All-Time Toileting Record!

  1. 1
    OK, I want to know if any of you can top this: A resident in the dementia unit where I work broke the all-time toileting record today. She was toileted a whopping total of 14 times during my 8 hour shift. I am not at all kidding -- we have electronic hand-held computers that we use to chart each time a resident is toileted at the time it happened.

    Incidentally she doesn't have a UTI to account for the frequency of urge to go, and she's also on an anti-anxiety drug to try and stop her hysterical fixation on going to the can. In other words this is all in her head....although she does tend to get constipated (despite the use of Miralax) and today she was an absolute terror in her demands to be sat down on the commode.

    Here's the official record of toiletings:

    5:59 am, 6:39 am, 7:00 am, 7:11 am, 8:20 am, 9:19 am, 9:46 am, 10:25 am, 10:31 am, 10:54 am, 11:48 am, 12:22 pm, 1:05 pm, and 2:01 pm. All these were performed by myself and my partner, the 2:01 toileting was done by the RN who gave her a suppository.

    I spoke with the Assistant Dir. of Nursing about this resident today and told her how much this situation is getting out of hand. If we try to gently reassure her that she'll be OK for just a little while and just to please wait to be taken back to the toilet she gets extremely agitated and upset. She'll sit in her wheelchair in the doorway of her room and cry out 'HELP!! HELP!!' until one of us comes to toilet her again. Her behavior is frightening and upsetting to the other residents. She gets extremely angry when told that there are others that need help as well and it's not fair to make them wait to use the bathroom when the majority of our time is spent only on her. She's awake day and night and hardy ever sleeps, the NOC shift is not spared her behavior either. You'd think she would wear herself out with this routine day after day. She's like the Energizer Toilet Bunny.
    Boerne Lou likes this.

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  2. 23 Comments...

  3. 1
    At my last job, I had a similar day with one of my residents...at the end of 2nd shift, our nurse looked at the total for first and second shifts...she had been toileted a total of 31 times between the hours of 8 a.m. and 10 p.m. We would walk out of her room, and her call light would literally be back on within 2 minutes. We had to ignore it for a few minutes just to get anything else done. To make it worse, we weren't allowed to remind her that we had other people to take care of, because that was considered "abuse".

    To be perfectly honest with you, I have NO patience for that kind of thing. It's one of the reasons I didn't like geriatrics (or the hospital, for that matter) very much. I know that for the most part, they can't help it, but that doesn't help your sanity when you already have a heavy workload!
    enchantmentdis likes this.
  4. 0
    Maybe there is an underlying cause for her having to void so often...maybe she is diabetic, or has CHF, or maybe she is on a diuretic that is making her void so often?
  5. 0
    Quote from Nurse2bKimberly
    Maybe there is an underlying cause for her having to void so often...maybe she is diabetic, or has CHF, or maybe she is on a diuretic that is making her void so often?
    Yes, she is a diabetic, but we have other diabetics in the Unit and on the floor and none of them act like this. It just seems to be a symptom of anxiety. Sometimes you'll get her on the toilet and after about 15 minutes if sitting there she won't even go at all because there is literally nothing there to eliminate. I think today was worse than usual because she kept on passing very small hard BM's that were difficult to pass, hence the suppository.
  6. 0
    Quote from yousoldtheworld
    At my last job, I had a similar day with one of my residents...at the end of 2nd shift, our nurse looked at the total for first and second shifts...she had been toileted a total of 31 times between the hours of 8 a.m. and 10 p.m. We would walk out of her room, and her call light would literally be back on within 2 minutes. We had to ignore it for a few minutes just to get anything else done. To make it worse, we weren't allowed to remind her that we had other people to take care of, because that was considered "abuse".

    To be perfectly honest with you, I have NO patience for that kind of thing. It's one of the reasons I didn't like geriatrics (or the hospital, for that matter) very much. I know that for the most part, they can't help it, but that doesn't help your sanity when you already have a heavy workload!
    You bring up a very good point -- I suppose it wasn't really right for me to remind this lady that there are others that need help as well. I was trying to appeal to her intelligence, she's a very smart and educated lady and I was trying to justify her reason for waiting. However, as anyone who's ever worked with dementia can tell you, sometimes these people simply cannot be reasoned with and they cannot really help their behavior. This lady won't even leave her room for fear of being too far from the john. As she's being helped off the toilet, she's already obsessing 'Oh no, I'm going to have to go again.....' The last thing I heard as I left my shift today was that there's going to be a mental health assessment. Like.....it's about time, people !!!
  7. 1
    Oh, I definitely know what you mean. The night I talked about was the biggest nightmare one, but over the years I have had so many that are obsessed with the toilet. And often, they ARE fairly alert and oriented I have sympathy for them, I really do...but that doesn't make it any less frustrating to deal with, ya know?

    Having to go often is normal for the elderly, but obsession is NOT, and I'm glad they're going to assess her, because that takes away the time that you should be caring for your other residents, as well. It's not fair for staff OR residents.
    enchantmentdis likes this.
  8. 0
    Wow. Never had a wetter like that.

    That wouldn't bother me. Way I see? AT LEAST, she's using the d..mn call-light!
    *laugh*
    My residents have no shame. I have one or two mobile, SANE, residents (b/c they insist on pullups and walking to the bathroom) who will lie in bed, wet themselves -- and just lay in it.
    You walk by the room. Peek in. They're just staring at *you*...looking crazy.
    *laugh*
  9. 0
    We have one woman who does that every single day. I think the minimum is 18, the maximum is 35. She goes just about every 15 minutes. She is alert and oriented and doesn't have any major health problems (come to think of it, I don't know why she is even with us). I'm pretty sure that most of the time she just sits on the toilet and farts. I think she does it because she's bored and she wants to annoy her roommate. As luck would have it, she's at the very end of the hall.
  10. 2
    Wow. I hope this is being addressed by nursing. Urology consult to R/O patho origin. Psych consult if neg, for patho. These unfortunate residents have degraded quality of live and decreased level of functioning secondary to impaired urinary elimination. Does the care plan address this?
    Hygiene Queen and KimberlyRN89 like this.
  11. 0
    We have a woman that did this when she was first admitted. I didn't work the hall at the time but I heard stories about it from the other girls. I believe it ended up that she had bladder spasms or something. She was telling me today that she had incidents at the grocery store and had to walk out with wet pants and how embarrassing it was.

    Anyway, she has a catheter now so it isn't an issue anymore. I asked my charge nurse the other day why we can't put catheters in some of these people (half joking, half serious!) and she said that they have to have a medical reason for it. I guess this situation was one of them.

    Maybe that is something they can do for this woman. There has to be some kind of underlying condition with this. I hope they figure it out because that is ENTIRELY too much.


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