Urinary Cathed pt's - Continent or not?

[MryRose]

A friend who is a CNA at a LTC facility was told to chart the patients who have urinary catheters as continent. Since they are unable to void voluntarily, why would they be considered continent. She asked, but the answer was "because that's how we do it".

As pre-nursing students, we would like to understand the rationale behind this.

I knew this would be THE place to ask.

Thanks!

MaryRose

[Katnip, RN]

No. They have a Foley because they're incontinent. I chart, has Foley in place, intact, 500ml drained from bag. The point is, you can't chart that they are continent. Just state they have a Foley, or urinary catheter.

[Antikigirl, ASN, RN]

No. They have a Foley because they're incontinent. I chart, has Foley in place, intact, 500ml drained from bag. The point is, you can't chart that they are continent. Just state they have a Foley, or urinary catheter.

I totally agree! I have residents that are continent, but have a temp foley for various reasons..but I still don't list them as continent because I can't tell if they have bladder control with a tube up there draining! To say continent is to make a assumption you can not really prove. And..lol, I am not going to test it by asking my client to 'not pee' with a cath in place to see if they have control...LOL!!!!!

Also, continence or lack of is diagnostic. We have many folks that the first thing you see with a UTI is sudden incontinence when they were continent! So best to save these terms for the diagnostic reasons we have them for :).

[MryRose]

Thank you for your answers!!! That is what we thought too.

One more question along similar lines.

Hypothetically, of course, in LTC if a patient has frequent UTI's, would long term cathetization be considered a normal practice??

Shouldn't there also be charting regarding the foley and the output???

Thanks so much for your help!

MaryRose

[VivaLasViejas, ASN, RN]

Actually, for MDS purposes, any resident with a Foley is considered continent.

[GeriatricNurse]

For MDS coding indwelling catheters are considered continent. Its the act of soiling linens etc requiring hygiene/linen and clothing change that is incontinency.

[meownsmile, BSN, RN]

Well actually i was thinking the same thing. If there is a foley in place the need for linen changes is decreased except for stool incontinence therefore would be considered continent with regard for skin breakdown evaluation. But im not a LTC worker so far be it from me.

As far as cathing a patient with frequent UTI's, unless the patient is otherwise incontinent when there is no catheter in place there is no good reason to use a foley just due to a UTI. Unless there is excessive discomfort for the patient during urination from the UTI. Foley's can increase risk for further UTI. Documentation of catheter care should always be done per your facilities protocol. No need necissarily for documentating a patients output unless they are in kidney failure or have decreased their intake or at risk or hx of CHF, in which case they should also be weighed daily anyway. JMO, follow your facilities protocol.

[MryRose]

Actually, for MDS purposes, any resident with a Foley is considered continent.

Please explain MDS as I can't remember what that means. It's in the ADL charting that continant or incontinant are being listed.

Thanks,

MaryRose

[Talino]

MDS (Minimum Data Set) is a mandatory tool used in SNFs to obtain an overall picture of a resident and his needs. It drives the care plan and determines the amount paid to the facility for his care.

Charting or documenting "Urinary incontinence" is when resident's skin gets wet w/ urine (or whatever is next to the skin, i.e. clothing, pads). Since a catheter prevents that from happening, resident is therefore considered "Continent", regardless the setting, LTC or Acute Care.

[MryRose]

MDS (Minimum Data Set) is a mandatory tool used in SNFs to obtain an overall picture of a resident and his needs. It drives the care plan and determines the amount paid to the facility for his care.

Charting or documenting "Urinary incontinence" is when resident's skin gets wet w/ urine (or whatever is next to the skin, i.e. clothing, pads). Since a catheter prevents that from happening, resident is therefore considered "Continent", regardless the setting, LTC or Acute Care.

Ok... that explanation is very helpful, thank you.

What still is bothersome to me however, is if a patient is catheterized wouldn't that in itself necessitate extra care compared to a patent who can ambulate to the bathroom on their own? And the issue of determining voiding ability is still confusing to me.

I guess once we get into the actual nursing program, these things will become clearer.

I confess to being a "why" junkie! lol As I go through school, I find myself driven for explanation for better understanding.

Thanks so much!

MaryRose