Assessment items

3. Interruption of bed-resting therapy associated with voiding behavior and its risk

1) High risk condition

□ Have a strong sense of shame

□ Dirty and filthy appearance with smell at hospital admission (high risk of urinary tract infection)

4) Some sort of needs

□ Sexual deviation behavior

Specific Nursing Care Practice

3. The amount and frequency of urine excretion increase in patients with diuretics; once we remove the catheter, they will frequently repeat voiding behavior/action. This may cause increase of cardiac stress, leading to aggravation of heart failure.

2) Reduction of unpleasant and discomfort feeling associated with the bladder indwelling catheter

□ Use bladder indwelling catheter made of silicone with a sufficient amount of lubricant at insertion.

3) Reinforcement of observation to prevent the patients’ self-removal of the catheter.

□ If the patient frequently shows his/her desire to void, measure the urine volume in the bladder using a bladder scan and consider if urination induction is necessary.

8) Attempt to prevent the patients’ self-removal of the catheter so that they will not have excessive cardiac load.

□ Write down on a piece of paper at what time the patient voided last time, and let the patient know that he/she just finished voiding by showing a clock and the paper.

4. The patients’ cardiac load may increase when they move to the toilet, resulting in aggravation of heart failure.

1) Attempt to avoid excessive cardiac load

□ If the patient has been extracting stool by him/herself, ask if a nurse can do it for him/her.

10. If the symptoms are overlooked, aggravation of heart failure may not be detected in the early stage.

(1) Attempt to detect and manage aggravation signs in the early stage.

□ Nurses who know the characteristics of the patient, such as primary nurses, should deal with the case.