Urinary Retention Nursing Diagnosis & Care Plan – devshopsimplenursing

Urinary Retention Nursing Diagnosis & Care Plan

Amanda Thomas Headshot
By Amanda Thomas
Updated On May 2025
Medically Reviewed by:
Angela Slater FNP, RN
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When the bladder’s full but nothing’s coming out, it’s more than just annoying. 

It’s a clinical red flag.

Urinary retention can creep in slowly or hit all at once, causing major discomfort and setting the stage for serious complications like urinary tract infections (UTIs) or bladder damage. That’s why nurses need to know the signs, the causes, and most importantly — the nursing interventions for urinary retention that work.

What is Urinary Retention?

Urinary retention is a patient’s inability to completely or partially empty the bladder. 

It can be acute (sudden onset) or chronic (gradual onset). Acute urinary retention is a medical emergency, while chronic retention may be asymptomatic but lead to bladder dysfunction over time. 

Causes include:

  • Obstruction (e.g., enlarged prostate, urethral stricture)
  • Neurological disorders (e.g., spinal cord injury)
  • Medication side effects

Signs and Symptoms of Urinary Retention

Nursing interventions for urinary retention begin with understanding the signs. 

Look for:

  • Inability to void
  • Suprapubic discomfort or pain
  • Distended bladder 
  • Frequent, small amounts of urination
  • Weak or interrupted urinary stream
  • Dribbling of urine
  • Increased post-void residual (PVR) volume
  • Lower abdominal pressure

Nursing Process for Urinary Retention

The nursing process includes a comprehensive assessment to:

  • Identify underlying causes.
  • Determine a diagnosis based on symptoms and patient history.
  • Planning interventions to relieve retention.
  • Implementing care strategies.
  • Evaluating patient outcomes.

Urinary Retention Nursing Assessment

Before any intervention, observation leads the way. 

A thorough assessment uncovers the root of urinary retention and guides next steps — from identifying physical barriers to spotting red flags like infection or medication side effects. Each data point adds clarity to the bigger picture.

  • Assess for urinary frequency, urgency, and volume.
  • Palpate the bladder for distention.
  • Perform a bladder scan to assess residual volume.
  • Obtain a detailed medical and surgical history.
  • Monitor input and output accurately.
  • Assess for signs of infection (fever or dysuria).
  • Evaluate the patient’s mobility and ability to access the toilet.
  • Review medications that may contribute to retention (e.g., anticholinergics).

Urinary Retention Nursing Diagnosis

Some common nursing diagnoses associated with urinary retention include:

  • Urinary retention related to mechanical obstruction or impaired detrusor muscle function
  • Acute pain related to bladder distension
  • Risk for infection related to stasis of urine

Nursing Interventions for Urinary Retention

These interventions help relieve symptoms and prevent complications:

  • Monitor urinary output and PVRs.
  • Use a bladder scan to assess for incomplete emptying.
  • Encourage timed voiding and double voiding techniques.
  • Provide privacy and ensure a comfortable environment for voiding.
  • Educate on potential causes and lifestyle modifications.
  • Administer prescribed medications (e.g., alpha-blockers).
  • Perform intermittent catheterization if indicated.
  • Encourage fluid intake to maintain hydration.

Nursing Goals and Expected Outcomes for Urinary Retention

Setting clear goals and establishing expected outcomes helps nurses evaluate if interventions are working. 

These benchmarks guide care decisions and highlight progress over time.

  • Patient will void within an acceptable volume and frequency
  • Patient will report relief from pain or discomfort associated with bladder fullness
  • Patient will demonstrate proper techniques to facilitate urination
  • Patient will remain free from urinary tract infections

Nursing Care Plans for Urinary Retention

After completing the assessment and setting goals, the next step is putting those insights into motion. 

The following care plans provide real-world strategies for applying nursing interventions for urinary retention in different clinical scenarios.

Care Plan #1

Diagnostic Statement

Urinary Retention related to bladder outlet obstruction secondary to benign prostatic hyperplasia as evidenced by difficulty initiating urination and increased PVR volume.

Expected Outcomes

  • Patient will demonstrate effective voiding without discomfort
  • PVR volume will be less than 50 milliliters
  • Patient will verbalize understanding of bladder management strategies

Assessment

  • Monitor for bladder distension and perform bladder scans.
  • Assess for signs of urinary tract infection.
  • Monitor intake and output, noting the frequency and volume of urination.
  • Evaluate benign prostatic hyperplasia’s on urinary function.

Interventions

  • Encourage fluid intake of two to three liters per day unless contraindicated.
  • Teach double voiding techniques to ensure bladder emptying.
  • Administer alpha-blockers as prescribed to relieve urinary obstruction.
  • Educate on avoiding caffeine and alcohol, which may exacerbate symptoms.
  • Monitor for signs of acute urinary retention and intervene promptly.

Care Plan #2

Diagnostic Statement

Acute pain related to bladder distension, as evidenced by complaints of suprapubic pain and restlessness

Expected Outcomes

  • Patient will verbalize reduced pain levels within 30 minutes of intervention
  • Patient will exhibit relaxed posture and reduced agitation
  • Patient will demonstrate understanding of pain management techniques

Assessment

  • Assess pain characteristics (location, intensity, duration)
  • Monitor bladder fullness through palpation and bladder scanning
  • Evaluate the effectiveness of pain relief measures

Interventions

  • Provide non-pharmacological interventions (warm compresses to the lower abdomen).
  • Administer prescribed analgesics if indicated.
  • Facilitate bladder emptying through intermittent catheterization if necessary.
  • Educate on relaxation techniques to reduce discomfort.
  • Monitor for worsening symptoms, which may indicate acute retention.

Care Plan #3

Diagnostic Statement

Risk for infection related to urinary stasis

Expected Outcomes

  • Patient will remain free from symptoms and signs of urinary tract infection
  • Patient will demonstrate proper perineal and catheter care
  • Patient will verbalize understanding of infection prevention techniques

Assessment

  • Monitor the patient for signs of infection: fever, cloudy urine, foul odor.
  • Regularly assess the catheter site for redness, swelling, or discharge.
  • Monitor urinalysis results for signs of infection.

Interventions

  • Perform catheter care according to protocol.
  • Educate on perineal hygiene to prevent contamination.
  • Encourage increased fluid intake to flush the urinary tract.
  • Monitor for early signs of infection and report any abnormalities.
  • Use sterile technique during catheter insertion and maintenance.

Preventing Urinary Retention Recurrence

Effective nursing interventions for urinary retention also include strategies to prevent future episodes.

  • Educate the patient on bladder training and scheduled voiding.
  • Teach patients the importance of regular physical activity to support bladder function.
  • Encourage adherence to the prescribed medication regimen.
  • Educate on dietary modifications to reduce bladder irritants.
  • Instruct on pelvic floor exercises to strengthen bladder control.

Patient Education and Discharge Planning

Before discharge, reinforce essential self-care techniques and follow-up plans.

  • Educate the patient on recognizing symptoms of urinary retention and when to seek help.
  • Provide information on lifestyle modifications (fluid management and avoiding bladder irritants).
  • Emphasize the importance of follow-up appointments and bladder health monitoring.
  • Provide resources for managing chronic urinary retention.

Mastering Retention Management as a Nurse

Nursing interventions for urinary retention go beyond catheterization. 

They reflect the ability to assess holistically, act early, and educate patients on lifelong bladder health. With the right urinary retention nursing care plan, nurses can help patients regain control and get back to feeling normal again. 

Looking for more tools to boost confidence and sharpen skills to provide safe, effective, patient-centered care? 

Check out SimpleNursing’s guides on medication administration and head-to-toe assessments.

Recommended Resources on Urinary Retention

Staying informed means knowing where to look. 

These trusted organizations offer evidence-based insights and ongoing education on urinary retention and bladder health.

Nursing Care Plan Resources

References and Sources

  1. American Urological Association. (n.d.). Chronic urinary retention: Clinical consensus statement and quality improvement issue brief. Retrieved April 7, 2025.
  1. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2025). Nursing care plans: Guidelines for individualizing client care across the life span (11th ed.). F.A. Davis Company.
  1. National Association for Continence. (n.d.). Urinary retention. Retrieved April 7, 2025.
  1. National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Treatment of Urinary Retention. U.S. Department of Health and Human Services. Retrieved April 7, 2025.
  1. UpToDate. (n.d.). Acute urinary retention. Retrieved April 7, 2025.
  1. Weiss, B. D. (2018). Diagnostic approach to urinary retention. American Family Physician, 98(8), 496-503. Retrieved April 7, 2025.
  2. a