FOCUS GOAL(S) TIMELINES INTERVENTIONS ACCOUNTABILITY
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. Resident will not experience any urinary tract infections.
Resident’s score on ADL Short Form decreases from ___ to ____.
Resident’s score on Self-Performance Hierarchy Scale will decrease from ___ to )___. Resident will demonstrate less incontinence as measured on the improved bladder incontinence quality indicator.
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.
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; foul-smelling 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.
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 staff/PSW/HCA PSW/HCA PSW/HCA PSW/HCA PSW/HCA Registered Staff
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.
PSW/HCA
PSW/HCA
PSW/HCA
PSW/HCA/Registered Staff
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. Resident’s score on ADL Short Form decreases from ___ to ____.
Resident’s score on 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.
PSW/HCA
PSW/HCA
PSW/HCA
PSW/HCA
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.
PSW/HCA
PSW/HCA/Registered Staff
Urinary retention related to loss of urge to urinate due to stroke
Resident will not experience urinary retention.
Assess for full bladder and contact physician as necessary.
Reassessment of medications that may contribute to urinary retention.
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 Staff Registered Staff PSW/HCA PSW/HCA/Registered Staff
Risk of urinary tract infection related to indwelling catheter due to stroke.
Resident will not 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.
Check that drainage bag is positioned below level of bladder.
Position catheter tubing so it does not kink or pull on catheter.
PSW/HCA/Dietary
PSW/HCA PSW/HCA
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; foul-smelling drainage around catheter; urine leakage around catheter; fever, chills, shaking, delirium or confusion.
Educate resident/family on urinary tract infection and interventions.
PSW/HCA PSW/HCA PSW/HCA PSW/HCA/Registered Staff Constipation related to
weakened rectal muscles due to stroke.
Resident will not 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. PSW/HCA PSW/HCA PSW/HCA PSW/HCA PSW/HCA Dietary
Document a routine toileting schedule. Assist resident to adhere to toileting schedule through prompting and/or assistance with mobility and clothing.
Position the individual on
toilet/commode/bedpan in position that will help with toileting.
Educate resident/family on constipation and interventions. Registered Staff PSW/HCA PSW/HCA PSW/HCA/Registered Staff
