Toileting self-care deficit

Domain 4. Activity-rest
Class 5. Self-care
Diagnostic Code: 00110
Nanda label: Toileting self-care deficit
Diagnostic focus: Toileting self-care

Toileting self-care deficit is one of the many NANDA nursing diagnoses (Nursing Diagnostic Terminology or NDT). This diagnosis consists of both physical and psychosocial deficits that impede an individual’s capacity to toilet themselves effectively. The individual may need help with basic activities typically associated with toileting such as dressing, hygiene maintenance, and even urinating and defecating. Factors such as underlying medical conditions, environmental conditions, and even cognitive abilities can affect how effective an individual is when it comes to toileting self-care.

NANDA Nursing Diagnosis Definition

According to NANDA, Toileting self-care deficit is defined as “an impairment in an individual’s ability to perform activities related to the management of his or her elimination needs”. Impairment may include decreased mobility and/or sensation, muscle weakness, cognitive impairments, and/or mental health issues.

Defining Characteristics

Subjective

• Expresses lack of confidence in performing elimination management activities
• Verbalizes difficulty completing toileting activities
• Reports difficulty or inability to transfer or move independently, or to initiate toileting activities
• Indicates limited verbal, cognitive, and physical skills required for toileting activities

Objective

• Demonstrates limited physical range of motion, strength and coordination, visual skills, fine motor skills, communication and problem-solving skills
• Needs assistance with dressing, bathing, and using the toilet or commode
• Requires use of adaptive equipment or assistance with toileting
• Behaviors indicate anxiety and confusion about toileting

Related Factors

The Toileting self-care deficit can be due to factors such as underlying medical conditions, environmental conditions, and cognitive abilities. Examples of underlying medical conditions that may lead to toileting self-care deficit include diseases such as multiple sclerosis (MS) and Parkinson’s, stroke, arthritis, and spinal cord injuries, among others. Environmental factors such as lack of have toileting supplies, inadequate lighting, overcrowding, noise, and inaccessible facilities can also lead to deficits in toileting self-care. Cognitive abilities, including limited perceptual motor and cognition, language difficulties, as well as psychiatric and behavioral disturbances may also impair toileting self-care.

Associated Conditions

Some possible associated conditions of Toileting self-care deficit include increased risk for falls, skin breakdown, muscle contracture, fluid volume alteration, and urinary tract infections.

Suggestions of Use

The diagnosis of toileting self-care deficit can be used in a variety of nursing practice settings. This can include home health care, long term care, and acute care. The diagnosis can also be useful when planning and providing patient care, evaluating the progress of treatment, or formulating discharge plans.

Suggested Alternative NANDA Nursing Diagnoses

Toileting self-care deficit is similar to other related diagnoses and may require similar interventions. For example, impaired Physical Mobility and deficient Diversional Activity are related diagnoses that may require similar interventions. In addition, activity intolerance, sensory perception disturbances, and self-care deficit are other related diagnoses that may benefit from similar Interventions.

Usage Tips

This diagnosis should not be used when the cause of the Toileting self-care deficit is unknown. It should also not be used in isolation, as the diagnosis may require multiple interventions.

NOC Outcomes

When treated appropriately, Toileting self-care deficit has the potential to improve the following outcomes:

• Activities of Daily Living: Ability to perform activities necessary for daily living such as bathing, grooming and dressing.
• Continence Management: Control and management of bladder and bowel functions.
• Elimination Management: Effective use of resources to meet elimination needs.
• Musculoskeletal Mobility: Ability to move about without physical limitation or pain.

Explanation

• Activities of Daily Living: This outcome evaluates the patient’s ability to independently perform everyday activities such as bathing, grooming and dressing, which can all be helped by maintaining toileting self-care.
• Continence Management: When a patient is able to spontaneously and effectively manage their bladder and bowel functions, they may require less assistance with toileting activities.
• Elimination Management: Maintaining good toileting self-care allows the patient to utilize resources to meet their elimination needs, allowing them to be as independent as possible.
• Musculoskeletal Mobility: Having independence with toileting can help maintain good musculoskeletal mobility, by reducing the risk of muscle contractures and falls.

Evaluation Objectives and Criteria

Treatment goals and objectives when dealing with Toileting self-care deficit include improved self-care, improved bladder and bowel skills, improved musculoskeletal mobility, and reduced risk of complications. Evaluation criteria may include the patient’s ability to determine and plan toilet activities, demonstrate proper toileting technique, and apply toileting skills in daily activities and situations.

NIC Interventions

Interventions for Toileting self-care deficit may include:

• Patient Assessment: Evaluate and monitor patient’s elimination elimination needs.
• Instructional Training: Educate patient and/or family members on appropriate toileting practices.
• Therapeutic Techniques: Implement therapeutic techniques such as bladder training, bowel control exercises and bowel evacuation methods.
• Activities of Daily Living: Assist patient with activities necessary for cleaning and dressing after toileting.
• Environmental Management: Analyze and modify environment to maximize safety, comfort, and privacy.
• Nutritional Modification: Modify diet to reduce constipation.

Explanation

• Patient Assessment: Monitor patient’s elimination needs to identify the exact toileting needs, evaluate patient’s abilities, and assess the environment.
• Instructional Training: Teach patient and/or family about correct toileting practices, modifications of toileting, and use of adaptive equipment.
• Therapeutic Techniques: Promote bladder and bowel control through beneficial therapeutic techniques such as bladder retraining, bowel control exercises, and bowel evacuation methods.
• Activities of Daily Living: Assisting patient in self- management activities of dressing and cleaning.
• Environmental Management: Review and modify environment as necessary to ensure safety, privacy, and comfort.
• Nutritional Modification: Adjusting nutritional intake to reduce constipation and other potential elimination problems.

Nursing Activities

Nursing activities for this diagnosis can include health promotion and illness prevention. Examples may include providing safety education to the patient and family, assessing toileting needs and abilities, suggesting assistive devices and techniques, and discussing changes in dietary needs such as limiting excess fluids and adjusting dietary fiber to prevent constipation.

Conclusion

Toileting self-care deficit is a common nursing diagnosis with potential physical, social and mental health implications. The diagnosis requires interventions to ensure optimal elimination and mobility. Education, monitoring, and environmental and nutritional modifications are essential to improving and maintaining toileting self-care and reducing risks for complications such as falls, skin breakdown, and infection.

FAQs

1. What is Toileting Self-Care Deficit?
2. What are the possible associated conditions with Toileting Self-Care Deficit?
3. What are the NOC Outcomes associated with Toileting Self-Care Deficit?
4. What interventions can be used for Toileting Self-Care Deficit?
5. What are the nursing activities to be undertaken when diagnosing Toileting Self-Care Deficit?

Answers

1. Toileting Self-Care Deficit is an impairment in an individual’s ability to perform activities related to the management of their elimination needs.
2. Associated conditions with Toileting Self-Care Deficit include increased risk for falls, skin breakdown, muscle contracture, fluid volume alteration, and urinary tract infections.
3. NOC Outcomes associated with Toileting Self-Care Deficit include activities of daily living, continence management, elimination management, and musculoskeletal mobility.
4. Interventions for Toileting Self-Care Deficit may include patient assessment, instructional training, therapeutic techniques, activities of daily living, environmental management, and nutritional modification.
5. Nursing activities to be undertaken when diagnosing Toileting Self-Care Deficit can include health promotion and illness prevention such as providing safety education to the patient and family, assessing toileting needs and abilities, suggesting assistive devices and techniques, and discussing changes in dietary needs.