Bowel, Bladder Continence care plan

STROKE CARE PLAN: BLADDER & BOWEL CONTINENCEAll interventions must be monitored, evaluated and documented as per Home policyAny changes (improvements or deterioration) must be reported to the RN/RPNFOCUS GOAL(S) TIMELINES INTERVENTIONS ACCOUNTABILITYUrinary incontinence related toloss of ability to identify andrespond to need to urinate;involuntary bladder contractions,increased nightly urineproduction, difficultycommunication need to urinatedue to stroke.Resident will reduceepisodes ofincontinence from__ to __ per day.Resident will notexperience anyurinary tractinfections.Observe, document and report signs of urinaryincontinence including dribbling or loss oflarge amount of urine, sudden urges tourinate, urinating more than 8 times/day or 2times/night, weak or interrupted urine streamfrequent urinary tract infections.Maintain a voiding diary.Registeredstaff/PSW/HCAPSW/HCAResident’s score onADL Short Formdecreases from ___to ____.Resident’s score onSelf-PerformanceHierarchy Scale willdecrease from ___to )___.Report any change in output in a 4-hourperiod; pain in abdomen, pelvis or at catheterinsertion site; restlessness or agitation;change in colour of urine; blood in urine; foulsmellingdrainage around catheter; urineleakage around catheter; fever, chills, shaking,delirium or confusionObserve for skin breakdown around perinealarea and report to registered staff.PSW/HCAPSW/HCAResident willdemonstrate lessincontinence asmeasured on theimproved bladderincontinence qualityindicator.Support prompted voiding by asking resident ifthey would like to use toilet at regularintervals, watching for behaviour that shows aneed to urinate, distract resident betweenvoiding times to encourage bladder control,report incontinence to registered staff andprovide positive feedback when resident staysdry and uses toilet.PSW/HCAPage 1 of 5

STROKE CARE PLAN: BLADDER & BOWEL CONTINENCESet bladder retraining schedule.Registered StaffFollow bladder retraining protocol byprompting resident to urinate as scheduled,reminding resident to practice pelvic floorexercises.PSW/HCACheck that all assistive devices andequipment are in place and secure beforetoileting (specify the assistive devicesrequired)PSW/HCAProvide positive feedback throughout theprocess and provide cueing / assistance asrequired.PSW/HCAEducate resident/family on urinaryincontinence and interventions.PSW/HCA/RegisteredStaffUrinary incontinence related tovision problems (cannot find wayto bathroom), decreased mobility(cannot get to bathroomindependently or quicklyenough), decreased motorcoordination (cannot mangeclothing, briefs, transfers or toilet)due to stroke.Resident will reduceepisodes ofincontinence from__ to __ per day.Resident’s score onADL Short Formdecreases from ___to ____.Resident’s score onSelf-PerformanceHierarchy Scale willdecrease from ___to )___.Position the individual on toilet/commode inposition that will help with toileting. Haveresident sit leaning forward with feet flat onfloor or on stool.Position resident on bedpan with head of bedraised as upright as possible.Orient resident to location of toilet, commode,bedpan, urinal.Keep path to bathroom clear of any obstaclesand that is lighted at night.PSW/HCAPSW/HCAPSW/HCAPSW/HCAAssist resident to adhere to toileting schedulethrough prompting and/or assistance withmobility and clothing.PSW/HCAPage 2 of 5

STROKE CARE PLAN: BLADDER & BOWEL CONTINENCEEnsure that all assistive devices andequipment are in place and secure beforetoileting (specify the assistive devicesrequired)PSW/HCAEducate resident/family on urinaryincontinence and interventions.PSW/HCA/RegisteredStaffUrinary retention related to lossof urge to urinate due to strokeResident will notexperience urinaryretention.Assess for full bladder and contact physicianas necessary.Reassessment of medications that maycontribute to urinary retention.Registered StaffRegistered StaffReport to registered staff if resident unable topass urine for 4 hours (excluding nighttime),has fever, complains of lower back orabdominal pain.PSW/HCAEducate resident/family on urinary retentionand interventions.PSW/HCA/RegisteredStaffRisk of urinary tract infectionrelated to indwelling catheter dueto stroke.Resident will notexperience anyurinary tractinfections.Offer resident drinks 6 to 8 cups of fluid perday. Limit caffeinated drinks to 2 cups/day.Offer cranberry juice.PSW/HCA/DietaryPSW/HCACheck that drainage bag is positioned belowlevel of bladder.PSW/HCAPosition catheter tubing so it does not kink orpull on catheter.PSW/HCASecure catheter tubing to resident’s leg.PSW/HCAPage 3 of 5

STROKE CARE PLAN: BLADDER & BOWEL CONTINENCEEmpty urinary drainage bag every 8 hours.PSW/HCAReport any change in output in a 4 hourperiod; pain in abdomen, pelvis or at catheterinsertion site; restlessness or agitation;change in colour of urine; blood in urine; foulsmellingdrainage around catheter; urineleakage around catheter; fever, chills, shaking,delirium or confusion.PSW/HCAEducate resident/family on urinary tractinfection and interventions.PSW/HCA/RegisteredStaffConstipation related toweakened rectal muscles due tostroke.Resident will notexperienceconstipation.Observe document and report signs of bowelproblems such as constipation, abdominalpain, rectal bleeding, liquid stools, constantstraining with bowel movements, fever, weightloss or no bowel movement in at least 3 days.PSW/HCAMaintain a record of all bowel movements.PSW/HCAMaintain a record of diet and fluid intake.PSW/HCAObserve for skin breakdown around perinealand rectal area and report to registered staff.PSW/HCAAssist resident to participate in physicalactivities that are of interest.PSW/HCAAdjust diet to reduce or treat constipation.DietaryDocument a routine toileting schedule.Registered StaffAssist resident to adhere to toileting schedulethrough prompting and/or assistance withmobility and clothing.PSW/HCAPage 4 of 5

STROKE CARE PLAN: BLADDER & BOWEL CONTINENCEPosition the individual ontoilet/commode/bedpan in position that willhelp with toileting.Educate resident/family on constipation andinterventions.PSW/HCAPSW/HCA/RegisteredStaffPage 5 of 5