Nursing Care for Urinary and Bowel Management

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Questions and Answers

Which of the following is NOT a usual manifestation in patients with urinary and bowel elimination issues after a stroke?

Increased urination frequency

Constipation

Fecal impaction

Severe dehydration (correct)

What nursing intervention is primarily aimed at improving bladder function in stroke patients?

Limit patient mobility

Increase fluid intake to 3000 mL/day

Discourage Kegel exercises

Conduct bladder training (correct)

Why is it important to maintain an upright position for bowel elimination?

It prevents drooling.

It promotes normal bowel elimination. (correct)

It allows for faster digestion.

It reduces urinary frequency.

What role does fiber play in bowel elimination for stroke patients?

It stimulates intestinal motility. Signup and view all the answers

Which of the following actions would be least beneficial for promoting urinary elimination?

Reducing fluid intake Signup and view all the answers

What should be monitored to ensure safety and prevent complications in patients experiencing dysphagia?

Swallowing ability Signup and view all the answers

Which nursing intervention can help prevent constipation in stroke patients?

Administering prescribed stool softeners Signup and view all the answers

Which patient behavior can be reinforced to improve urinary management?

Using the call light for assistance Signup and view all the answers

Which position should the patient be in to minimize the risk of aspiration during eating?

Sitting upright with the neck slightly flexed Signup and view all the answers

What intervention is essential to ensure safety while a patient is eating?

Minimizing distractions during the meal Signup and view all the answers

Which of the following should be monitored for signs of aspiration during meals?

Patient's lung sounds Signup and view all the answers

In which manner should food be placed in the mouth to enhance swallowing for a patient?

In the unaffected side behind the front teeth Signup and view all the answers

What is a critical evaluation metric for a patient in the acute phase after a stroke?

The patient's participation in assigned therapies Signup and view all the answers

Which of the following interventions is necessary to protect a patient from choking while eating?

Having suction equipment available at the bedside Signup and view all the answers

What indicates a need to revise the nursing care plan for a stroke patient?

Frequent changes in the patient's status Signup and view all the answers

During rehabilitation, which progress aspect should the nurse evaluate for the patient?

Recovery of strength, movement, and verbal skills Signup and view all the answers

Study Notes

Urinary and Bowel Elimination

Stroke patients may have issues with urinary and bowel elimination due to various factors including neurologic changes, impaired mobility, communication deficits, preexisting conditions, medication side effects, and alterations in food and fluid intake.
Common manifestations include constipation, fecal impaction, urinary incontinence, and urinary retention.
Nursing interventions to promote normal urinary elimination include:
- Assessing for urinary urgency, frequency, incontinence, nocturia, and small voiding amounts.
- Assessing the patient's ability to respond to the need to void, use the call light, and utilize toileting equipment.
- Promoting bladder training.
- Teaching Kegel exercises.
- Using positive reinforcement for successful urinary elimination management.
Nursing interventions to promote bowel elimination include:
- Assisting with toilet use at consistent times daily.
- Ensuring privacy and having the patient sit upright, if possible.
- Encouraging fluid intake up to 2000 mL/day along with a high-fiber diet for those with functional swallowing.
- Promoting physical activity as tolerated.
- Administering prescribed stool softeners when necessary.

Maintaining Safety

Swallowing ability is crucial for stroke patients.
Coordination and tongue weakness, attention deficits, and swallowing reflex impairment can contribute to dysphagia.
Dysphagia can result in drooling, choking, aspiration, and regurgitation.
Swallowing evaluation is an interdisciplinary process with speech and language therapists contributing expertise.
Nursing care in the acute phase focuses on safety, preventing aspiration, and ensuring adequate nutrition with these interventions:
- Monitoring swallowing study results before providing oral fluids or food.
- Ensuring safety during meals.
- Minimizing distractions and providing step-by-step eating instructions.
- Positioning the patient upright with the neck slightly flexed.
- Ordering soft or pureed foods.
- Teaching the patient to eat with food placed on the unaffected side of the mouth behind the front teeth.
- Instructing the patient to chew and swallow one bite at a time, slightly flex the neck, and tilt the chin forward to swallow.
- Monitoring for coughing during meals.
- Having suction equipment readily available for choking or aspiration.
- Monitoring lung sounds to identify potential aspiration.

Evaluation

Patient outcomes can be evaluated based on expected outcomes such as:
- Patient participation in assigned therapies.
- Effective patient communication.
- Active participation of the patient's significant other and family members in the patient's care.
- Minimal complications stemming from immobility, dysphagia, and reduced motor or sensory function.
Frequent evaluations are necessary, as patients' statuses can change frequently in acute care.
Nursing care plans need to be revised for each status change to meet the patient's needs.
During rehabilitation, the nurse evaluates the patient's progress in regaining strength, movement, and verbal skills.
Changes in status can indicate a worsening condition, necessitating additional nursing interventions or suggest recovery and readiness for discharge.

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Description

This quiz focuses on the nursing interventions for managing urinary and bowel elimination in stroke patients. It covers the challenges they face due to neurologic changes, impaired mobility, and medication side effects, as well as strategies for promoting normal elimination. Test your knowledge on assessment techniques and effective nursing practices.