| 释义 |
DictionarySeeincontinencefunctional urinary incontinence
incontinence [in-kon´tĭ-nens] 1. inability to control excretory functions.2. immoderation or excess. adj., adj incon´tinent.bowel incontinence 1. fecal incontinence.2. a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as a state in which an individual has a change in normal bowel habits, with involuntary bowel movements.continuous incontinence continuous urinary leakage from a source other than the urethra, such as a fistula.fecal incontinence (incontinence of the feces) inability to control defecation" >defecation; both physiologic and psychological conditions can be contributing factors. Called also encopresis and bowel incontinence. See also elimination, altered" >bowel elimination, altered. Physiologic causes include neurologic sensory and motor defects such as those occurring in stroke and spinal cord injury; pathologic conditions that impair the integrity of the sphincters, such as tumors, lacerations, fistulas, and loss of sensory innervation; altered levels of consciousness; and severe diarrhea. Psychological factors include anxiety, confusion, disorientation, depression, and despair.
There is potential for physical and psychological stress when a person is unable to control his or her bowel movements. Damage to the integrity of the skin and its breakdown into ulcers" >pressure ulcers is always a possibility no matter how hard caregivers might try to keep the patient clean and dry. Psychologically the person is likely to suffer from loss of self-esteem and is certain to experience some alteration in self-image. From the time of toilet training a person is expected to be able to handle the tasks of bowel elimination. An adult who for some reason is no longer able to do this is often embarrassed by and ashamed of the inability to perform this most basic of self-care activities.Patient Care. Assessment of the problem of fecal incontinence should be extensive and thorough so that a realistic and effective plan of care can be implemented. Sometimes all that is needed is a regularly scheduled time to offer the patient a bedpan or help using a bedside commode or going to the bathroom. If diarrhea is a problem it may be that dietary intake needs changing or tube feedings are not being administered correctly. Dietary changes may also help the patient who has a stoma leading from the intestine. In cases of neurologic or neuromuscular deficit, retraining for bowel elimination is a major part of rehabilitation of the patient. Frequently, it is possible to help a patient achieve control by means of a well-planned and executed bowel training program.
Biofeedback techniques can be helpful in many cases. The person learns to maintain higher tone in the anal sphincter through use of a balloon device that provides feedback information about pressures in the rectum. With practice the person can learn better control and develop a more acute awareness of the need to defecate.functional incontinence incontinence due to impairment of physical or cognitive functioning.functional urinary incontinence a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as an inability of a usually continent person to reach the toilet in time to avoid the unintentional loss of urine. See also incontinence" >urinary incontinence.overflow incontinence (paradoxical incontinence) incontinence" >urinary incontinence due to pressure of retained urine in the bladder after the bladder has contracted to its limits; there may be a variety of presentations, including frequent or constant dribbling or symptoms similar to those of stress or incontinence" >urge incontinence.reflex incontinence the incontinence" >urinary incontinence that accompanies hyperreflexia" >detrusor hyperreflexia.reflex urinary incontinence a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as an involuntary loss of urine at somewhat predictable intervals, whenever a specific bladder volume is reached. See also incontinence" >reflex incontinence.risk for urge urinary incontinence a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as the state of being at risk for involuntary loss of urine associated with a sudden strong sensation of urinary urgency. See also incontinence" >urge urinary incontinence.severe stress urinary incontinence severe stress incontinence as a result of incompetence of the sphincter mechanism.stress incontinence incontinence" >urinary incontinence due to strain on the orifice of the bladder, as in coughing or sneezing.stress urinary incontinence a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as loss of urine of less than 50 ml when there is increased abdominal pressure. See also incontinence" >stress incontinence.total urinary incontinence a nursing diagnosis accepted by the Seventh National Conference on the Classification of Nursing Diagnoses, defined as a state in which an individual has continuous and unpredictable loss of urine; see also incontinence" >urinary incontinence.urge incontinence (urgency incontinence) urinary or fecal incontinence preceded by a sudden, uncontrollable impulse to evacuate (see also urgency). Urge incontinence of urine is a major complaint of patients with urinary tract infections" >urinary tract infections and is also present in some women two or three days before onset of the menstrual period.urge urinary incontinence a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as the involuntary passage of urine soon after feeling a strong sense of urgency to urinate; see also incontinence" >urge incontinence.urinary incontinence (incontinence of urine) loss of control of the passage of urine from the bladder; see also enuresis. It can be caused by pathologic, anatomic, or physiologic factors affecting the urinary tract, as well as by factors entirely outside it. See also elimination, altered" >urinary elimination, altered.Patient Care. The Agency for Health Care Policy and Research (AHCPR) convened an interdisciplinary, non-Federal panel of physicians, nurses, allied health care professionals, and health care consumers that has identified and published Clinical Practice Guidelines for Urinary Incontinence in Adults. Identification and documentation of urinary incontinence can be improved with more thorough medical history taking, physical examination, and record keeping. Routine tests of lower urinary tract function should be performed for initial identification of incontinence. There are also situations that require further evaluation by qualified specialists.
The guidelines provide an informed framework for selecting appropriate behavioral, pharmacologic, and surgical treatment and supportive services that can be used to treat urinary incontinence. The panel concluded that behavioral techniques such as bladder training and pelvic muscle exercises are effective, low cost interventions that can reduce incontinence significantly in varied populations. Surgery, except in very specific cases, should be considered only after behavioral and pharmacologic interventions have been tried. The panel found evidence in the literature that treatment can improve or cure urinary incontinence in most patients. The address of the AHCPR is Agency for Health Care Policy and Research, P.O. Box 8547, Silver Spring, MD 20907. They can also be called toll free at (800) 358-9295.functional urinary incontinenceInability of a usually continent person to reach the toilet in time to avoid unintentional loss of urine. Urinary incontinence (UI) affects about 30% of older adults living at home and about 50% of those in nursing care facilities. Women are more likely than men to develop UI. UI can result in physical problems such as skin breakdown, but it also causes emotional problems such as embarrassment, frustration, depression, and loss of self-esteem, which may lead to social isolation, loss of independence, and even institutionalization. Patient careHealth care professionals should make questions about incontinence a routine part of taking a patient's history because the patient may be too embarrassed to report the problem without prompting. The type of episodes experienced should be documented and how long the problem has been present. Many factors may be involved, including neurologic disorders, urinary tract infection, adverse drug effects, irritants such as artificial sweeteners, caffeine, certain foods, and decreased muscle tone. Physical examination should follow up on the problem, and a urologic consultation may be warranted. Functional UI may afflict older adults who have normal bladder control but have a difficult time getting to the toilet because of problems that interfere with mobility, e.g., arthritis, Parkinson disease, or stroke. Environmental factors (such as clutter, lack of ready access to facilities, distance to the toilet) may also play a part. Health care professionals should assess the patient’s fluid intake to be sure he or she is drinking enough and should review his or her medication regimen to determine if any of the drugs affect continence. The patient should be encouraged to use the toilet on a planned schedule (upon arising, before and after each meal and at bedtime, and as adjusted to his or her needs). For patients living independently, walkways should be kept free of clutter, and, if necessary, a commode placed closer to the person’s living space. See also: incontinence |