Question

You are a visiting nurse caring for a 32-year-old writer who became paraplegic as a result of a motorcycle accident 1 year ago. He is recovering from a subsequent depression, and your visits are to monitor not only his emotional outlook but also to encourage his hygienic self-care and offer strategies for his success. He wears a leg bag, is incontinent of stool, and you’re monitoring a red spot on his left buttock. (Learning Objectives #5 & #8)

a. Which hygienic issues are of utmost importance for a patient using an indwelling urinary catheter?

b. What other information can be communicated to a nurse as a result of a hygienic assessment?

c. How does help with bathing promote health?

d. Which nontraditional bathing technique might be extremely helpful for this patient? Why?

e. What would be appropriate interventions for the spot on his left buttock?

Answer 1

a.) Issues with catheterization

Catheter-associated-urinary tract infections (CA-UTIs) account for over 80% of all intensive care patients treated with an indwelling urinary tract catheter during their hospital stay

Always wash your hands before and after handling your catheter.

Wash the visible part of the catheter and the area where it enters your body with warm soapy water once daily during your shower.

Men – you may notice a slight discharge around your catheter where it enters your penis. In most cases this is a normal bodily discharge from the urethra (the channel you urinate down). Gently clean this off when you wash.

Avoid scented soap, perfume, talcum powder, antiperspirants, bubble bath, bath salts or creams/lotions in this area.

Women should always wash from front to back, particularly after a bowel movement.

It is better to have a shower than a bath. Leave your bag or valve attached to the catheter while showering.

If you have a leg bag, it must be kept below the level of your bladder at all times.

Sometimes you may get urine leaking down the urethra. This is nothing to worry about but contact your doctor or nurse to get further advice.

Men with catheters must ensure they wash under the foreskin:

If you are not circumcised, pull back your foreskin and clean the area underneath to avoid a ring forming which can cause irritation and soreness.

Remember to return your foreskin to its normal position afterwards. If you don’t, you may develop a painful swelling called para-phimosis. If this should occur, seek medical advice immediately.

If you can’t pull your foreskin back because it is too tight (phimosis) don’t try – you may injure yourself. Tell your nurse who will instruct you how to clean underneath your foreskin using a syringe filled with cool tap water.

b.) Communication with nurses :

Difficulty in micturition and defecation or help with other normal functions. Itching or rashes present anywhere on the body. Any infections present in any part of the body. Any discharge or pain present. All these can be communicated with the nurse

c.) Help with bathing :

Patient is paralysed, and is on urinary catheter as he immobile. Helping with bathing will ensure in cleaning places where he can't reach. Resulting in completed hygiene. Also, a nurse who knows rhe hygiene and health will definitely clean better compared to self cleaning

d) Non traditional Bathing technique:

Turn the person to one side and place the smaller, warm towel from the plastic bag on the back, washing in a similar manner, while warming the person's front with the bath blanket or warm, moist towel. No rinsing or drying is required. Use a washcloth from the plastic bag to wash the genital and rectal areas.

A bed bath is often a good choice for persons who are frail, non-ambulatory, considerably overweight, experience pain on transfer, or are fearful of lifts. It is possible to wash people adequately in the bed and it is often much less stressful. It is usually done with a basin of water, soap and washcloths, and rinsing off the soap. A variation on this method is the towel bath. Here, a person is covered with a large, warm, moist towel containing a no-rinse soap solution, and is washed and massaged through the towel.

e.) Spot on left buttock :

It should be monitored carefully. Skin biopsy can be taken to diagnose the spot and it can be removed by excision if its simple and bening. If its an infection, Anti-biotics can be given