NursingLink

I am taking care of an ALS patient who recently lost urinary continence and had a Foley cath put in.  we've replaced it once so far.  No problems with it.    The problem is: Due to the ALS, she is to the point where she can only blink her eyes or shake her head.  I do passive range of motion on knees, arms, etc. but I am only there for 3 hours daily.  She has pretty much lost any movement.  When I try to do the ROM now, especially involving the knees, she is in agony, even after giving her a pain med via her G-tube first.  Before the foley catheter, she used to be lifted out of bed by her husband numerous times a day to use the bedside commode.  Now there's not even that limited activity.  A few months ago, when her legs were still able to bend, he was able to get her from bed to wheelchair to shower chair and give her a shower.  this got increasingly more difficult as she lost mobility.  then, one day, they fell in the shower and that ended the showers.  She is also having difficulty having BM's.  Her NP prescribed medication for this and Fleet's enemas.  She only goes after she gets the Fleets.  I'm relating this as background for my real dilemma:  My patient cannot lift or bend her knees.  Cannot sit on a bedpan.  Can only lay flat.  When she has the BM, it goes everywhere, up between her thighs, all around the catheter (you get it).  Her husband and I are banging our heads trying to figure out a better way.  We solved the hair shampooing problem by ordering this WONDERFUL inflatable shampoo "sink" that fits right under her head while she's flat in bed.  Works perfectly.  In the same catalog was this inflatable tub that you roll under the patient, then blow up.  It has a drain tube, a pillow and looks like it would work really well.  the problem is it is not protocol to give someone who has an indwelling catheter a bath.  A shower is OK, but not bathing.  For infection reasons, I'm certain.  However, there is only so much sponge bathing in the world.  This is a patient who cannot open her legs without significant pain.  Do we risk infection because we cannot get her clean enough from fecal contamination or do we risk a quick bath where we can swish water around and get her really clean for once?

there are external incontinence devices available that you could have ready to put in place after the fleets. Does she have a hospital bed so you can tilt the bed slightly to let things flow downhill and away from her? I have also had some good luck with disposable chucks, to create a barrier to keep stool from getting on the foley tubing.

sounds like you are doing a great job of patient care. Shan is right, you have to clean her completely after every episode of BM incontinence or she will get infections. You might have to question the use of the foley if you cannot keep the tubing clean. She needs to be turned every 2 hours anyway, so it might be better to do urinary incontinent care for her. I do not know anybody that liked having a foley in place for very long. She might be more comfortable without it.

take care

Walt