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bladder record
by Diane K. Newman, RNC, MSN, CRNP, FAAN
Figure 1: Bladder Record
Name____________________
Date_____________________
Instructions
Column 1 - Place a check next to the time you urinated in the toilet.
Column 2 - Place a check next to the time you have an accident, large or small.
Column 3 - Place a check next to the time you change your WET PADS.
Column 4 - Note a reason why you may have had an accident, like sneezing, coughing, lifting something heavy, "couldn't make it to the bathroom," etc.
Column 5 - Make a check for every 8 oz or 1 glass of fluid you drink and indicate if it contains caffeine.
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Column 1 |
Column 2 |
Column 3 |
Column 4 |
Column 5 |
| Time Interval |
Urinated in toilet |
Had an accident |
Changed wet pad |
Reason for accident |
The fluid I drank |
| 6-8 AM |
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| 8-10 AM |
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| 10-12 Noon |
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| 12-2 PM |
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| 2-4 PM |
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| 4-6 PM |
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| 6-8 PM |
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| 8-10 PM |
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| 10-12 PM |
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| Overnight |
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References
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Posted October 2006
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