Managing incontinence. Is this done?

Posted
by debi49 Member

Specializes in psych,maternity, ltc, clinic. Has 15 years experience.

I am a nurse at a home for people with mental illness, many who also are DD. We do NOT do skilled nursing. I have a resident who has terrible urinary incontinence. She is middle aged and ambulatory, cognitive impairment, and just does not recognize when she is incontinent. We have set up behavior management plans with her, but it is not working. The constant smell is affecting other residents.

Her county case manager suggests I see about her getting an indwelling foley and she will send around a skilled nurse every month to change it out. SHE SAYS THIS IS OFTEN DONE. This seems ridiculous.

Has anyone ever heard of this? Forget the fact that my resident is not capable of doing her own cath care or irrigation, and we are not skilled nursing, but is this something that is actually done??? Basically a catheter for convenience?

ProgressiveActivist, BSN, RN

Specializes in ICU. Has 20 years experience. 670 Posts

A UTI smell is revolting. Take her to the doctor. She needs a ua C/S, and possibly antibiotics and meds for urinary retention. Dont wait until she develops urosepsis.

debi49

Specializes in psych,maternity, ltc, clinic. Has 15 years experience. 189 Posts

She doesnt have a UTI. The smell is garden variety urine. :) I think is long term catheter is the path to a UTI.....

ProgressiveActivist, BSN, RN

Specializes in ICU. Has 20 years experience. 670 Posts

She doesnt have a UTI. The smell is garden variety urine. :) I think is long term catheter is the path to a UTI.....

Catheter associated UTI can be life threatening and that is the reason that urinary catheters are not inserted for convenience.

debi49

Specializes in psych,maternity, ltc, clinic. Has 15 years experience. 189 Posts

I know! That's why when the social worker said lots of her clients have this, I couldn't believe it.

hppygr8ful, ASN, RN, EMT-I

Specializes in Psych, Addictions, SOL (Student of Life). Has 20 years experience. 2 Articles; 4,244 Posts

I would be curious to know a bit more about the setting. Are you working in an ICF (Intermediate Care Facility) If so is it CC, DDH or DDN. CC or DDH would not allow this under state regs (Title 22) DDN might if deemed medically necessary. First step would be urology consult and possibly bladder training program. Is resident ambulatory? what would keep them from pulling it out? Now we are getting into a restraint/ Patients rights issue. Perhaps house staff needs to be more diligent in reading her body language so they know when she has to urinate. I worked as a consultant in DDH homes for several years with lots of incontinent residents and none of them smelled as bad as you say. Your house staff is not doing enough with regard to hygiene.

Hppy

ProgressiveActivist, BSN, RN

Specializes in ICU. Has 20 years experience. 670 Posts

Good answer hppy.

A SW can not prescribe an invasive medical procedure to you or a homehealth agency nurse.

The emotional trauma is another reason why this is wrong.

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience. 5,047 Posts

The following are accepted rationale for a catheter:

●Medically needed strict I&O (Acute/critical care)

●Deep sedation/paralysis (OR, ICU)

●Pelvic/GU procedure

●GU-area wounds

●Urinary obstruction/neurogenic bladder (i.e. pt cannot urinate, and of course only if intermittent catheterization isn't a feasible option)

●End of life comfort

I think I got all of them.

But anyway, incontince is NOT a clinical justification for a foley, and CAUTI is a very real risk.

I was an LTC CNA for several years, with the majority of my pts being incontinent. Nobody ever had a urinary odor enough for anyone else to notice, because we checked/changed our residents q 2 hrs. I would guess she needs to be changed more frequently.

I wouln't think incontinence care needs "skilled nursing" either. My husband was a group home PCA for men on the low-functioning end of the autism spectrum, while in college. He wasn't/isn't a CNA even, and he changed their Attends.

Penelope_Pitstop, BSN, RN

Has 13 years experience. 2,365 Posts

●Medically needed strict I&O (Acute/critical care)

●Deep sedation/paralysis (OR, ICU)

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When I worked MICU, strict I&O was NOT an indication for a foley, nor was deep sedation. (Nimbexing someone, yes, that got a Foley).

We could usually keep a Foley if the patient was on pressors and was incontinent, though. Other wise, the CAUTI police would come get us during rounds!

Just adding my experience!

loriangel14, RN

Specializes in Acute Care, Rehab, Palliative. 6,923 Posts

Would they put in a catheter just because staff is too lazy to change the poor woman? You don't need any special skills to do that.

brownbook

Has 37 years experience. 3,413 Posts

Well.....this is right up my ally!!

My daughter and 12 year old grandson live with me. He is normal, healthy, in every way, except he is still incontinent at night and has accidents during the day. Honestly I don't know if he doesn't notice or it just doesn't bother him! He'll be sitting on the couch for some amount of time, gets up and his pans are wet! (Along with my couch!)

He has been seeing a NP who specialized in this for several year.

There is no miracle cure, but some interventions that may apply to your patient are:

Make sure they are not constipated. (Being full of poop puts pressure on your bladder.) He is on a daily lactulose and biscadyl regime and has to sit on the toilet for 10 minutes after breakfast and dinner. (Also lunch when it isn't a school day.)

He has been on oxybutin several years. It doesn't seem to be doing anything, but maybe it would be worse if he wasn't on it???

He just started DVAP for night time incontinence. He still wets at night but at least there is much less urine. He isn't soaking through his double diapers, missing the bed pad, and needing his bed changed every day!!!!

(I was almost ready to ask Allnurses how to get diapers on him, or a pad on the bed, so I wasn't having to change his linen every day!!!!!)

I know your patient is impaired. Just wanted to give you a few options instead of a foley.

Sunflowerinsc, ADN, RN

Specializes in Med/Surg. Has 46 years experience. 210 Posts

A UA seems in order, rule out a UTI just to be sure. And is she diabetic, a large urinary output with strong odor is a sign.