A 68-yr-old patient admitted to the hospital with dehydration is confused and incontinent of urine. Which nursing action should be included in the plan of care?

A. Fleet enema: Fleet enemas contain phosphate, which can be absorbed systemically and worsen hyperphosphatemia in patients with impaired kidney function. For a patient with elevated BUN and creatinine, indicating possible renal impairment, phosphate-based enemas increase the risk of electrolyte imbalance and should be questioned.

B. Sennandocusate (Senokot-S): This stool softener and stimulant combination works by drawing water into the bowel and softening stools. It does not contain phosphate or other nephrotoxic substances, making it generally safe for patients with renal impairment.

C. Tap-water enema: Tap-water enemas are non-phosphate-based and generally safe for patients with impaired kidney function. They help evacuate the bowel without introducing substances that could exacerbate electrolyte disturbances.

D. Bisacodyl (Dulcolax) tablets: Bisacodyl is a stimulant laxative taken orally, which acts locally on the colon. It does not contain phosphate and does not pose significant risk to patients with elevated BUN or creatinine, making it an acceptable bowel preparation.

A. Reflex incontinence: Reflex incontinence occurs when the bladder empties without the sensation of the need to void, often related to neurologic impairment such as spinal cord injury. It is not associated with a distended bladder or continuous small leakage of urine.

B. Urge incontinence: Urge incontinence involves a sudden, strong need to urinate followed by involuntary bladder emptying. It is caused by detrusor overactivity and is not characterized by a consistently distended bladder or constant small leakage.

C. Stress incontinence: Stress incontinence is the leakage of urine with activities that increase intra-abdominal pressure, such as coughing, sneezing, or lifting. It does not usually involve bladder distension or continuous dribbling of urine.

D. Overflow incontinence: Overflow incontinence occurs when the bladder is overdistended and cannot empty completely, leading to constant dribbling of urine. The presence of a distended, palpable bladder and continuous leakage of small amounts is consistent with this type of incontinence.