An alert and oriented female client in early hospice care is experiencing urinary incontinence. Which is the most appropriate initial intervention for this client?
A) Teach pelvic floor muscle strengthening exercises
B) Establish a voiding schedule
C) Limit all fluid intake
D) Place diapers on the client
B) Establish a voiding schedule
Explanation: A) While pelvic floor muscle strengthening exercises have been demonstrated as effective for stress incontinence in other patient populations, hospice and palliative care patients may be unable to perform these exercises.
B) Urinary incontinence in terminally ill patients can be treated with behavioral methods; one approach is to establish a voiding schedule for patients who can tolerate movement using a bedpan, bedside commode, or toilet.
C) Patients may find that limiting intake of beverages with a diuretic effect, such as those containing caffeine, throughout the day and minimizing fluid intake before bedtime improve symptoms. However, reducing all fluid intake can result in dehydration.
D) While the use of diapers may be used to keep skin clean and dry, it is not the initial intervention in a client who is alert and oriented. The use of a voiding schedule should be used first.
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