All-Time Toileting Record!

[interceptinglight]

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.

[CNA2PA]

man oooo man this would be were a catheter would save some lives lol....but really ive been here and my DON always said check the care plan...if it says toilet every 2hrs try to do it every 2 hours....even if the Res is freaking out for the first few days this in my experience has always helped even though its time consuming, hard and not a generally pleasant exp. Its not like you cant neglect all your other residents b/c one is super needy. Its a freaking catch 22!! lol

[interceptinglight, CNA]

Yes, this is really bad because you have the combination of a very intelligent strong-willed lady who also has dementia and is on terminal care. Yesterday I spoke with her about waiting just a little bit longer in between going to the toilet so that she could regulate her bladder a little bit better. She had a fit and said....yeah that's what you do with an 18-month old, you toilet train them...yeah yeah yeah....... Of course she wouldn't listen. Then when you try and hold her off, she'll just call out 'Help!! Help!!' and cry and moan so loudly it upsets our other residents and disrupts anything we're trying to do. Lately she's just transferring herself without help, and the nurse's answer to this is tabs alarms on her at all times. Great solution, now we have to come running whenever she pulls the tabs for umpteenth time each day. Geez.

[JDZ344]

I bet I can beat that record :)

[blackandyellow]

I had a resident that would constantly say she needed to go to the bathroom. It got to the point that it was too much. I couldn't spend any time getting other residents ready for bed because we were constantly toileting her. Eventually she was put on I+O's. We made sure we charted how often she went to the bathroom and the amount. Our DON had a meeting with her and her daughter it turns out the woman was extremely anxious and scared of the dark and now has a nighttime ativan prescription and a nightlight that works wonders.

[yousoldtheworld]

Thats nothing. I had a woman who would use the commode (and she had limited mobility so it was HELL getting her onto it), back to bed and she's want to pee again straight away- she was literally doing drops. Turned out when I spoke to her she was so scared she would have an accident and "be in trouble". Lots of these older folks would get physically punished as kids for bed wetting, so I'll bet in quite a few cases that's a factor. Also, these people are probably anxious about the lack of control- they can't take themselves to the bathroom, so they want to make sure they don't have an accident.

I do try to have patience and understanding. But it's hard :)

Yep, I've had quite a few of these people...and it's hard. Because you can't really tell them "It's okay if you have an accident" without it sounding like you're saying "Just pee on yourself, so I don't have to toilet you". (And yes, I once had another aide tell the nurse that I told a resident to just pee in his pants. What I had ACTUALLY told him was that if he did have an accident, it would be no big deal and we'd just get him changed. Because he'd been anxious about going to eat in the dining room in case he had an accident. Luckily, he was oriented enough to tell the nurse that I had not told him to just pee himself.

[pca_85]

Poor things! I've had days that I've been worked to death, but never that bad. Jeez. This here donut I'm about to eat shall be eaten in the honor of all you hard workers!

[interceptinglight, CNA]

Update on the Toilet Queen: she's been catheterized. Apparently an ultrasound of her bladder after urinating revealed a residual volume of 400 cc. She's not emptying her bladder, hence the constant urge to go since she also drinks water constantly (she's diabetic and always thirsty). She's tolerating the catheter fairly well, although now her constant complaint is that it must be plugged or something because she still feels the urge to urinate, plus she also has a lot of anxiety about BM's.

[peppylady]

I have a resident that uses the bedpan every hour on the hour during the night. She uses the big big bed pan. It holds a quart, I measured it. She overflows this bed pan 8 times every night. I can't believe all the urine that comes out of her. She says she going home. I don't think her husband will be able to handle her at night...she'll be back.

[lams]

Been there!

haha, interesting~~~

[peppylady]

She went home. The bedpan queen went home. I hope the husband has extra sheets.

[northernguy]

Its common to get residents who are fixated with having to go to the toilet, or having a BM. We have always have a couple like that. One of them will say they have to pee, you toilet them, then 2 minutes later they ring again and say they have to have a BM, and so it goes the entire shift. We have one resident who will ring constantly to be toileted, and will call their family on their room phone if they arent toileted immediately. If it happens to someone who normally doesnt have this fixation obviously you think UTI.

[kool-aide, RN]

Can anyone say PSYCH EVAL?!?!?!?! lol I was going to say maybe just take a few minutes to sit and chat with her(crazy, I know) because maybe she just wants some attention, but if she's afraid to leave her room because of her frequent trips to the BR, I would say there's something wrong with that picture (either mentally or urologically!)

On a side note, I absolutely DO NOT think it's "abuse" to tell your resident/pt who calls for you with ridiculous requests that you DO have other pts to care for... they need a good reminder sometimes!

Good luck!