CARE FOR INCONTINENT CLIENTS
As we have already mentioned, incontinence is a common condition affecting millions of people. At some point in your career you will probably care for someone who is incontinent. If you work in a nursing home, chances are that a high number of your current clients are incontinent. It has been estimated that about 50% of older adults in institutions are incontinent. Incontinence is actually a common reason for admission to a nursing home.
Outlined below are a number of care considerations for you to follow as you attend to people with urinary incontinence. Some of them have been mentioned earlier in this book, but they are important enough to be mentioned again.
Urinary incontinence can be very embarrassing and uncomfortable for the people who suffer from it, their families, and their friends. It is important to support them. Treat them with dignity and encourage them to stay active and not to avoid family and friends.
About half the people with incontinence do not seek help for it. Encourage the people you care for to have regular physical check-ups and to report any episodes of incontinence. Teach them to keep a record of when they are incontinent and what they are doing when the incontinence takes place. Ask them to record what makes the incontinence worse and what makes it better.
People who are incontinent may wet the bed or their clothing. They may need help to go to the bathroom because of frequent urges. Some healthcare workers may become impatient with them. They may not understand that their clients cannot control when and how often they may need to go to the bathroom. Help your co-workers understand how important it is to be supportive and not to complain or make fun of someone who is incontinent.
Stress incontinence occurs when the person laughs, coughs, sneezes, or exercises vigorously. Women who are pregnant or have recently had children are at increased risk. They should be informed of this fact. Remember that the risk of stress incontinence increases after menopause.
Some people have difficulty getting to the bathroom in time. It may help if their bedroom is close to a bathroom. Ensure a clear path to the bathroom. Use a night light. When someone asks for help to get to the bathroom, try to respond as soon as possible.
People who have trouble thinking (such as those who have had a stroke or Alzheimer’s disease) may not realize that they have to go to the bathroom until it is too late. Be patient with them and their loved ones. Encourage your co-workers to be patient, too.
The people in your care should know the symptoms of bladder infections. Tell them to notify their doctor if they notice that their urine is an unusual color, has blood in it, or smells unpleasant. They should also seek medical help if they have pain or a burning sensation when they pass their urine.
It is important to drink enough fluid every day. This will help the body get rid of waste products and prevent bladder infections. Some people who suffer from incontinence drink very little. They think that they will be incontinent less often if they drink very little. Instead, this practice increases the risk of bladder infections and other problems.
People with incontinence should avoid alcoholic drinks and fluids (as well as other products) that contain caffeine.
Sometimes incontinent people have trouble with starting to pass urine. Running water or stroking the inner thigh may help.
Encourage the person to avoid drinking large amounts of fluid in the evening. This will reduce his chances of being incontinent at night or in his sleep.
Advise the people in your care not to push or strain to empty their bladders.
Obesity puts extra pressure on the bladder and may increase the risk of incontinence. Encourage the person to maintain her weight within a normal range for her height and age.
Acquiring new habits is not always easy. If someone in your care is learning to perform Kegel exercises, explain that these must be done several times a day (according to the schedule developed with the doctor) for the rest of their lives.
If people are taking prescribed medications to help treat their incontinence problems, make sure that they tell their doctors which ones they are currently taking. They should also tell their doctors about over-the-counter medications, vitamins, herbal supplements, and other supplements, such as weight loss products.
If electrical stimulation is part of the treatment plan, explain that most people do not feel pain during this procedure. They will probably feel tingling and/or a tightening of the bladder muscles.
Incontinent people need support and help to retrain their bladders. If someone is using a timed voiding approach, make sure that he is able to get to the bathroom when he needs to.
If someone is using a pessary, help her to learn how to insert it, remove it, and clean it as needed.
Surgery is a serious treatment but it is often very successful.
Urine is very irritating to skin. If urine is left on the skin for long periods, skin breakdown can occur. Find out about the policy for skin care at your facility and follow it. If there is no specific policy, washing with mild soap and water is usually effective. Make sure the person has dry clothes to change into.
If the person in your care has an indwelling catheter in place, wash and dry the area around the catheter carefully. Look at the urine for signs of infection and other problems such as bloody urine, cloudy urine, or urine that seems to have particles of tissue in it. You may be instructed to empty the catheter bag at regular times. When you do so, note if the urine smells unpleasant.
Men who use an external catheter will need to wash and dry the penis carefully when changing the catheter. This will help to keep the skin free of infection and avoid skin breakdown.
Protect beds, chairs, and other furniture from becoming soiled with urine. Bedpads can be placed on the bed under the person’s waist and thighs. Covers can be used to protect mattresses, pillows, blankets, chairs, and sofas. Sometimes plastic covers are used because they can be washed and used again. These covers often become hard, however, and may split after a few washes. No matter what types of pads are used, make sure that they are removed as soon as they are soiled and clean ones put down. Wash and dry reusable pads. If the pads are to be thrown away, do so right away. Remember to help people wash and dry themselves whenever you change the pads.
A variety of incontinence products can be worn inside a person’s underwear to protect the clothing from being soiled by urine. These products are disposable. Some people prefer to use underpants that absorb urine. Some of these products are disposable. Others are washable so that they can be used more than once.
Incontinence products vary in shape, size, and ability to absorb urine. Some work best during the day, others at night. Ensure that the person in your care uses the right product at the right time to meet his or her individual needs.
Clothing that can be easily removed is available for people who suffer from arthritis or other similar conditions. Use of this type of clothing may allow the person to access the bathroom in time to prevent an accident from occurring.