STROKE CARE PLAN: BLADDER & BOWEL CONTINENCE
All interventions must be monitored, evaluated and documented as per Home policy
Any changes (improvements or deterioration) must be reported to the RN/RPN
FOCUS
GOAL(S)
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.
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.
Registered
staff/PSW/HCA
Maintain a voiding diary.
PSW/HCA
Resident’s score on
ADL Short Form
decreases from ___
to ____.
Resident’s score on
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
PSW/HCA
Observe for skin breakdown around perineal
area and report to registered staff.
PSW/HCA
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.
PSW/HCA
Resident will
demonstrate less
incontinence as
measured on the
improved bladder
incontinence quality
indicator.
TIMELINES INTERVENTIONS
ACCOUNTABILITY
Page 1 of 5
STROKE CARE PLAN: BLADDER & BOWEL CONTINENCE
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 )___.
Set bladder retraining schedule.
Registered Staff
Follow bladder retraining protocol by
prompting resident to urinate as scheduled,
reminding resident to practice pelvic floor
exercises.
PSW/HCA
Check that all assistive devices and
equipment are in place and secure before
toileting (specify the assistive devices
required)
PSW/HCA
Provide positive feedback throughout the
process and provide cueing / assistance as
required.
PSW/HCA
Educate resident/family on urinary
incontinence and interventions.
PSW/HCA/Registered
Staff
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.
PSW/HCA
Position resident on bedpan with head of bed
raised as upright as possible.
PSW/HCA
Orient resident to location of toilet, commode,
bedpan, urinal.
PSW/HCA
Keep path to bathroom clear of any obstacles
and that is lighted at night.
PSW/HCA
Assist resident to adhere to toileting schedule
through prompting and/or assistance with
mobility and clothing.
PSW/HCA
Page 2 of 5
STROKE CARE PLAN: BLADDER & BOWEL CONTINENCE
Urinary retention related to loss
of urge to urinate due to stroke
Risk of urinary tract infection
related to indwelling catheter due
to stroke.
Resident will not
experience urinary
retention.
Resident will not
experience any
urinary tract
infections.
Ensure that all assistive devices and
equipment are in place and secure before
toileting (specify the assistive devices
required)
PSW/HCA
Educate resident/family on urinary
incontinence and interventions.
PSW/HCA/Registered
Staff
Assess for full bladder and contact physician
as necessary.
Registered Staff
Reassessment of medications that may
contribute to urinary retention.
Registered Staff
Report to registered staff if resident unable to
pass urine for 4 hours (excluding nighttime),
has fever, complains of lower back or
abdominal pain.
PSW/HCA
Educate resident/family on urinary retention
and interventions.
PSW/HCA/Registered
Staff
Offer resident drinks 6 to 8 cups of fluid per
day. Limit caffeinated drinks to 2 cups/day.
PSW/HCA/Dietary
Offer cranberry juice.
PSW/HCA
Check that drainage bag is positioned below
level of bladder.
PSW/HCA
Position catheter tubing so it does not kink or
pull on catheter.
PSW/HCA
Secure catheter tubing to resident’s leg.
PSW/HCA
Page 3 of 5
STROKE CARE PLAN: BLADDER & BOWEL CONTINENCE
Constipation related to
weakened rectal muscles due to
stroke.
Resident will not
experience
constipation.
Empty urinary drainage bag every 8 hours.
PSW/HCA
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.
PSW/HCA
Educate resident/family on urinary tract
infection and interventions.
PSW/HCA/Registered
Staff
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.
PSW/HCA
Maintain a record of all bowel movements.
PSW/HCA
Maintain a record of diet and fluid intake.
PSW/HCA
Observe for skin breakdown around perineal
and rectal area and report to registered staff.
PSW/HCA
Assist resident to participate in activities that
are of interest.
PSW/HCA
Adjust diet to reduce or treat constipation.
Dietary
Document a routine toileting schedule.
Registered Staff
Assist resident to adhere to toileting schedule
through prompting and/or assistance with
mobility and clothing.
PSW/HCA
Page 4 of 5
STROKE CARE PLAN: BLADDER & BOWEL CONTINENCE
Position the individual on
toilet/commode/bedpan in position that will
help with toileting.
PSW/HCA
Educate resident/family on constipation and
interventions.
PSW/HCA/Registered
Staff
Page 5 of 5