Are you wondering how to handle an assignment on a nursing care plan for urinary retention? Then, this article will give you answers. It will deeply look at each component of the nursing care plan, from the diagnosis, assessment, and outcomes to the nursing intervention. Before looking at the urinary retention care plan, we will define what a nursing care plan and urinary retention are.
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A nursing care plan (NCP) is a document a nurse prepares highlighting the care and intervention to be offered to an individual patient. It assists in providing quality, holistic, and personalized care. An NCP's other purpose is to promote effective communication and coordination among healthcare specialists when delivering patient care.
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NCP comprises the following 5 components:
Read more: How to Write a Nursing Care Plan
This article focuses on the nursing care plan for urinary retention. It is thus wise to discuss what urinary retention refers to.
Urinary retention is a health problem of the bladder whereby this organ is unable to empty completely or effectively. It can be acute or chronic. Acute means that it is sudden, quick, and severe. Most patients with this type are unable to empty their bladder at all. On the other hand, chronic urinary retention is mild and happens over a long time when a person cannot empty the bladder completely.
Urinary retention signs and symptoms differ for the acute and chronic types.
The manifestations of acute urinary retention are:
The manifestations of chronic urinary retention are:
Many factors can lead to urinary retention. It includes:
This article focuses on a nursing care plan for urinary retention. As seen above, the components of NCP are:
This section will look at urinary retention nursing diagnosis. Then, the other sections of the article will deeply discuss the assessment, outcomes, and nursing interventions, respectively.
According to NANDA guidelines, a urinary retention nursing diagnosis is referred to as “incomplete emptying of the patient’s bladder.” It is worth noting that impairments in urinary elimination are mainly due to urinary retention or urinary incontinence. Also, urinary incontinence is a common symptom of urinary retention (this has been mentioned above).
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A nurse can do the following assessments for patients suffering from urinary retention:
When doing a urinalysis, a nursing specialist should check the characteristics of the urine. This includes elements like odor, color, and clarity. These elements can assist in signaling an infection. Additionally, nurses can do tests for the urine to analyze kidney function and inflammation levels. Common abnormalities in kidney function are chronic and acute renal disease. They should major on the PSA (prostate-specific antigen) when assessing the inflammation levels.
Assess the quantity and frequency of void. It is also beneficial to assess post-void residuals. Some patients may feel the urge to empty their bladder even after they urinate. A feeling like this is brought about by urine that is remaining in the bladder, commonly caused by urinary retention.
Regular, small quantities of urine are indicators of urinary retention. Frequent, burning urination episodes are suggestive of UTIs. Incomplete emptying or dribbling may indicate a prostate issue. Back pain can signal kidney issues.
Some drugs lead to urinary retention. This is common with medications with anticholinergic impacts that cause voiding difficulties. Typical drugs with this effect are tricyclic antidepressants, antipsychotics, and antiparkinson. Discussing alternative drugs with the physicians is vital if the patient’s urinary retention is due to medication.
Another essential assessment nurses can perform is evaluating the abdomen. Physical and imaging tests are handy in doing this assessment. In physical, palpating the bladder is common. Here, nurses look at bladder distention and abdominal tenderness.
Imaging tests include specifics like cystoscopy, urodynamic testing, and KUB. These tests help spot structural problems, cancer, and other diseases that may be causing issues.
Some patients with bladder dysfunctions depend on permanent or intermittent catheters to drain urine. In case they are self-catheterizing, ensure they perform catheterizations well and aseptically to avoid introducing pathogens and leading to infections. In addition, confirm if the indwelling catheters are still needed. Extended and unnecessary catheterization raises infection risks.
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Below are some anticipated outcomes that nurses hope to achieve after implementing interventions on a patient with urinary retention.
Below are typical nursing interventions for urinary retention.
In most cases, patients with chronic urinary retention are ordered to take certain medications to help with bladder function. So, as a nurse, ensure you administer or thoroughly educate the patient about their prescribed medication and when is the appropriate time to take it.
Some medications you may come across are Ditropan and Flomax. Ditropan is an anticholinergic whose function is to control bladder contractions that bring about urination urges. Flomax relieves obstruction by relaxing bladder muscles.
Nurses should encourage patients to consume fluids unless it is medically restricted. It may seem wrong to do this when the patient has incontinence, but it is not. Anhydrated bodies have worse effects on urinary retention than hydrated ones. Appropriate hydration facilitates voiding reflexes and helps flush waste products and pathogens, such as bacteria. Patients should be encouraged to drink more than 1500ml daily.
Not all fluids are safe for consumption. They should keep away from alcohol, carbonated beverages, and caffeinated drinks (i.e., coffee) as they can irritate the bladder, increasing urgency and frequency. Sweet tea and carbonated drinks are great contributors to kidney stones in urinary retention patients.
Nurses can use many measures to improve voiding efficiency and frequency. First, patients can stay upright to allow for successful voiding. Bedpans are great tools to achieve this posture when the patients are voiding while on the beds. It is also suitable for patients to sit upright even when in a toilet.
Second, patients should be encouraged to urinate after every four hours. A voiding frequency like this assists in emptying the bladder and decreasing the risks of urinary retention. Some tricks to encourage patients to urinate when they find it problematic are:
The Crede method is the act of gently pressing the bladder with hands to encourage voiding. Doing a Crede maneuver puts pressure on the bladder, which raises the urinary bladder pressure and facilitates the sphincters to relax. Eventually, urination occurs.
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Catheterization is vital when patients cannot fully empty the bladder. Nurses should catheterize patients by following a physician’s instructions. Urinary retention needs to be avoided at all costs. So, when other strategies like medication and body posture are ineffective, catheterization should be considered. Urine retention leads to grave consequences such as urinary tract infections.
Although catheters are great interventions, they can worsen urinary retention if handled poorly. Thus, it is super-important for nurses to educate patients about catheter care. Poor catheter management increases the risk of infection, further exacerbating urinary retention.
A good strategy for ensuring patients have grasped the ins and out of catheter care is observing them as they perform the act. Some proper cath care techniques are cleaning daily using water and soap and making sure the drainage bag is below the bladder level, and there are no kinks.
Appropriate perineal cleaning drastically reduces infection risks. Some practices patients can apply for proper cleansing are wiping themselves from front to back after using a washroom, removing wet bathing suits as soon as possible, wearing loose clothing and cotton underwear, and voiding instantly after sexual intercourse.
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Several medical interventions can treat urinary retention. The most common ones are as follows (If you want to know the nursing treatment plans for urinary retention, then go through this article, specifically the nursing intervention section.):
Below are activities you can do to self-care if you have urinary retention:
Urinary retention is a condition where one cannot void completely or is unable to void at all. In comparison, urinary incontinence is a condition where a person cannot control their bladder, making urine leak out of their body uncontrollably. Note that the two can happen together.
According to NANDA guidelines, the urinary retention nursing diagnosis is “incomplete emptying of the patient’s bladder.”
This article has covered the nursing care plan for urinary retention in detail. It has looked at the most critical components of NCP. For starters, the nursing diagnosis is “incomplete emptying of the patient’s bladder.” The assessments that can be performed are urinalysis and evaluating medication, patients’ abdomen, and catheterization issues. The most extensive section of this article is on nursing interventions for urinary retention. Some critical interventions are administering prescribed medicine, catheterization, and encouraging voiding measures and fluid intake.
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