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Impaired Urinary Elimination | Nursing Care Plan for Multiple Sclerosis

Nursing diagnosis: impaired Urinary Elimination related to Neuromuscular impairment, such as spinal cord lesions, neurogenic bladder

Possibly evidenced by
Incontinence, nocturia, frequency
Retention with overflow
Recurrent UTIs

Desired Outcomes/Evaluation Criteria—Client Will
Urinary Continence
Verbalize understanding of condition.
Demonstrate behaviors and techniques to prevent or minimize infection.
Empty bladder completely and regularly, voluntarily or by catheter, as appropriate.
Be free of urine leakage between voiding.

Nursing intervention with rationale:
1. Note reports of urinary frequency, urgency, burning, incontinence, nocturia, and size and force of urinary stream.
Rationale: Urinary habits indicate kidney and bladder function and possible UTI. Bladder fullness after voiding indicates inadequate emptying or retention and requires further evaluation and intervention. Palpate bladder after voiding.

2. Review drug regimen, including prescribed, OTC, and street drug use.
Rationale: A number of medications, including some antispasmodics, antidepressants, and opioid analgesics; OTC medications with anticholinergic or alpha-agonist properties; or recreational
drugs such as cannabis, may interfere with bladder emptying.

3. Institute bladder training program or timed voiding, as appropriate.
Rationale: Bladder training program helps restore bladder functioning and reduces incontinence and bladder infection.

4. Encourage adequate fluid intake, avoiding caffeine and use of aspartame and limiting intake during late evening and at bedtime. Recommend use of cranberry juice and vitamin C.
Rationale: Sufficient hydration promotes urinary output and aids in preventing infection. Note: When client is taking sulfa drugs, sufficient fluids are necessary to ensure adequate excretion of drug, reducing risk of cumulative effects. Note: Aspartame, a sugar substitute (e.g., NutraSweet), may cause bladder irritation leading to bladder dysfunction.

5. Promote continued mobility.
Rationale: Continued mobility promotes bladder emptying, thus decreases risk of developing UTI.

6. Recommend good hand-washing and perineal care.
Rationale: Perineal care reduces skin irritation and risk of ascending infection.

7. Encourage client to observe for sediment, blood in urine, foul odor, fever, or unexplained increase in MS symptoms, such as spasticity and dysarthria.
Rationale: Urinary symptoms indicate infection that requires further evaluation and prompt treatment.

8. Refer to urinary continence specialist, as indicated.
Rationale: The continence specialist helps develop individual plan of care to meet client’s specific needs using the latest techniques and continence products.

9. Administer medications, as indicated, such as Tolterodine (Detrol), oxybutynin (Ditropan), propantheline (Pro-Banthine), hyoscyamine sulfate (Cytospaz-M), flavoxate (Urispaz).
Rationale: These medications reduce bladder spasticity and associated urinary symptoms of frequency, urgency, incontinence, and nocturia.

10. Teach self-catheterization. Instruct in use and care of indwelling catheter.
Rationale: Self-catheterization helps maintain client autonomy and encourages self-care. Indwelling catheter may be required, depending on client’s abilities and degree of urinary problem.
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