During the assessment of the client with urinary incontinence, the nurse is most likely to assess for which of the following? Select all that apply.
A. Perineal skin irritation
B. Fluid intake of less than 1,500 mL/d
C. History of antihistamine intake
D. Hx of UTI
E. A fecal impaction
Correct Answer: A, B, D, and E
Urinary incontinence is the involuntary leakage of urine. This medical condition is common in the elderly, especially in nursing homes, but it can affect younger adult males and females as well. Urinary incontinence can impact both patient health and quality of life. The prevalence may be underestimated as some patients do not inform health care providers of having issues with urinary incontinence for various reasons.
Option A: The perineum may become irritated by the frequent contact with urine. Approximately 13 million Americans experience urinary incontinence. The prevalence is 50% or greater among residents of nursing facilities. Caregivers report that 53% of the homebound elderly are incontinent. A random sampling of hospitalized elderly patients reports that 11% of patients have persistent urinary incontinence at admission, and 23% at discharge.
Option B: Normal fluid intake is at least 1,500 mL/d and clients often decrease their intake to try to minimize urine leakage. Functional urinary incontinence is the involuntary leakage of urine due to environmental or physical barriers to toileting. This type of incontinence is sometimes referred to as toileting difficulty.
Option C: Antihistamines can cause urinary retention rather than urinary incontinence. The urethra is the tube that takes urine from the bladder out of the body. The problem can also be caused by using drugs such as antihistamines (like Benadryl®), antispasmodics (like Detrol®), and tricyclic antidepressants (like Elavil®) that can change the way the bladder muscle works.
Option D: UTIs can contribute to incontinence. Patients should be asked about medical conditions such as chronic obstructive pulmonary disease and asthma (which can cause cough), heart failure (with related fluid overload and diuresis), neurologic conditions (which may suggest dysregulated bladder innervation), musculoskeletal conditions (which may contribute to toileting barriers), etc.
Option E: A fecal impaction can compress the urethra, which results in sm. amts of urine leakage. Overflow urinary incontinence is the involuntary leakage of urine from an overdistended bladder due to impaired detrusor contractility and/or bladder outlet obstruction. Neurologic diseases such as spinal cord injuries, multiple sclerosis, and diabetes can impair detrusor function. Bladder outlet obstruction can be caused by external compression by abdominal or pelvic masses and pelvic organ prolapse, among other causes. A common cause in men is benign prostatic hyperplasia.