All-Time Toileting Record!

yousoldtheworld · May 18, 2011

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!

KimberlyRN89, BSN, RN · May 18, 2011

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?

interceptinglight, CNA · May 18, 2011

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.

interceptinglight, CNA · May 18, 2011

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 !!! :uhoh3:

yousoldtheworld · May 18, 2011

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.

MedChica · May 18, 2011

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*

fuzzywuzzy, CNA · May 18, 2011

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.

systoly · May 18, 2011

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?

Dorali, BSN, LPN, RN · May 19, 2011

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.

lrlat · May 19, 2011

Been there!

interceptinglight, CNA · May 19, 2011

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?

That's just the thing that irks me about this job, one of the reasons I'm leaving this facility. We are ever only given the most cursory information on each of the residents we take care of. It seems that all we are allowed to know about any of them is just the very minimum it takes to take care of them (how do they transfer, do they have dentures or hearing aids, etc...) even though we are the ones who provide direct care !!! We NEVER know what their diagnosis is, what meds they are on, or if they add new meds that might change their behavior or cause strange side effects. It's endlessly frustrating!! I didn't even know this at first, but apparently this lady is under hospice care!!! I don't even know why, or what her problems or diagnoses are. She has terrible social anxiety and freaks out about ever leaving her room. Worrying about urinating and poking wads of tissue up her rear-end to make herself have a BM is all she seems able to focus on. Apparently she's a widow who also lost a son within a couple of months of losing her husband. Her dementia and social anxiety probably stem from that.

When I started this job I was very idealistic -- I was told that I was going to be 'the eyes and ears' of the facility. Yeah, sure. The truth is, nobody gives a crap what us CNA's have to say about anything even though we are the ones most closely involved with the residents. Sometimes it takes days to get a seriously ill person to a doctor or hospital. One lady was upset that they weren't treating her mother's pneumonia, in fact they denied she even had pneumonia. Finally she took her mother to a Quick Care center and yeah, she had pneumonia for which they prescribed an antibiotic. That lady ended up moving her mother out of the facility because she didn't like the care she was getting (actually, NOT getting).

In short -- this place I work is little more than a warehouse for old people. The lady who is the subject of this post is on hospice care, therefore I'm sure they'll not be doing any extensive work-up in her case if she's not expected to live more than 6 months.