Scenario 4
Nurse Mark is concerned about skin breakdown in an 88-year-old male patient with dementia who is incontinent of urine. The patient was admitted with a urine catheter from the emergency department (ED). The patient does not have a condition that would require an indwelling catheter. Mark wants to ask the physician for an order to remove the catheter, but he expects the patient to be incontinent of urine. He includes the potential for skin breakdown in the nursing care plan.

Question:
Which action is not correct?

  1. Leaving the catheter in place because the physician ordered a urine catheter (it saves nursing time to monitor and change the bed when the patient is incontinent).
  2. Considering the use of a condom catheter (if the patient is cooperative with keeping it on).
  3. Considering a prompted voiding program, when the patient is stood at the bedside and assisted to use the bathroom or urinal on a planned schedule.
  4. Considering checking bladder volume with the bladder ultrasound to assess retention every 6 hours.

Question:
The prevention of skin breakdown in the incontinence patient can be achieved using the following methods (check all that apply):

  1. Using barrier cream to keep the skin dry.
  2. Consider the use of an adult brief while the patient is out of bed (do not use them overnight).
  3. Restricting fluid intake.
  4. Keeping the patient on strict bed rest.
 
 

Correct Answer

The urine catheter should only be used when necessary. The list of appropriate uses does not include incontinence, nursing convenience, or because the physician wants a catheter. Consider the less invasive alternates to manage incontinence.

Correct Answer (Both 1 and 2)

Barrier cream and adult briefs will protect the skin if the patient is incontinent of urine. Restricting fluid intake and immobilization increase the risk of a urinary tract infection.

Learning Points

  • Many indwelling urine catheters are inappropriate, especially in older, female patients. Inappropriate urinary catheter use in acute care hospitals ranges from 21% to 50%. It is estimated that 30% of all indwelling urine catheters are inserted in EDs.
  • Indications for the use of indwelling urethral catheters are limited and include the following:

chart

  • The plan of care must be individualized for the patient with incontinence and should include the following components1:
    • Assessment and management of incontinence etiology
    • Perineal skin and risk assessment
    • Gentle cleansing and moisturization
    • Application of skin barriers
    • Use of containment devices if indicated