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?
I would first dip her urine to make sure there is no uti.
If none, make sure she is sitting up as high as possible in the bed if she must use the bedpan bc it's hard enough as it is for some older folks to get a stream going while sitting on the toilet with gravity on their side.
Do a bladder scan also for post void residual after she is sitting up and done voiding.
Just an idea...you might want to ask your question on the Developmental Disabilities forum here on AN.
Go to Specialty (above, 3rd from left) & then click Nursing Specialities & you could ask for advice as to what kind of behavior therapy/modification/incentives those type of nurses use for pt.'s like this. :)
I also agree with checking for a UTI. I've done direct support and this was a common cause of more frequent urination. Ask them about pain while voiding and pay attention to the smell.
Allowing time and privacy on a bedside commode may help to encourage complete emptying of the bladder if there is no medical cause. I used to stick one of my clients on the bedside commode first thing when she woke up and turn on the cartoons for 30 minutes. She would do her BM and pee 1-2 times on the commode. Depending on their level of assistance, it's also a perfect time to get them dressed, put on deodorant/spongebath, check their skin for breakdown, etc.
Checking every 2 hours while asleep is probably ok, but I would at least ask every hour while awake. Also, you may want to make sure that all workers are following protocol and no one is leaving her in a urine-soaked brief for hours on end. A doctor may also be able to prescribe you or suggest some type of barrier cream.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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?
I would check for an infection. and if it is based on the hydrocephalus the isn't much you can do it's neurological. As a member of the dribble when I laugh club......things just aren't the same "down there" after having babies and getting old. Possibly allowing her to sit for a longer peroid of time. There are medications that can be ordered for leaky/drippy faucets...but these may be contraindicated with the hydrocephalus...let you RN/LPN know and ask for a note to be left....check out this link it may help you
Get a GOOD barrier cream or even A&D ointment/desitin. Thins about placing small pads in the overgarment (I hate the term diaper for adults) to wick away moisture and help with a quick change but i would have the nurse check for a UTI first.....
Specializes in dementia, intellectual disabilities.
The biggest problem with checking for a UTI is that the doctor prescribes meds just because we ask for the test.
I'm definitely alert for smells but there are none right now.
Lastly she will respond several different ways to "is it burning/does it hurt?" depending on what she thinks staff wants to hear. We are not totally sure just how much or what types of pains she can feel.
No matter how long she sits she still pees again when I take her off Is there some sort of hospital bed where the legs drop down to allow her to sit up more? That might allow for her to get on the bedpan first, transferring to a sitting position will not end well.
Unfortunately, if Medicare or Medicaid is involved with this patient, there has to be a diagnosis for a Foley- behavior won't work
A urology consult sounds like it couldn't hurt. Even with the hydrocephalus, there can be other reasons- and if all is found "working", then behavioral interventions might help- appropriate for the developmental stage. It could be she just can't help it, and it seems deliberate; neurological disorders can manifest AS behavioral disorders- especially right frontal lobe issues... JME :)
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.
Is there some sort of hospital bed where the legs drop down to allow her to sit up more? That might allow for her to get on the bedpan first, transferring to a sitting position will not end well.
Michelleni
1 Post
Hello just posting a reply
I would first dip her urine to make sure there is no uti.
If none, make sure she is sitting up as high as possible in the bed if she must use the bedpan bc it's hard enough as it is for some older folks to get a stream going while sitting on the toilet with gravity on their side.
Do a bladder scan also for post void residual after she is sitting up and done voiding.