potential to cause urinary retention. If the patient is has a problem witth urinary retention due to medication, it will be beneficial to consult with the healthcare provider about alternative medications.
Urinary Retention Nursing Interventions
- Provide routine voiding measures to the patient, such as privacy, regular voiding positions, the sound of running water, and so on. These measures can help to relax the perineal muscles, which can help to promote appropriate, effective urination.
- Encourage/make available appropriate perineal cleansing. Appropriate cleansing reduces the risk of infections, which can exacerbate urinary retention.
- Provide appropriate catheter care when a catheter is present. Appropriate catheter care will decrease the risk of potential infection, which can further contribute to urinary retention.
- Catheterize the patient as needed. Catheterization may be required if the patient retains a significant amount of urine. Ensure that catheterization occurs as directed by the healthcare provider.
- Keep any indwelling catheter in good working order. Kinks in the tubing can cause the catheter to malfunction and the bladder to overflow. Examine the catheter tubing for kinks and ensure that it is in a position that allows for proper urine drainage.
- Keep the patients and family members aware on how to deliver catheter care and benefits of catheter care if the patient is going home with the catheter in place. It is critical to provide appropriate education regarding catheters that the patient will take home with them to be self-sufficient in their care at home and avoid further complications associated with the catheter.
- As needed, perform a bladder scan. Condiuct a bladder scan to determine if the patient is retaining urine and if there is a problem with bladder retention (i.e., several hours since the last void). Also, after a patient’s void, a bladder scan can be performed to determine if there is any post-void residual.
- If the urinary retention is chronic, administer medications as directed. Some people with chronic urinary retention may take medications regularly to control their symptoms. Ensure that all medications for the treatment of urinary retention are taken on time to maintain proper bladder function.
Conclusion
A nursing care plan for urinary retention can occur for various reasons and manifest itself in various ways. Patients and their families will appreciate the assistance of anyone who can assist them in resolving this issue. At nursingpapersmarket.com, we have the proper expertise to help complete any nursing care plan assessment and assignment. Quench your thirst for an A+ grade in your nursing papers by connecting with our professionals today.
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