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Use The RAP To Identify, Address Causes Of Incontinence
Published on Wed Mar 28, 2007
Incontinence is a care and quality of life issue.
If the resident has urinary incontinence or an indwelling urinary catheter, check out what the resident assessment protocol suggests evaluating as potential causes and testing.
Possible reversible problems to be reviewed in evaluating incontinence or need for catheter:
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Conditions: Delirium [B5], Fecal Impactions [H2d], Depression [I1ee], UTI [I2j], Edema [J1g].
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Environment: Locomotion [G1c,d,e,f], Lack of access to toilet, Barriers [observation], Restraints [P4].
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Diagnoses: Diabetes [I1a], CHF [I1f], CVA [I1t], Parkinson's [I1y].
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Medications: Diuretics [O4e], Parkinson's meds, Disopyramide, Antispasmodics, Antihistamines, Drugs that stimulate or block sympathetic nervous system, Calcium channel blockers (verapamil, nifedipine, diltiazem), Narcotics [from record].
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Psychoactive Medications: Antipsychotics, Antianxiety, Antidepressants, Hypnotics, [O4a,b,c,d].
Other potential factors contributing to incontinence or use of catheter:
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Conditions: Pain [J2]
Excessive or inadequate urine output
Atrophic vaginitis
Cancer of bladder, prostate, brain, or spine, tabes dorsalis [from record or exam].
Final evaluation if incontinence persists:
[Note: Tests not indicated when Comatose [B1] or when No memory recall [B3e] AND Dependent in Transfer, Locomotion [G1b,c,d,e,f ] are both present.]
Final evaluation for residents with indwelling catheters:
If indwelling catheter [H3d], do Voiding Trial unless Untreatable urethral blockage [I3]
Terminal illness [J5c] or
Stage 3 or 4 pressure ulcer [M2a] present.