Incontinence Management

By Janet Wolfson, PT, CLWT, CWS, CLT-LANA My current job as wound coordinator has pulled me into the world of incontinence and the many disciplines that care for people challenged by this disorder. I was previously acquainted with the therapy side as I worked with therapists certified in pelvic floor therapy. My work with venous edema acquainted me with medications that caused continence-challenged people to resort to absorbent adult briefs. As I work more closely with physicians, I am more familiar with medications to support weakened or sensitive pelvic muscles and nerves. On the nursing side, I have researched support surfaces, incontinence pads, and barrier creams. I see patients and occupational therapists working together to regain continence independence through problem-solving mobility issues.

By Margaret Heale, RN, MSc, CWOCN Not very long ago, when working in an in-patient rehab center, I was shocked to discover patients calling the adult incontinence garments "hospital underwear." We were making good inroads into reducing the use of these products with the hope that if we used less it would be possible to acquire higher-quality products that would function optimally for patients who really needed them. It was of concern that some facilities had become diaper-free because many of our patients benefited from briefs, particularly as a "just in case security blanket" and we felt it was unrealistic for our patient population to be brief-free.

Diaper rash, more officially known as incontinence-associated dermatitis (IAD), affects hospitalized and incontinent patients of all ages. In my years as a WOC Nurse in a pediatric hospital, IAD has been by far the most frequently treated condition. However, outside of a health care setting, IAD is the most common skin problem in infants and young children who are not yet toilet trained. Diaper rash has plagued babies and new parents for centuries, yet its treatment remains highly debated. For the purpose of this article, I am focusing on the prevention and treatment of diaper rashes in infants and young children, although the principles of topical treatment discussed here apply to all patients.

Ivy Razmus, RN, PhD, CWOCN Moisture-associated dermatitis has been described as "inflammation and erosion of the skin due to prolonged exposure to moisture and its contents which include urine, stool, perspiration, wound exudate, mucus, or saliva." Incontinence dermatitis is caused by overhydration of the skin, maceration, prolonged contact with urine and feces, retained diaper soaps, and topical preparations. Indeed, diaper dermatitis has been used to describe an infant's skin breakdown related to moisture exposure.

By Aletha Tippett MD For over a decade now I have treated wounds in palliative care patients and non-palliative care patients. The “funny” thing is that there is no difference in how I treat these wounds, all are approached the same way, with similar treatments used. As I teach more and more about palliative wound care, it seems obvious to me that all wounds and all people deserve this approach. Who does not deserve less pain? Who deserves to be embarrassed by wound odor? Who deserves to have an infection? Who deserves a lesser quality of life? When asked these questions I would think the answer would be NO ONE.

By Terri Kolenich, RN, CWCA, AAPWCA We all have hobbies outside of what we do for a living. At least, we all should have hobbies or interests outside of our careers. Our hobbies are our outlet for stress. I love to draw. I also enjoy painting. What I love most of all is acting and theater. I love being on stage, performing, and getting an emotional response from my audience. Everyone that knows me well knows how much I love acting on stage. Bringing a script to life exhilarates me. Just the thought of performing live, delivering memorized lines, and anticipating the reaction of my fellow actors stirs and motivates me. Most of all I crave the opportunity to use my improvising skills when a scene goes an unexpected direction.

By Margaret Heale, RN, MSc, CWOCN People can be open with few secrets and little to hide but even then there are behaviors, memories, hopes, fears and desires that are not revealed. We have a right to be in control of this part of ourselves and the flesh that encompasses it. Such control is part of the freedom we covet as a nation.

By Karen Zulkowski DNS, RN, CWS I previously discussed the need for a complete head-to-toe skin assessment. Certainly this can tell you whether or not the person is dehydrated, has open or discolored areas, and many other things about their overall health. Color, for example, can give you clues to additional problems such as vitamin and mineral deficiencies that can show on the skin.

By Margaret Heale, RN, MSc, CWOCN Well, I was a matron such a long time ago when we still had candy stripers and you swallowed tablets or wrote on them with chalk. My granddaughter is doing some work at a local nursing home and offered to show me around. I held my breath as we entered, to assess the OOS (odor offense scale), something I learned when doing nursing home assessments way back when. A breath out and a slow even breath in through the nose and- mmm! Most unexpected, it must be almost lunchtime. Quite different from my day. Today's chat is about why.