STROKE CARE PLAN: BLADDER & BOWEL CONTINENCE

Transcription

1 Urinary incontinence related to loss of ability to identify and respond to need to urinate; involuntary bladder contractions, increased nightly urine production, difficulty communication need to urinate due to stroke. Resident will reduce episodes of incontinence from to per day. experience any urinary tract infections. Observe, document and report signs of urinary incontinence including dribbling or loss of large amount of urine, sudden urges to urinate, urinating more than 8 times/day or 2 times/night, weak or interrupted urine stream frequent urinary tract infections. Maintain a voiding diary. Registered staff/ ADL Short Form decreases from to. Self-Performance Hierarchy Scale will decrease from to ). Report any change in output in a 4-hour period; pain in abdomen, pelvis or at catheter insertion site; restlessness or agitation; change in colour of urine; blood in urine; foulsmelling drainage around catheter; urine leakage around catheter; fever, chills, shaking, delirium or confusion Observe for skin breakdown around perineal area and report to registered staff. Resident will demonstrate less incontinence as measured on the improved bladder incontinence quality indicator. Support prompted voiding by asking resident if they would like to use toilet at regular intervals, watching for behaviour that shows a need to urinate, distract resident between voiding times to encourage bladder control, report incontinence to registered staff and provide positive feedback when resident stays dry and uses toilet. Set bladder retraining schedule. Registered Page 1 of 5

2 Follow bladder retraining protocol by prompting resident to urinate as scheduled, reminding resident to practice pelvic floor exercises. Check that all assistive devices and equipment are in place and secure before toileting (specify the assistive devices required) Provide positive feedback throughout the process and provide cueing / assistance as required. Educate resident/family on urinary incontinence and interventions. /Registered Urinary incontinence related to vision problems (cannot find way to bathroom), decreased mobility (cannot get to bathroom independently or quickly enough), decreased motor coordination (cannot mange clothing, briefs, transfers or toilet) due to stroke. Resident will reduce episodes of incontinence from to per day. ADL Short Form decreases from to. Self-Performance Hierarchy Scale will decrease from to ). Position the individual on toilet/commode in position that will help with toileting. Have resident sit leaning forward with feet flat on floor or on stool. Position resident on bedpan with head of bed raised as upright as possible. Orient resident to location of toilet, commode, bedpan, urinal. Keep path to bathroom clear of any obstacles and that is lighted at night. Assist resident to adhere to toileting schedule through prompting and/or assistance with mobility and clothing. Page 2 of 5

3 Ensure that all assistive devices and equipment are in place and secure before toileting (specify the assistive devices required) Educate resident/family on urinary incontinence and interventions. /Registered Urinary retention related to loss of urge to urinate due to stroke experience urinary retention. Assess for full bladder and contact physician as necessary. Reassessment of medications that may contribute to urinary retention. Registered Registered Report to registered staff if resident unable to pass urine for 4 hours (excluding nighttime), has fever, complains of lower back or abdominal pain. Educate resident/family on urinary retention and interventions. /Registered Risk of urinary tract infection related to indwelling catheter due to stroke. experience any urinary tract infections. Offer resident drinks 6 to 8 cups of fluid per day. Limit caffeinated drinks to 2 cups/day. Offer cranberry juice. /Dietary Check that drainage bag is positioned below level of bladder. Position catheter tubing so it does not kink or pull on catheter. Page 3 of 5

4 Secure catheter tubing to resident s leg. Empty urinary drainage bag every 8 hours. Report any change in output in a 4 hour period; pain in abdomen, pelvis or at catheter insertion site; restlessness or agitation; change in colour of urine; blood in urine; foulsmelling drainage around catheter; urine leakage around catheter; fever, chills, shaking, delirium or confusion. Educate resident/family on urinary tract infection and interventions. /Registered Constipation related to weakened rectal muscles due to stroke. experience constipation. Observe document and report signs of bowel problems such as constipation, abdominal pain, rectal bleeding, liquid stools, constant straining with bowel movements, fever, weight loss or no bowel movement in at least 3 days. Maintain a record of all bowel movements. Maintain a record of diet and fluid intake. Observe for skin breakdown around perineal and rectal area and report to registered staff. Assist resident to participate in physical activities that are of interest. Adjust diet to reduce or treat constipation. Dietary Page 4 of 5

5 Document a routine toileting schedule. Assist resident to adhere to toileting schedule through prompting and/or assistance with mobility and clothing. Registered Position the individual on toilet/commode/bedpan in position that will help with toileting. Educate resident/family on constipation and interventions. /Registered Page 5 of 5