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Andrew Pollack-Gray

Nursing Notes

Incontinence Care

4 min read

Patient Needs

Support residents experiencing urinary or fecal incontinence while preserving dignity, comfort, independence, and skin integrity.

Care Goals:

  • Promote continence and independence when possible.
  • Provide timely toileting assistance.
  • Prevent moisture-associated skin damage.
  • Maintain cleanliness and comfort.
  • Respect privacy, preferences, and individual abilities.

What Should I Assess?

Observe and report:

  • Urinary or bowel incontinence episodes and changes from baseline.
  • Frequency, timing, and patterns of elimination.
  • Ability to recognize and communicate toileting needs.
  • Mobility, balance, and assistance required for toileting.
  • Skin redness, irritation, moisture damage, or breakdown.
  • Pain, burning, discomfort, constipation, diarrhea, or other unusual symptoms.
  • Resident preferences and emotional responses to incontinence.

How Do I Provide Care?

Toileting Assistance

  1. Review the care plan and prescribed toileting schedule.
  2. Offer toileting assistance at appropriate times and when requested.
  3. Provide safe assistance with walking, transfers, bedpans, or commodes as directed.
  4. Allow adequate time and encourage independence.
  5. Provide privacy and ensure the call light is accessible.
  6. Document elimination and incontinence episodes when required.

Individualized Toileting Schedule:

  • Follow the resident’s prescribed toileting plan.
  • A two-hour schedule may be appropriate for some residents but is not a universal requirement.
  • Report recurring accidents or changes in elimination patterns so the nurse can reassess the plan.

Common Approaches:

  • Scheduled/Timed Toileting: Offering toileting at planned intervals.
  • Prompted Voiding: Regularly checking for toileting needs and encouraging participation.
  • Habit Retraining: Using observed elimination patterns to support an individualized schedule.

CNAs assist with established toileting programs rather than independently prescribing or changing them.

Cleansing and Skin Care

  1. Perform hand hygiene and use appropriate PPE.
  2. Remove soiled garments or absorbent products promptly.
  3. Clean the affected skin gently using approved products.
  4. Follow Perineal Care procedures.
  5. Rinse when required by the product instructions and pat the skin dry.
  6. Apply an approved skin protectant or barrier product when directed.
  7. Replace soiled garments and use appropriate clean absorbent products.
  8. Ensure the resident is comfortable and safely positioned.
  9. Dispose of soiled materials and perform hand hygiene.

Important: Avoid harsh scrubbing, unnecessary friction, and leaving skin exposed to urine or stool.

Supporting Independence

  • Encourage residents to communicate toileting needs.
  • Offer assistance without rushing or expressing frustration.
  • Provide appropriate clothing and approved adaptive equipment.
  • Support the resident’s preferred toileting routine when safe.
  • Avoid embarrassing or infantilizing language.

Safety & Precautions

  • Follow fall precautions and prescribed assistance levels during toileting.
  • Stay with residents who require continuous supervision for safety.
  • Use appropriate infection-prevention measures.
  • Check skin during routine hygiene care and report abnormalities.
  • Use only approved cleansing and skin-protection products.
  • Do not restrict fluids independently to reduce incontinence episodes.
  • Do not leave wet or soiled absorbent products in place unnecessarily.
  • Do not treat new incontinence as an inevitable consequence of aging.
  • Follow the resident’s care plan and facility procedures.

What Should I Report?

  • New or worsening urinary or fecal incontinence.
  • Changes in frequency, timing, or elimination patterns.
  • Skin redness, rash, open areas, or other signs of breakdown.
  • Pain, burning, blood in urine or stool, or other unusual findings.
  • Constipation, diarrhea, or difficulty passing urine.
  • Increased assistance needs or toileting-related falls.
  • Repeated incontinence episodes despite the established toileting plan.
  • Resident distress, refusal of care, or difficulty maintaining dignity and comfort.

Report urgent or concerning changes promptly according to facility policy.

Sources

Flashcards

What reduces skin injury related to incontinence?03-application / patient-care
Answer

Prompt cleansing, drying, and approved skin protection.

Should every resident with incontinence follow a two-hour toileting schedule?03-application / patient-care
Answer

No. Toileting schedules are individualized according to the care plan.

Why is gentle skin cleansing important during incontinence care?03-application / patient-care
Answer

It limits irritation and moisture-associated skin damage.

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