- Incontinence and dementia
- Catheter care
Video: Incontinence Care and Dementia
A Messy Topic: Incontinence and Dementia
Clinical
Skillful incontinence care makes a big impact on quality of life for our residents. It takes plenty of patience, the right supplies, being organized, and utilizing good techniques. The result of good incontinence care is healthier skin, and healthier residents. We appreciate your attention to these needs and recognize it can be stressful sometimes. We want to help so please let us know when you experience difficulties.
Safety first means safety for all — you and the resident. Report when you see a change in a resident’s mobility. We may need to reassess needs for a mechanical lift, a mobility assistance device such as a Sara Stedy, a bedside commode, or provide bed care for incontinence if a resident cannot safely transfer to a toilet.
- Assess the individual’s needs. Consider their mobility, cognitive function, and daily routines when creating an individualized continence care plan. For example: Before the morning exercise program, get some steps in and take a walk to the bathroom! Sing or hum a song on the way. Keep it positive. When assisting them to the dining room for a meal, swing by the bathroom first. It will help with a more enjoyable meal time with fewer urgent interruptions to get to the bathroom in time.
- Our goal is to maintain dignity and respect for all aspects of care. Find ways to help the resident feel at ease during your incontinence care time. Reassure them that you are happy to be of help even in a messy situation. Incontinence can be embarrassing. Be calm, patient, and tactful when discussing the issue. Encourage open communication and provide privacy whenever possible. Incontinence is usually caused by mobility impairment, and underlying health conditions like kidney disease, heart disease, history of colon cancer and many other common health conditions shared by our residents. Some medications may cause loose stools or diarrhea that could lead to incontinence of bowel. Make sure you record bowel movements each time in the bowel chart. We will work the resident’s primary care physician on medication side effects.
- Provide toileting assistance and anticipate needs. Offer verbal or visual prompts to use the toilet, for residents who are ambulatory. A toileting routine every 2-3 hours can help reduce incontinence, and especially within an hour of eating breakfast. Mornings are the most active time for bowels to move. Residents with mobility difficulties will benefit from anticipating toileting needs and from a consistent routine. Use grab bars for ease and safety getting on and off the toilet. Always assists with mobility devices like walkers using safe techniques for sitting and standing. Feet back, nose over toes, and use both hands on the arm rests to push up to a standing position.
- Maintain an organized variety of skin care products for incontinence.Keep these supplies close at hand where care is needed most — in the bathroom and at the bedside. Many of these products help with gentle cleaning while also protecting the skin. And they help the resident to feel good because they are soothing and smell good! Remember to report and address skin irritation promptly. Regularly check the individual’s skin for redness, rashes, or sores, which are signs of incontinence-associated dermatitis. Heal skin irritation immediately by applying the correct cream, powder or ointment that is prescribed for the resident or that is already included in their care routine to prevent further more serious complications like open wounds or infections.
- Always practice infection prevention: wash hands before and after care, wear gloves, and use a clean gloved hand for grabbing wipes and using sprays or creams. Always assist with wiping FRONT to BACK (start at the urethra opening and wipe back towards the peri area) to prevent bacteria from entering the urinary tract. Use a peri bottle for spraying water on the urethra to wash out bacteria. Wipe down supplies with a disinfectant cloth whenever needed. Keep supplies separate.
- Modify clothing. We encourage clothing with elastic waistbands or Velcro fasteners that are easier to manage than zippers or buttons. Let us know if a resident needs clothing that creates more ease for their care. Hospital gowns at night can help and they come in cheerful fabrics.
- Report problems with eliminating or urinating like: pain or burning sensation, constipation or difficult bowel movements, loose stools, discolored (very dark/black), and strong odors. Signs of blood in urine or stool need to be reported right away.
Catheter Care
Best practices for nursing aides caring for patients with indwelling urinary catheters include performing routine hand hygiene, providing daily perineal care with soap and water, keeping the catheter system closed, ensuring the drainage bag is below the bladder and tubing is not kinked, and reporting any problems to the nurse. Aides should also stabilize the catheter tubing to prevent pulling and stress, empty the drainage bag at least once per shift, and ensure the resident drinks enough fluids. [1, 2, 3, 4, 5]
Hygiene & Cleaning
- Hand Hygiene: Always wash hands thoroughly before and after any contact with the patient’s catheter, tubing, or drainage bag. [1, 3]
- Perineal Care: Perform daily perineal care using soap and water to keep the area clean and prevent infection. [2, 3]
- Urine Bag/Sampling Port: When emptying the bag, ensure the outlet port does not touch anything and is cleaned before and after draining by wiping with an alcohol prep pad. You can also disinfect the sampling port before any use by a nurse by wiping it with an alcohol prep pad. [3]
System Maintenance & Positioning
- Keep System Closed: Maintain a closed drainage system to prevent bacteria from entering. [2, 3, 6, 7]
- Prevent Kinks & Obstructions: Keep the catheter and tubing free from kinking or obstruction to ensure proper urine flow. [2, 3, 8]
- Secure Catheter Tubing: Secure the catheter tubing to the patient’s leg to prevent tension and stress on the catheter insertion site. [4, 6, 8, 9, 10]
- Position Drainage Bag: Keep the drainage bag below the level of the bladder and ensure it is not touching the floor at any time to prevent urine from flowing back into the bladder. [1, 4]
- Drainage Bag Emptying: Empty the drainage bag regularly, at least once per shift, or when it is about one-third to one-half full. [1, 4, 11, 12]
- Cleaning supplies after emptying the bag: Clean the urinal used for emptying the bag each time the bag is emptied. Use solution of half white vinegar and water and then rinse. Wipe out the bin under the catheter bag with disinfectant wipe.
Monitoring & Reporting
- Regular Inspection: Inspect the catheter site and the surrounding skin for any signs of redness, irritation, or breakage. [1, 13, 14, 15, 16, 17]
- Observe Urine Output: Check the urine for color, odor, or any cloudiness. [1, 3, 18, 19, 20]
- Report Issues: Immediately report any problems, such as leaks, blockages, or changes in urine, to the nurse. [1, 21, 22, 23, 24, 25]
Patient Care
- Encourage Fluid Intake: Ensure the resident drinks plenty of fluids to help flush the urinary system and reduce the risk of infection. [1, 5]
- Proper Positioning: During movement or repositioning, be careful not to put unnecessary stress or pulling on the catheter. [1, 26]
[2] https://www.medline.com/strategies/infection-prevention/catheter-care-by-cnas-for-cauti-prevention/
[5] https://ninkatec.com/caregivers-guide-caring-for-patients-with-urinary-catheter/
[7] https://www.medline.com/strategies/infection-prevention/catheter-care-by-cnas-for-cauti-prevention/
[9] https://opentextbc.ca/clinicalskills/chapter/10-3-urinary-catheters/
[11] https://www.theliveincarecompany.co.uk/care-guides/a-guide-to-catheter-care/
[13] https://pmc.ncbi.nlm.nih.gov/articles/PMC5998608/
[14] https://www.akdh.org/article/S1073-4449(96)80024-0/pdf
[15] https://study.com/academy/lesson/managing-patients-with-epidural-catheters-in-nursing.html
[16] https://www.jcmg.org/wp-content/uploads/2016/02/Indwelling-Catheter-Care.pdf
[17] https://www.wellead.com/a-guide-on-how-to-shower-with-foley-catheter/
[18] https://truthhealthacademy.com/2024/09/30/urinary-catheterization-procedure/
[20] https://www.grovemedical.com/Customer/grmein/Customerpages/specpages/4A5146_User%20Guide.pdf
[23] https://www.freseniuskidneycare.com/treatment/dialysis-access-types/pd-access
[24] https://nursekey.com/78-urinary-catheter-insertion/
[25] https://www.medelit.com/uk/portfolio-items/indwelling-catheter-care-at-home/