Caring For the Incontinent Patient
As a healthcare professional in any setting, at some point, you will provide care for a patient that is incontinent. Whether you are a nurse, physical therapist, or nurse assistant, you’ll have to modify your care plan to accommodate for their incontinence. As the primary care provider, your care will revolve around the incontinence and maintaining good hygiene for health and patient comfort. Join us in today’s post as we discuss some concerns for caring for the incontinent patient.
For the patient who is mixed continent-incontinent or has frequent accidents, anticipate needs to reduce incontinence. For some patients, it is a matter of physical limitations preventing them from making it to the restroom on time, while for others, the sensory receptors may not be completely intact, making it difficult to know when they have to go or are going. Cognitive deficits can hinder continence as well. Pain is another contributing factor to incontinence in patients who would otherwise be continent.
To help, you can anticipate needs. Make frequent and regular rounds, asking if they would like to try to use the restroom or if they need to use the restroom while you are there. Sometimes the reminders or the assistance is enough to prevent incontinence. You can also ensure that you stay on top of pain management to prevent severe pain from limiting basic movements. For those who suffer from frequency or urgency incontinence, have a bedpan or bedside commode available for use.
Use proper equipment or materials.
Patients should always be encouraged to remain continent and you can work with them to develop a toileting plan that meets their needs. One of the most important parts of managing the incontinent patient is to use the proper equipment or materials. For instance, you should avoid the use of briefs as patients may become reliant on them and they don’t allow the skin to breathe as well as other options. Bedside commodes should be used over bedpans or urinals because the encourage movement and proper toileting positioning. when at all possible. Indwelling urinary catheters should be limited to need and not used for convenience in patients who are incontinent. Patients should regularly be assessed for the removal of the catheter. Fabric chuck pads should be used rather than disposable ones to promote air circulation on the skin and prevent breakdown.
For those patients who have special equipment that helps manage their incontinence including supra-pubic, condom, or Foley catheters or rectal tubes or ostomies, be sure to use well-fitting equipment that is for the intended purpose. Ensure these devices are cleaned and changed regularly, assessed for efficiency, and monitored for blockages and infection.
Protect the skin.
Urine and bowel contents are incredibly caustic to skin and can very quickly cause skin breakdown and sores to form. Skin protection is critical for the incontinent patient. For those patients who are incontinent, there should be regular rounding that includes checking on and cleaning incontinence. The skin should be thoroughly cleaned with soap and water and then dried. Barrier cream can be used to heal skin and prevent further irritation.
For skin around devices, ensure the areas are cleaned regularly with soap and water and monitored for leaking. For ostomies, ensure that the wafer is trimmed to fit snuggly around the ostomy without allowing contents to touch the skin around it. Use skin prep before adhering the device to the abdomen to prevent trauma when removing or changing the device. For catheter straps, check placement regularly to ensure it is not to tight or irritating the skin beneath it.
Use the right medical lubricant.
If you are managing a rectal tube or indwelling Foley catheter, the medical lubricant you use to guide insertion is almost as important as maintaining a sterile field while you do it. The medical lubricant you use should be water-based, bacteriostatic, and sterile. This will prevent breaking down the silicone tubing of the catheters which helps protect the integrity of the equipment as well as the tissues of the cavity the tube is inserted into. Using a sterile, bacteriostatic lubricant will also help reduce the incidence of infection. Using a medical lubricant with a premium viscosity will make the procedure more comfortable for the patient and the easier to complete for the healthcare practitioner.
At HR Pharmaceuticals, we create medical lubricants with the health and safety of your patients in mind. If you insert equipment for the incontinent patient, consider using Surgilube® Surgical Lubricant. Surgilube is available in a variety of packaging including single-use packets for urinary catheter kits as well as larger multi-use tubes. Visit our product section online to find the right product for your needs.