Risk for urinary retention

Domain 3. Elimination and exchange
Class 1. Urinary function
Diagnostic Code: 00322
Nanda label: Risk for urinary retention
Diagnostic focus: Retention

Nursing diagnosis risk for urinary retention is a condition where the bladder is unable to completely empty, leaving urine trapped in the bladder. This can result in an increase in urinary frequency and urgency, as well as discomfort from the pressure of the urine on the bladder wall. It is particularly common in elderly individuals, who may have decreased bladder muscle strength, weakened patient control and changes to their urinary system caused by disease, injury or age. Early detection and diligent monitoring are key for mitigating potential risks associated with this condition.

NANDA Nursing Diagnosis Definition

According to NANDA International, nursing diagnosis risk for urinary retention is defined as “At risk for inhibition of normal bladder emptying, resulting in obstruction of urine or urine accumulation”. This can be further broken down into four stages:

• Inability to initiate voiding. This is caused by an impaired ability of the patient to initiate voluntary urination. It is usually accompanied by an increased sensation of urgency.
• Delayed or arrested voiding. This is caused by an interruption to the normal process of coordination between the detrusor muscles, the sphincter muscles, and the pelvic floor muscles during urination.
• Incomplete emptying of the bladder. This is caused by an impairment of the contractility of the detrusor muscles during urination, leading to difficulty in emptying the bladder completely.
• Reflux of urine. This occurs when the bladder pressure becomes very high, causing urine to flow back into the ureters and eventually back into the kidneys.

Risk Factors

There are a number of physical and psychological conditions which can lead to nursing diagnosis risk for urinary retention. These include:

• Neurological disorders. Patients with spinal cord injury, multiple sclerosis, stroke or Parkinson's disease, amongst others, can be more prone to developing urinary retention due to altered nerve signals.
• Prostate enlargement. The enlarged prostate can put the bladder under increased pressure, making it difficult to empty completely.
• Adverse drug reactions. Anticholinergic drugs (used to treat Parkinson's disease, depression, overactive bladder, etc.) as well as alpha-adrenergic agonists (used for treating high blood pressure) can cause symptoms of urinary retention.
• Congenital disorders. Some congenital disorders can cause repeated urinary tract infections (UTIs), leading to serious damage to the kidneys, ureters and bladder, and thus, urinary retention.
• Bladder outlet obstruction. Prostatic hyperplasia, tumours, cysts and strictures can lead to an obstructed outlet to the bladder,making it harder to pass urine.
• Psychological factors. Urological fear,depression and other psychological issues can limit the patient's ability to produce a strong enough urge to pass urine.

At Risk Population

There are certain groups in the population who are more vulnerable to developing nursing diagnosis risk for urinary retention. Amongst them are:

• Older individuals. The prevalence of urinary retention increases with age due to the weakening of muscle strength and signals to the bladder,as well as physiological changes associated with ageing.
• Male patients. Men have a higher risk of developing urinary retention because of the enlarged prostate associated with ageing.
• Post-operative patients. Robotic surgeries or operations to the urinary tract can put patients at a greater risk of urinary retention.
• Patients under long-term medication. Long term use of medications such as diuretics and alpha- blockers can knock out the normal rhythm associated with bladder control.
• Patients with neurological conditions. Neurological conditions such as spinal cord injury,stroke and Parkinson's disease can inhibit signals from the nervous system to the bladder,leading to urinary retention.

Associated Conditions

Nursing diagnosis risk for urinary retention can be associated with a range of other conditions, such as:

• Urinary tract infections. UTIs can be a source of irritation and discomfort in the bladder, and the patient may find it hard to initiate urination.
• Benign prostatic hyperplasia. This prostate enlargement is caused by hormonal changes in older men, leading to an obstruction of the bladder outlet and the risk of urinary retention.
• Cardiovascular diseases. Cardiovascular diseases such as hypertension, coronary heart disease and diabetes can lead to impaired bladder contractility and interruption of normal neural signals.
• Bladder cancer. Bladder cancer can block the urethral opening, or even spread to the bladder walls, making it harder to pass urine.
• Incontinence. Loss of bladder control can lead to overflow incontinence, with milkersurine often passing before the urge to go.

Suggestions of Use

Nursing diagnosis risk for urinary retention requires immediate medical attention. Depending on the situation, the patient may require specialised radiographic assessment such as ultrasound or cystoscopy. Urodynamic studies may be needed to assess the flow of urine and its pressure. Treatment options include medications, lifestyle modifications, and in severe cases, surgery.

Suggested Alternative NANDA Nursing Diagnosis

In addition to nursing diagnosis risk for urinary retention, NANDA International suggests the following nursing diagnoses:

• Ineffective bladder control. This is used to describe the inability to voluntarily control the bladder despite the presence of a strong urge to go to the bathroom.
• Nighttime enuresis. This is used to refer to the uncontrollable production of urine during sleeping hours, mainly seen in younger children.
• Deficient knowledge regarding urinary retention. This is used when the patient lacks knowledge or understanding regarding urinary retention,leading to inappropriate treatment.
• Risk of bladder injury or impairment. This is used to describe the risk of bladder damage due to inadequate knowledge or an incorrect usage of medications.
• Functional urinary incontinence. This is used to describe the inability to reach the toilet in time due to physical or psychological barriers.

Usage Tips

When dealing with nursing diagnosis risk for urinary retention, it is important to remain aware of any changes in the patient's urinary habits. Frequent monitoring of urine output, urine colour and any type of physical strain while passing urine should be done in order to prevent any complications. Bladder retraining can also be useful for some patients who have less severe symptoms.

NOC Outcomes

Below are some expected outcomes for nursing diagnosis risk for urinary retention, as recommended by NANDA International:

• Urine Output. The patient should demonstrate a steady urine output over several days.
• Bladder Control. The patient should be able to maintain bladder control,avoiding any night-time enuresis.
• Urinary Continence. The patient should be able to regain a degree of urinary continence,with little or no involuntary passage of urine.
• Urge Recognition. The patient should be able to recognise a strong need to pass urine,and be able to physically carry out this action.
• Health Perception/Health Management. The patient should demonstrate understanding of the risks and benefits associated with managing this condition.

Evaluation Objectives and Criteria

When evaluating nursing diagnosis risk for urinary retention, the nurse should consider the following objectives and criteria:

• Objectives. The nurse should observe the patient's ability to initiate urination, empty the bladder completely and control the leak of urine.
• Criteria. The nurse should ensure that the patient's urinary frequency and urgency are within normal limits, and that there is no excessive pain or discomfort upon urination.

NIC Interventions

In order to manage nursing diagnosis risk for urinary retention, nurses must be vigilant across a range of interventions. These include:

• Behavioural management. the patient should be taught healthy methods of bladder control,behavioural adaptations and relaxation techniques.
• Medication administration. Appropriate antibiotics, anti-inflammatory agents and anticholinergics can be prescribed as deemed necessary.
• Foley catheterisation. This can be done as an emergency measure when the patient cannot be adequately managed through conservative methods.
• Assessment of voiding patterns. The patient'sconsecutive voiding patterns should be closely monitored.
• Fluid management. The patient should be encouraged to drink sufficient amounts of fluids in order to ensure proper hydration.

Nursing Activities

Apart from the interventions mentioned above, nurses must also ensure effective using of communication techniques when providing care for patients with nursing diagnosis risk for urinary retention. In particular, nurses should:

• Initiate dialogues. This helps develop a trusting relationship between the patient and nurse, which is important in managing the condition.
• Evaluate patient responses. Understanding the patient's responses and behaviours provides the nurse with better insight into the patient's condition.
• Provide guidance and support. The nurse should overlook the planning, implementation and evaluation of strategies to manage the condition.
• Educate the patient and family.This helps in sharing information concerning the condition, and developing proper awareness to prevent future episodes.

Conclusion

Nursing diagnosis risk for urinary retention is a condition where the bladder fails to completely empty, leading to an increase in urinary frequency and urgency, and the risk of serious harm if left unchecked. Nurses must remain vigilant and be aware of risk factors, associated conditions, and suggested interventions to ensure effective management