Care of patients undergoing removal of an indwelling urinary catheter.

An indwelling urinary (Foley) catheter may be used in the management of various urological conditions, such as intractable incontinence and urinary retention, or as part of treatment regimens such as chemotherapy. Although some catheters may be required for long-term use, healthcare practitioners should regularly assess whether the device is still necessary and if it can be removed. This is because urinary catheters are a highly invasive intervention and their use is associated with a range of potential complications, including healthcare-associated infection and trauma to the neck of the bladder. This article outlines the procedure for the safe removal of a urinary catheter, including the patient care and monitoring required before, during and after this procedure. It also explains the complications that are associated with catheter removal and how these can be prevented and managed.

Assessment, prevention and treatment of faecal incontinence in older people.

Faecal incontinence is an impaired ability to control the passage of stool, often described as involuntary loss of solid or liquid stool, and the symptom of an underlying diagnosis. It is a common problem in older adults. Although not a life-threatening condition, it can have a significant negative effect on an individual's quality of life and adverse medical, social and economic consequences. Due to the taboo and stigmatising nature of the condition many individuals do not seek assistance. Healthcare professionals should take every opportunity to ask about faecal incontinence symptoms so that symptomatic relief and treatment interventions can be initiated. There are several conservative approaches available for the treatment of faecal incontinence, which should be considered as first line to target symptomatic relief.

Assessment, management and prevention of urinary tract infections in men.

While urinary tract infections (UTIs) are uncommon in healthy men aged under 50 years, their prevalence rises in men aged over 65 years. UTIs can be classified as uncomplicated or complicated. UTI in men is considered to be more complicated than in women, because it is often related to abnormalities of the urinary tract, such as prostatic enlargement or a urethral stricture. UTI is associated with a significant disease burden and cost to patients and healthcare organisations. It is one of the most common reasons for prescription of antibiotics in primary care; however, because antibiotic resistance is becoming increasingly widespread, it is essential that these drugs are used prudently. The main strategy for preventing UTIs in men is to avoid the use of indwelling catheters.

Diagnosis, prevention and treatment of urinary tract infections in older people.

Urinary tract infections (UTIs) are common in older people, with the prevalence increasing with age in both sexes. UTI is a frequent reason for emergency admission to hospital. There are many conditions that contribute to older people being more at risk of UTI and the main preventive strategy is to avoid the use of indwelling urethral catheters. Where an indwelling catheter is inserted its continued use should be regularly reviewed and the catheter removed, especially if the reason for insertion is incontinence and the person becomes additionally incontinent of faeces. Diagnosis of UTI can be complex because older people do not always exhibit the signs and symptoms commonly associated with UTI. Diagnosis can be further complicated by a person's inability to provide a comprehensive history and by difficulties obtaining an uncontaminated, 'clean catch' urine specimen. Antibiotic therapy should not be used routinely for people with asymptomatic bacteriuria and, where antibiotics are required, healthcare professionals should follow local prescribing guidelines.

Assessment and treatment options for patients with constipation.

Constipation is a common complaint for people of all ages, with prevalence increasing with age and during pregnancy. Women are more likely to be affected than men. Severity of constipation varies from person to person; most people experience short periods of constipation during their lives, including possibly after surgery, while others have constipation as a chronic long-term condition that can significantly affect their quality of life. There are a number of factors that can contribute to developing constipation including diets low in fibre, changes in lifestyle, side effects of certain medications and low fluid intake. People can successfully treat constipation by making changes to their diet and lifestyle. However, medication may be required to manage constipation for some.

How to remove an indwelling urinary catheter in female patients.

Rationale and key points This article aims to assist nurses to undertake the removal of an indwelling urinary catheter in female patients in a safe, timely, effective and patient-centred manner, while maintaining the patient's privacy and dignity. It is important for the nurse to be competent in undertaking this procedure, and to be aware of local and national policies on catheter removal. ¼ Indwelling urinary catheters should be changed only when clinically necessary, or according to the manufacturer's guidelines. ¼ Urinary catheters should be removed using sterile equipment. ¼ The balloon of the indwelling catheter must be deflated before removal, and the catheter should be removed slowly to minimise trauma. Reflective activity 'How to' articles can help you update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: ¼ How you think this article might change your practice when removing an indwelling urinary catheter. ¼ How you could use this article to educate your colleagues.

An overview of urinary incontinence.

Urinary incontinence is a common problem that is often under-reported due to the embarrassing nature and social stigma attached. Urinary incontinence can have a considerable effect on an individual's quality of life, but can be significantly improved with correct assessment, treatment and management. Conservative treatment options, including pelvic floor exercises, bladder retraining and fluid modification, are recommended before referral to secondary services. This article provides an overview of the main types of urinary incontinence, and summarises recent guidelines for the assessment, diagnosis and effective conservative treatment options for them, and when a referral to specialist care is required.

ISC in women following urogynaecologic surgery.

Urinary retention is a common problem for women following surgery, and a significant complication for those who have undergone urogynaecologic surgery, with prevalence estimated between 2.5% and 24% (Dorflinger and Monga, 2001). Postoperative urinary retention (POUR) can lead to bladder distention, causing altered bladder function, urinary tract infections and poor surgical outcomes. Intermittent self-catheterisation (ISC) for women is generally considered preferable to indwelling catheterisation wherever possible. This article explores the role of ISC for women following surgery.

Approaches to managing chronic constipation in older people within the community setting.

Constipation is a common presenting problem within the community setting, but its treatment is often unsatisfactory. It is important for nurses to remember that constipation is a symptom and not a disease. For older adults, constipation can have a gradual onset over a number of years, with many people 'self-medicating' with over-the-counter laxatives and herbal products, which then result in the need for daily laxatives. This article will consider best practice for the assessment, treatment, and prevention of constipation in adults within the community.

How to perform a urinalysis.

RATIONALE AND KEY POINTS: This article aims to help nurses to undertake a urinalysis in a safe, timely, effective and patient-centred manner, ensuring privacy and dignity. Urinalysis is a common clinical procedure involving examination of urine to detect problems in the body. ▶ Urinalysis should be carried out by competent healthcare practitioners. ▶ Urinalysis is a simple, cost-effective tool which can be performed for screening, diagnosis and management of conditions, because urine might undergo several changes as an individual becomes unwell. ▶ Urinalysis is an essential component of the holistic and symptomatic assessment of any individual in poor health. ▶ The healthcare practitioner should explain the procedure to patients. ▶ The healthcare practitioner should document relevant findings. REFLECTIVE ACTIVITY: Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How reading this article will change your practice. 2. The learning points you have identified, and how you can dissesminate these points to your colleagues. 3. Any further learning needs you have identified. Subscribers can upload their reflective accounts at: rcni.com/portfolio.

Safe and effective catheterisation for patients in the community.

Approximately 450 000 people use long-term urinary catheters in the UK. Permanent catheters are used by 3% of the community population and occupy an estimated 4% of a district nurse's caseload in the UK. Catheterisation is defined as 'drainage or aspiration of the bladder or urinary reservoir' and can be intermittent or indwelling. Long-term indwelling catheterisation can be transurethral or suprapubic via the anterior abdominal wall. This article will discuss the safe and effective use of different forms of catheterisation for patients in the community setting.

Intermittent self-catheterisation in women: reducing the risk of UTIs.

Intermittent self-catheterisation (ISC) is the insertion and removal of a catheter to drain the bladder and is a safe and effective way to preserve renal function. It can be used as a one-off intervention to drain urine post-operatively or to measure residual urine volumes if a bladder scanner is unavailable. ISC can also be used as a long-term option to manage bladder dysfunction, and for some provides an excellent option to maintain independence and improve quality of life. Urinary tract infections are a common complication for women undertaking ISC. This article explores the prevention of urinary tract infections in women undertaking long-term ISC for the management of bladder dysfunction.

Promoting urinary continence in older women.

Continence promotion involves informing and educating the public and healthcare professionals that urinary incontinence is not an inevitable part of ageing, and can be treated or at least made more manageable. While awareness of urinary continence is improving slowly, the taboo around discussing incontinence remains. Women are at increased risk of developing urinary incontinence as they grow older because of physiological, functional and cognitive changes. Healthcare professionals can identify women with bladder symptoms by routinely asking trigger questions and can promote continence through education about lifestyle choices that aggravate or ameliorate urinary incontinence. This article discusses the main risk factors associated with urinary incontinence in older women and the ways in which healthcare professionals can help to identify those with symptoms of urinary incontinence.

Prevention and management of incontinence-associated dermatitis.

Maintaining skin integrity in people with incontinence is challenging. Incontinence is common in older people and those compromised by medical or surgical comorbidities. Urinary and faecal incontinence can result in skin breakdown, which is characterised by erosion of the epidermis, creating a moist, macerated appearance to the skin. Incontinence and associated skin breakdown can have a considerable effect on an individual's physical and psychological wellbeing. This article discusses the aetiology of incontinence-associated dermatitis and considers the best options for the prevention, management and treatment of this condition.

Key trends in the management and treatment of stress urinary incontinence.

Stress urinary incontinence is a problem affecting about 42% of women in the UK. Nurses are working to overcome the perception that it is a natural outcome of childbirth or the ageing process. This paper provides an overview of current treatment options, including lifestyle management, pelvic floor exercises and surgical options.