Managing incontinence. Is this done?

Nurses General Nursing

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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?

Specializes in Med-Surg.

I agree that an indwelling foley is not appropriate or indicated for this patient. The fact that she could not perform foley care herself (which needs to be done twice daily) would be like begging for her to develop a UTI.

Has she seen a doctor about her incontinence? Maybe a urologist? Have they ruled out any underlying causes, tried treatments? Has a UTI been ruled out by urinalysis? I ask because even if her urine isn't malodorous, she could still have a UTI.

I second the suggestion about bladder training as well.

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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!

Strict I/O orders without a Foley are a joke.

Specializes in Oncology.
Strict I/O orders without a Foley are a joke.

If there's any incontinence at all, yes. We have walkie talkie patients on strict I&O's without foleys who void in hats or urinals fine and we're able to measure that. If they're incontinent on strict I&O's they get a foley. We have a harder time keeping track of oral intact if they're not NPO, especially if they're able to refill their own water pitcher.

Specializes in LTC.

Has a urologist been consulted to see if this is a physiological issue? Perhaps there is some stricture in there, or chronic constipation, or OAB, or really any number of things, and it's a functional versus behavioral issue. There are so many possibilities to be investigated before just saying "we give up, use briefs" and we should NEVER say "we give up, use a foley". That case manager seems to have zero understanding of actual indication for caths.

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