Incontinence Management and Catheter Care

 

As a caregiver in long-term care, you have a responsibility to help residents maintain or improve their continence level. Incontinence is an important issue for the elderly and can be a very sensitive subject as well. To provide the best care, it’s important you understand some of the different kinds of incontinence issues:

  • Urge Incontinence: Abrupt onset of urgency, frequency and nocturia (having to go at night more often). Residents who have this may feel the need to urinate but isn’t able to hold it long enough to get to a toilet. This is the most common type of incontinence for elderly people.

 

When you are taking care of a resident and they tell you they need to go to the restroom, think of how you would like to have to try and hold it and wait on someone to help you.

 

  • Stress Incontinence: Urine leakage that is caused when someone coughs, sneezes, laughs, moves from sitting to standing, etc. Internal pressure is what causes the leakage. This is the second most common cause of urinary incontinence in older women, especially those who have birthed children.

 

  • Mixed Incontinence: When you have both urge and stress incontinence.

 

  • Functional Incontinence: Loss of urine that occurs in a resident who otherwise should be able to maintain continence and has no sign of urinary tract function damage. Some factors may include:

                  -Physical weakness

                  -Cognitive issues

                  -Medications

                  -Failure of staff to response to a request for assistance in a timely manner

                                                                                                Interventions

There are several interventions that should be considered when treating or preventing incontinence.

  • Treating pain

  • Removing or improving environmental impediments

  • Adjusting medications that affect incontinence

  • Implementing a fluid and/or bowel management program

  • Ensuring staff answer the call lights in a timely manner

 

When working in a long-term care community, make sure you are aware of each resident’s individual toileting needs. You can find these out by looking at the care plans. Additionally, talk with your charge nurse to find out what that facilities continence management program includes. While unfortunately still a common practice, “check and change” routines are not effective and are no longer considered standard of care. Unless there is some medical reason why a resident can’t sit on a toilet, commode or bedpan, he/she should be assisted to do so rather than staff waiting for them to be incontinent and then changing their incontinent product.

Issues

 

When bowel or bladder incontinence is not managed appropriately, several issues can arise:

  • Increased risk for skin breakdown including pressure injuries and moisture-associated dermatitis

  • Depression

  • Increased risk for urinary tract infections, which can lead to sepsis or death

  • Increased risk for falls

  • Decline in ability to maintain continence for as long as possible

  • Agitation or other behavior issues

 

                                                                                               Catheterization

Occasionally, incontinence issues require the use of an indwelling catheter. Catheters should not be used as a convenience item for staff, only when the residents medical condition deems it necessary.

 

Catheters can promote skin integrity, but they also lead to increased risk for urinary tract infections.

 

When providing catheter care, it is important to make sure you are using standard precautions, including washing your hands and using gloves, and clean the tubing starting closest to the body and moving away.

 

Other things to remember when a resident has an indwelling catheter:

  • Keep the bag covered to maintain the dignity of the resident

  • Make sure the tubing is secured to the inner thigh to prevent it from pulling on the urethra

 

                                                                                              Fecal Incontinence

 

A resident who experience fecal incontinence may have the following feelings:

  • Shame

  • Embarrassment

  • Loss of independence

  • Tend to isolate themselves due to fear of “accidents”

 

Fecal incontinence can lead to the same issues as urinary incontinence, with a higher risk for there to be odors and damage to clothing associated.

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