A client is frustrated and embarrassed by urinary incontinence. Which of the following measures should Nurse Ginny include in a bladder retraining program?
A. Establishing a predetermined fluid intake pattern for the client.
B. Encouraging the client to increase the time between voidings.
C. Restricting fluid intake to reduce the need to void.
D. Assessing present elimination patterns.
Correct Answer: D. Assessing present elimination patterns
The guidelines for initiating bladder retraining include assessing the client’s intake patterns, voiding patterns, and reasons for each accidental voiding. Bladder training is an important form of behavior therapy that can be effective in treating urinary incontinence. The goals are to increase the amount of time between emptying the bladder and the amount of fluids the bladder can hold. It also can diminish leakage and the sense of urgency associated with the problem.
Option A: Lowering the client’s fluid intake won’t reduce or prevent incontinence. The recommended amount of fluids consumed (all types) in 24 hours totals 6-8 glasses. The benefits of adequate fluid intake include prevention of dehydration, constipation, UTI, and kidney stone formation.
Option B: A voiding schedule should be established after assessment. Bladder training requires following a fixed voiding schedule, whether or not the client feels the urge to urinate. If he feels an urge to urinate before the assigned interval, he should use urge suppression techniques — such as relaxation and Kegel exercises.
Option C: The client should actually be encouraged to drink 1.5 to 2 L of water per day. Keeping a diary of the bladder activity is very important. This helps the health care provider determine the correct place to start the training and to monitor the progress throughout the program.
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