Now let's take a look at the renal
and urinary systems.
Now, our goal here is to promote normal
bladder function and the safest,
highest level of patient independence.
This is a very personal function, right?
Everyone wants to be able to go
to the bathroom by themselves.
It's an activity we like to do alone.
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.
You always act like it is no big deal.
For an adult patient to wet their bed
or to have an accident in their
bed is humiliating.
You always remind them, "It's not a big deal.
We're going to help retrain that bladder.
Just let me get you cleaned up, so you
feel better," and move on.
Now, we're going to try to avoid the
use of an indwelling catheter.
We want to get rid of it as
soon as possible.
An indwelling urinary catheter is
inserted in the urethra into the
bladder to drain the urine.
The problem is it really puts your
patient at risk for infection.
That's like an escalator for bacteria to
climb right on up into your patient's
body in a very personal spot.
So, we try to not use those unless
We use silver-coated catheters.
And if you do have to use it,
we get rid of them.
So, at this point, Mr. Johnson should
not have one of those.
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.
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.
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.
Bladder retraining and bladder ultrasound
are 2 powerful tools
in the process of helping him
restore normal function.
Now, the points of bladder retraining
are kind of similar to bowel retraining.
It has to be consistent.
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.
Wouldn't use those terms with a patient,
but it'll help you understand
kind of what we're doing.
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.
We're going to offer him
at least every 2 hours
to go to the bathroom to
try to empty his bladder.
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.
It's better than having him stand at
the bedside and use a urinal.
Now we can do that, but see you want to,
kind of, multitask when it comes
to him being mobile.
Having an excuse to have him
take more steps and to walk
is a great opportunity to keep him mobile.
So, watch fluids in the evening.
Try and limit those.
You want to make sure that he stays
normally hydrated, not overhydrated
or under hydrated.
And we offer him the restroom at least
every 2 hours throughout the day.
Now, bladder ultrasound. This is super
cool because you can do it at the bedside.
Sometimes, particularly gentlemen,
have a hard time knowing if they really
need to go to the bathroom.
Now, if they're an older gentleman,
they might have
pressure from a prostate gland
that's getting a little big.
So what this can tell us
is how well he's emptying his bladder
and if he needs to empty his bladder.
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.
We can also do a bladder ultrasound
and see how much volume
he has in his bladder.
So, nurses can do it at the bedside.
It's not a special test.
Sometimes it is a trick to try to
find the bladder ultrasound
wherever it is on your floor.
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.
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.