Carolyn E. Smith, DNP RN CNRN, is a Staff Nurse, Wellspan York Hospital and Nursing Faculty at York College of Pennsylvania, York, PA.
J Neurosci Nurs. 2020 Oct;52(5):219-223. doi: 10.1097/JNN.0000000000000536.
After a stroke, urinary dysfunction and urinary tract infection are estimated to be approximately 20%. Increased postvoid residual (PVR) is a risk factor for urinary dysfunction and urinary tract infections. These complications can negatively impact recovery weeks after the initial hospitalization. Early identification of risks and patient education are important.
This project was initiated for those patients admitted for a diagnosis of stroke on a 55-bed neuroscience unit in an acute care hospital. Patients were scanned after the initial void post stroke. Nurses followed a specific bladder scanning algorithm for subsequent scanning if the PVR volume was greater than 100 mL.
Seventy-eight patients were scanned in the original phase of the project, and 41 (53%) had PVR volumes greater than 100 mL after the initial void/scan. Of those, 22 patients still had a volume of greater than 100 mL after the second void/scan, and 12 had PVR volumes greater than 100 mL after a third scan.
Patients admitted with stroke have demonstrated increased PVR volumes. Portable ultrasound bladder scanning is a safe, noninvasive method to measure residual urinary volumes. The use of a bladder scanning algorithm encourages nurses' autonomy in assessing and identifying patients at a higher risk for urinary complications.
Identifying the risk for urinary complications post stroke can lead to early interventions that can improve recovery. This also allows for specific patient education related to preventative measures to reduce risk of urinary complications. The use of a specific bladder scanning protocol is recommended as standard practice for all patients admitted with stroke.
据估计，中风后约有 20%的患者会出现尿功能障碍和尿路感染。残余尿（PVR）增加是尿功能障碍和尿路感染的危险因素。这些并发症可能会对初始住院后数周的康复产生负面影响。早期识别风险和对患者进行教育非常重要。
该项目针对在急性护理医院的 55 张神经科学床位上因中风而入院的患者发起。患者在中风后首次排尿后进行扫描。如果 PVR 量大于 100ml，护士将根据特定的膀胱扫描算法对后续扫描进行跟踪。
在最初的项目阶段，对 78 名患者进行了扫描，其中 41 名（53%）在首次排尿/扫描后 PVR 量大于 100ml。其中，22 名患者在第二次排尿/扫描后仍有大于 100ml 的 PVR 量，12 名患者在第三次扫描后 PVR 量大于 100ml。
入院的中风患者 PVR 量增加。便携式超声膀胱扫描是一种安全、非侵入性的测量残余尿容量的方法。使用膀胱扫描算法鼓励护士在评估和识别更高风险的尿并发症患者时拥有自主权。
识别中风后尿并发症的风险可以促使及早采取干预措施，从而改善康复效果。这也使我们能够对患者进行具体的与预防措施相关的教育，以降低尿并发症的风险。建议将特定的膀胱扫描方案作为所有因中风入院患者的标准实践。
