During shift report, the nurse learns that an older female client is unable to maintain continence after she senses the urge to void and becomes incontinent on the way to the bathroom. Which nursing diagnosis is most appropriate?
A. Stress urinary incontinence
B. Reflex urinary incontinence
C. Functional urinary incontinence
D. Urge urinary incontinence
Correct Answer: D. Urge urinary incontinence
The key phrase is “the urge to void” option one occurs when the client coughs, sneezes, or jars the body, resulting in accidental loss of urine. If one feels a strong urge to urinate even when the bladder isn’t full, the incontinence might be related to overactive bladder, sometimes called urge incontinence. This condition occurs in both men and women and involves an overwhelming urge to urinate immediately, frequently followed by loss of urine before the client can reach a bathroom. Even if one never has an accident, urgency and urinary frequency can interfere with work and a social life because of the need to keep running to the bathroom.
Option A: Stress Urinary Incontinence (SUI) is when urine leaks out with sudden pressure on the bladder and urethra, causing the sphincter muscles to open briefly. With mild SUI, pressure may be from sudden forceful activities, like exercise, sneezing, laughing, or coughing.
Option B: Reflex urinary incontinence occurs with involuntary loss of urine at somewhat predictable intervals when a specific bladder volume is reached. Reflex incontinence occurs when the bladder muscle contracts and urine leaks (often in large amounts) without any warning or urge. This can happen as a result of damage to the nerves that normally warn the brain that the bladder is filling.
Option C: Functional urinary continence is the involuntary loss of urine related to impaired function. If the urinary tract is functioning properly but other illnesses or disabilities are preventing one from staying dry, the client might have what is known as functional incontinence. For example, if an illness rendered the client unaware or unconcerned about the need to find a toilet, the client would become incontinent. Medications, dementia, or mental illness can decrease awareness of the need to find a toilet.