Urinates before, during, and after use of bedpan

[DSPRoof]

First post everyone!

One of the residents here has taken to urinating once her brief is off, then in the bedpan, then she urinates maybe four more times in her fresh brief.

When I see that she is doing this, I change her brief and wipe her again. She is going through a lot of briefs and the repeated wiping isn't good for her skin breakdown. It doesn't seem to be an exposure to air or wipes issue, and she will have been dry all night previous to me removing the brief.

Has anyone else experienced anything similar? Is there something I can do to encourage one complete void?

[DennRN]

Hi DSPR,

Some more information on the particular resident would be very helpful. For instance does this client have any heart or kidney issues? What about any conditions having to do with the nervous system. It would also be helpful to know what your qualifications are so that people could know what you are able to do for this client.

Best I can do is suggest that you look into any changes that may be causing this issue. Has there been any new medications or dosages prescribed recently? What about changes in dietary patterns? Kidney function is a very big concern as well, I'm not sure what your qualifications are but I suggest you raise this issue and push for some diagnostics and assessments just to be safe.

If her kidney function is still good, I would also check to make sure that her bladder isn't still palpable/able to be percussed after voiding. If it is than there may be an underlying issue causing urinary retention.

Catheterization is a drastic approach long term, but if her skin does begin to become compromised it may be necessary to give it some time to heal back up.

It may also just come down to toileting on a tigher schedule. There are way to many variables to account for without more information.

[Zen123]

No comment.:monkeydance::brnfrt:

[DSPRoof]

No heart or kidney issues. Resident has hydrocephalus. No changes to meds but she has had a dramatic increase in sodium lately.

Although she may have incontinence related to her hydrocephalus she tends to experience it most frequently with staff she dislikes or before outings that she doesn't want to take.

I am a direct support professional, probably Direct Care Worker/Assistant to you.

I'm mostly looking for advice on positioning or possibly behavior modification, depending on your experience.

[xtxrn, ASN, RN]

First post everyone!

One of the residents here has taken to urinating once her brief is off, then in the bedpan, then she [b]urinates maybe four more times [/b]in her fresh brief.

When I see that she is doing this, I change her brief and wipe her again. She is going through a lot of briefs and the repeated wiping isn't good for her skin breakdown. It doesn't seem to be an exposure to air or wipes issue, and she will have been dry all night previous to me removing the brief.

Has anyone else experienced anything similar? Is there something I can do to encourage one complete void?

If she's got the same brief on, how do you know she's voiding that many times?

Gravity helps voiding.... bedside commode or bathroom. Bedpans aren't used many places... they're not helpful for emptying the bladder. I'm not used to briefs being on in bed, either....

Is this someone who can call when she has to go?

[DSPRoof]

I am placing the brief under her to fasten it and witness her urinating, stopping, urinating. I put a fresh brief under her when she seems to be finished then she urinates again.

She uses the bedpan at night and a hoyer lift during the day.

She is able to call but says she would rather sleep, and so is checked every two hrs.

[xtxrn, ASN, RN]

No heart or kidney issues. Resident has hydrocephalus. No changes to meds but she has had a dramatic increase in sodium lately.

Although she may have incontinence related to her hydrocephalus she tends to experience it most frequently with staff she dislikes or before outings that she doesn't want to take.

I am a direct support professional, probably Direct Care Worker/Assistant to you.

I'm mostly looking for advice on positioning or possibly behavior modification, depending on your experience.

You need to have someone contact the MD about this. We can't give medical advice here. :)

[DSPRoof]

MD says it is either related to dementia, hydrocephalus, or behavior.

I'm not asking for medical advice, asking for advice based on your experience.

Is there something I can do to encourage one complete void?

[DennRN]

She deserves the benefit of the doubt, her diagnosis can cause urinary incontinence and if I have learned anything in my time as a nurse its that doing something as simple as rolling someone 5 degrees can do crazy things like make a post surgical patient start to bottom out.

Try to hang in there and be supportive, I know it's probably frustrating but it can't possibly be pleasant for her either.

[morte, LPN, LVN]

No heart or kidney issues. Resident has hydrocephalus. No changes to meds but she has had a dramatic increase in sodium lately.

Although she may have incontinence related to her hydrocephalus she tends to experience it most frequently with staff she dislikes or before outings that she doesn't want to take.

I am a direct support professional, probably Direct Care Worker/Assistant to you.

I'm mostly looking for advice on positioning or possibly behavior modification, depending on your experience.

I may be a baaad nurse this AM but this was my first thought when i read your post......and, unfortunately i have no helpful thought.....good luck

[nelcoy4]

Do you have a bladder scanner on your unit? If you do, then start checking her with it every 4 hours pre & post void.

[DSPRoof]

No. She lives in a group home and we rely on the doctor for everything but blood pressure.