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Continence And Stroke

Continence And Stroke. Central South Regional Stroke Program September 2007 Funded by the Ministry of Health and Long Term Care. Session Overview. The types of stroke. The common changes that result from stroke. The link between stroke and continence The types of incontinence.

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Continence And Stroke

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  1. Continence And Stroke Central South Regional Stroke Program September 2007 Funded by the Ministry of Health and Long Term Care

  2. Session Overview • The types of stroke. • The common changes that result from stroke. • The link between stroke and continence • The types of incontinence. • Strategies to support a resident’s success in being continent.

  3. What is a Stroke • An interruption of the supply of blood and oxygen to an area of the brain. • This causes the brain cells in an area to die, and reduces the brain function in that area. • The area of the body controlled by the damaged area in unable to function properly. • There are two types of stroke. http://www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/stroke-vasculaire_e.html#ef

  4. What is a Stroke? A stroke can happen when a blood clot blocks a blood vessel in the brain. 80% of strokes are this type. A Guide to Understanding Stroke, Heart and Stroke Foundation of Canada, 1996

  5. What is a Stroke? A stroke can also happen when a blood vessel breaks and results in bleeding in the brain. 20% of strokes are this type. A Guide to Understanding Stroke, Heart and Stroke Foundation of Canada, 1996

  6. High blood pressure High blood cholesterol Heart disease Diabetes Being overweight Excessive alcohol use Physical inactivity Smoking Risk factors you can do something about… Pearson et.al., (2002) AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update: Consensus Panel Guide to Comprehensive Risk Reduction for Adult Patients Without Coronary or Other Atherosclerotic Vascular Diseases Circulation, 106, 388-391.

  7. What does a resident who has had a stroke look like in LTC?

  8. What are some of the losses due to stroke? • paralysis or weakness on one side of the body; • vision problems; • trouble speaking or understanding language; http://www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/stroke-vasculaire_e.html#ef

  9. What are some of the losses due to stroke? • inability to recognize or use familiar objects • tiredness; • depression; http://www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/stroke-vasculaire_e.html#ef

  10. What are some of the losses due to stroke? • exaggerated or inappropriate emotional responses; • difficulty learning and remembering new information; and • changes in personality. http://www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/stroke-vasculaire_e.html#ef

  11. Stroke Statistics • There are between 40,000 and 50,000 strokes survivors in Canada each year. • 10% (4-5,000) of strokes survivors each year require long-term care. • 40% (16-20,000) of strokes survivors each year are left with a moderate to severe impairment. http://ww2.heartandstroke.ca/Page.asp?PageID=33&ArticleID=1078&Src=news&From=SubCategory

  12. Stroke can cause a loss of bowel and bladder control. http://www.medicine.mcgill.ca/Strokengine/module_ui_intro-en.html

  13. Urinary Incontinence is common in stroke 40-60% of stroke survivors are incontinent after having their stroke. Thomas LH, Barrett J, Cross S, French B, Leathley M, Sutton C, Watkins C. Prevention and treatment of urinary incontinenceafter stroke in adults. Cochrane Database of Systematic Reviews 2005, Issue 3.

  14. Over time bladder continence can improve. Thomas LH, Barrett J, Cross S, French B, Leathley M, Sutton C, Watkins C. Prevention and treatment of urinary incontinence after stroke in adults. Cochrane Database of Systematic Reviews 2005, Issue 3.

  15. There may be improvement in their bladder/bowel function Upon discharge from hospital : 25% of stroke survivors are incontinent 1 year: 15% of stroke survivors are incontinent Thomas LH, Barrett J, Cross S, French B, Leathley M, Sutton C, Watkins C. Prevention and treatment of urinary incontinence after stroke in adults. Cochrane Database of Systematic Reviews 2005, Issue 3.

  16. Types of Incontinence • Physical incontinence • Functional incontinence

  17. Physical Incontinence • Urinary Frequency • Urgency (sudden compelling desire to pass urine which is difficult to defer) • Urge Incontinence(involuntary leakage) Thomas LH, Barrett J, Cross S, French B, Leathley M, Sutton C, Watkins C. Prevention and treatment of urinary incontinence after stroke in adults. Cochrane Database of Systematic Reviews 2005, Issue 3.

  18. Functional Incontinence Patient has either decreased mental ability or decreased physical ability and is unable to make it to the bathroom in time. Turhan et.al., Impact of stroke etiology, lesion location and aging on post-stroke urinary incontinence as a predictor of functional recovery, International Journal of Rehabilitation Research 2006, Vol 29 No 4

  19. To remain continent a resident must… • Know they have to void • Communicate their need to a caregiver • Be motivated Brittain et.al., (1998) Stroke and Incontinence, Stroke, 29, 524-528

  20. To remain continent a resident must… • Be able to • bear weight • assist in transferring to a toilet or commode • or use an appropriate appliance • Delay voiding until the appropriate time • Initiate voiding voluntarily Brittain et.al., (1998) Stroke and Incontinence, Stroke, 29, 524-528

  21. Impact of Stroke on Continence Care • Inaccurate interpretation of messages and sensations from the brain to the bladder. • Decreased thinking abilities (insight, impulse control) • Decreased functional ability Brittain et.al., (1998) Stroke and Incontinence, Stroke, 29, 524-528

  22. Stroke and Incontinence Link • Frequent coughing (difficulty swallowing) • Problems speaking (aphasia) Brittain et.al., (1998) Stroke and Incontinence, Stroke, 29, 524-528

  23. Fecal impaction Drug therapy Diuretics Poor diabetes control Urinary tract infections Low estrogen levels in women Pre-morbid conditions Other Causes of Incontinence Brittain et.al., (1998) Stroke and Incontinence, Stroke, 29, 524-528

  24. Incontinence Strategies • Use of individualized assessment and goal setting(Thomas LH, Barrett J, Cross S, French B, Leathley M, Sutton C, Watkins C. Prevention and treatment of urinary incontinence after stroke in adults. Cochrane Database of Systematic Reviews 2005, Issue 3.) • Scheduled toileting– before/after meals, q2h, and prn (MOHLTC standard)(Ostaszkiewicz J, Johnston L, Roe B. Timed voiding for the management of urinary incontinence in adults. Cochrane Database of Systematic Reviews 2004, Issue 1.) • Adequate fluid intake – 1500ml/day (MOHLTC standard) • Making sure the resident is close to a washroom

  25. Incontinence Strategies • Adaptable clothing • Communication – resident can tell you what they need • Adaptive devices – commode, grab bars, use of urinals, bed pans

  26. Incontinence Strategies • Use incontinent products when needed • Encourage independence and self-care • Environment prompting • Privacy • Dementia care strategies – responsive behaviour strategies, PIECES

  27. Allie Allie has been recently admitted to Cozy Acres with a diagnosis of stroke. This is the first time that you have worked with Allie and have not been able to review her chart. The RN lets you know that Allie is incontinent. Allie is able to walk with assistance but she has fallen before. Allie needs you to help her with washing and getting dressed. Allie needs assistance ambulating to the washroom and removing her clothing. Allie is unable to tell you that she needs to use the toilet, however she is able to accurately report Y/N responses. Allie often identifies when she needs to be changed by moaning or gesturing to staff.

  28. Allie What are two possible losses that Allie has experienced as a result of her stroke that may be affecting her incontinence. What can you do about this situation?

  29. Next Steps… • You are the eyes, ears and voice of your home. • Be aware of the diagnosis of your residents. • Take this stroke information and use it with the residents that you work with. • Share this stroke information and care strategies with other staff. • Follow-up in 2 months with the home’s best practice champions.

  30. More Information • Acute Changes and Stroke • Continence and Stroke • Dementia and Stroke • Falls and Stroke • Pain and Stroke Please contact: Rebecca Fleck or Kim Young Community and Long Term Care Specialist Central South Regional Stroke Program 905-521-2100 x 44127

  31. Acknowledgements • Best Practices long term care advisory group • Best Practices long term care evaluation group • Best Practice Continence Working Group, Haldimand Norfolk • Charmaine Martin, Hamilton Health Sciences, Acute Care Nurse Practitioner • Mary-Lou van der Horst, Regional Best Practice Coordinator Long-Term Care Central South Region • Wendy MacDougal, Regional Best Practice Coordinator Long-Term Care Central West. • Central South Regional Stroke Program • Maryann Watts, Hamilton Health Sciences, Clinical Manager Neuro-ambulatory Centre • Melanie Fall Stratton, Regional Stroke Program, Program Manager, • Kim Young, Regional Stroke Program, Community and Long-term Care Specialist • Rhonda McNIcoll-Whiteman, Hamilton Health Sciences, Stroke Best Practice Co-ordinator • Lisa Colizza, Regional Stroke Program, Regional Stroke Development Specialist • Nancy van Essen, Regional Stroke Program, Stroke Rehabilitation Coordinator • Carol Pereira, Regional Stroke Program, LTC Project Coordinator

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