Renal/Urinary Interventions – Stroke Nursing Care in Med-Surg

00:01 Now let's take a look at the renal and urinary systems.

00:04 Now, our goal here is to promote normal bladder function and the safest, highest level of patient independence.

00:10 This is a very personal function, right? Everyone wants to be able to go to the bathroom by themselves.

00:17 It's an activity we like to do alone.

00:19 So, this can be very touchy for your patients. You need to remain as calm and neutral in your appearance as possible, because some patients are going to have poor bladder control in the acute phase of stroke.

00:31 You always act like it is no big deal.

00:34 For an adult patient to wet their bed or to have an accident in their bed is humiliating.

00:40 You always remind them, "It's not a big deal. We're going to help retrain that bladder.

00:45 Just let me get you cleaned up, so you feel better," and move on.

00:49 Now, we're going to try to avoid the use of an indwelling catheter.

00:53 We want to get rid of it as soon as possible.

00:55 An indwelling urinary catheter is inserted in the urethra into the bladder to drain the urine.

01:02 The problem is it really puts your patient at risk for infection.

01:05 That's like an escalator for bacteria to climb right on up into your patient's body in a very personal spot.

01:12 So, we try to not use those unless absolutely possible.

01:16 We use silver-coated catheters.

01:18 And if you do have to use it, we get rid of them.

01:21 So, at this point, Mr. Johnson should not have one of those.

01:25 And last and almost more important , our job is to support and facilitate normal bladder function, okay? That's what our role is. Everything else falls under that category.

01:35 So, we downplay any accidents the patient might have, and we let them know, "Hey, we're just going to help this get better with bladder retraining.

01:44 It's no problem. It's very common that patients go through this, so I'm here to help you reestablish this normal body habit." So let's practice with Mr. Johnson.

01:54 Bladder retraining and bladder ultrasound are 2 powerful tools in the process of helping him restore normal function.

02:02 Now, the points of bladder retraining are kind of similar to bowel retraining.

02:06 It has to be consistent.

02:08 You're not going to want him to drink a lot of fluids right before he goes to bed, just like when we're potty training a toddler.

02:15 Wouldn't use those terms with a patient, but it'll help you understand kind of what we're doing.

02:19 So we don't have a lot of fluids right before he goes to bed for obvious reasons, but we do want him to stay well hydrated during the day.

02:27 We're going to offer him frequent opportunities, at least every 2 hours to go to the bathroom to try to empty his bladder.

02:36 Now the idea is to walk Mr. Johnson to the bathroom and make sure he's safe, and while he's trying to empty his bladder.

02:43 It's better than having him stand at the bedside and use a urinal.

02:47 Now we can do that, but see you want to, kind of, multitask when it comes to him being mobile.

02:52 Having an excuse to have him take more steps and to walk is a great opportunity to keep him mobile.

02:58 So, watch fluids in the evening. Try and limit those.

03:03 You want to make sure that he stays normally hydrated, not overhydrated or under hydrated.

03:09 And we offer him the restroom at least every 2 hours throughout the day.

03:14 Now, bladder ultrasound. This is super cool because you can do it at the bedside.

03:18 Sometimes, particularly gentlemen, have a hard time knowing if they really need to go to the bathroom.

03:26 Now, if they're an older gentleman, they might have pressure from a prostate gland that's getting a little big.

03:31 So what this can tell us is how well he's emptying his bladder and if he needs to empty his bladder.

03:37 So we can use a bladder ultrasound after he's emptied his bladder to see if he had any residual leftover or if he's able to empty it completely.

03:45 We can also do a bladder ultrasound and see how much volume he has in his bladder.

03:50 So, nurses can do it at the bedside. It's not a special test.

03:54 Sometimes it is a trick to try to find the bladder ultrasound wherever it is on your floor.

03:59 But once you locate it and can get it into your patient's room, it gives you great information about how much volume of urine is actually in the bladder.

04:08 2 times we use that is before he goes to the restroom, and after using the restroom, so we can see how efficiently and mark our progress in how we're doing at bladder retraining.