Chapter 15
Elimination
GOALS
- Discuss daily elimination patterns and needs.
- Explain special urinary and bowel elimination needs.
After practice, you will be able to: help a person use toilet/commode/bedpan/urinal; give perineal care with a catheter; empty a drainage bag; apply an external catheter (male); collect urine/stool specimens; strain urine; test urine for glucose/acetone; and give cleansing/oil‑retention enemas per policy.
Key Terms
Eliminating Body Waste — Overview
Food provides nutrients; wastes are eliminated as urine, feces, and perspiration. Use professional terms (void/urinate, defecate) while respecting the person’s preferred language to aid cooperation.
Daily Elimination
- Urine: ~1–1.5 quarts/day; clear golden to amber; darker in morning; lighter with good fluid intake.
- Stool: Typically brown, soft, and formed; ~¾ water. Adequate fluids support regularity.
Prolonged concentrated urine can irritate the bladder and promote infection.
Patterns & Maintaining Normal Patterns
- Ask how often the person voids and has a BM, usual time of day, and special habits.
- Consult family or chart to learn patterns if needed.
- Answer call lights promptly; provide privacy and adequate time.
- Be sensitive to embarrassment; keep a professional attitude.
- Encourage 6–8 glasses of fluid/day, exercise, and high‑fiber foods.
Helping a Person Use the Toilet
- Ensure safety; stay nearby and check every ~5 minutes.
- Help with robe/slippers; position and wait just outside the door.
- Report significant changes or difficulty voiding/defecating.
Alternative Toilets
- Seat over removable container; lock wheels if present.
- Check every ~5 minutes; person must be able to sit with little assist.
- Regular bedpan preferred; fracture pan for limited mobility.
- Men may prefer urinal; sitting or standing if safe.
- Limit time on bedpan; prolonged pressure ↑ ulcer risk.
Measuring Fluid Output (I&O)
Pour contents from commode/bedpan/urinal into a graduate to read the volume. Record on the I&O sheet; note incontinence episodes and other outputs (vomit, diarrhea) per nurse guidance.
Special Urinary Elimination Needs
Report changes in frequency, volume, color, or odor. Older adults may have atypical UTI symptoms. Causes of incontinence include neurologic issues, weakened sphincter, diuretics, confusion, mobility limits, unanswered call lights, and UTI.
Preventing & Recognizing UTIs
- Pain/burning on urination; frequent/urgent voids with small amounts.
- Cloudy, dark, or foul‑smelling urine; possible blood or mucus.
- Fever; behavioral changes in older adults.
- Offer fluids often; allow time to completely empty bladder.
- Perineal care front→back; change briefs promptly if used.
- Support bladder‑training programs (often q2h schedule).
Catheters — Perineal & Device Care
- Provide regular perineal care and when soiled; keep skin clean/dry; report redness, swelling, or blood.
- Keep drainage bag below bladder level; avoid kinks; secure tubing to thigh; keep off floor.
- Move the bag before transferring to chair; report accidental removal.
Emptying a Drainage Bag
Release the clamp and drain urine into a clean graduate without letting the tip touch anything. Record time, amount, and observations (color, clarity, odor, pain).
External (Condom) Catheter — Male
- Lower UTI risk than indwelling; fits over penis and connects to tubing and bag (leg bag or standard).
- Remove daily for bathing; reapply to clean, dry skin. Ensure it’s not too tight and fully unrolled; check circulation.
- Empty small leg bags at least q2h.
Collecting Urine Specimens
Testing Urine for Glucose & Acetone
Performed per care plan (often for diabetes). Report results promptly—diet or insulin may need adjustment.
Special Bowel Elimination Needs
Report pattern changes (e.g., usual daily post‑lunch BM → none for 3 days). Common issues: constipation, fecal impaction, diarrhea, and bowel incontinence.
Constipation & Fecal Impaction
- Contributors: low fluids, ignoring urge, inactivity, diet change, aging, disease, meds.
- Care: encourage fluids, fiber, walks; support normal patterns; report changes; enemas/meds per policy.
- Hard stool lodged in rectum; may ooze mucus/liquid around mass.
- Very painful; nurse may perform disimpaction or order enema.
Diarrhea — Care & Comfort
- Causes include infection, allergies, diet; risks include dehydration and skin irritation.
- Respond quickly; offer clear liquids as ordered; provide meticulous skin care; ensure cleanliness and airflow.
- Use Standard/Isolation Precautions; teach hand hygiene; report occurrences to nurse.
Bowel Incontinence & Training
- Causes: neurologic damage, weak sphincter, meds, confusion, limited mobility, delayed help, diarrhea, impaction.
- Care: prompt toileting, fluids, fiber, mobility help, privacy/time, frequent brief changes and perineal care, emotional support.
- Support individualized bowel‑training schedules on the care plan.
Collecting Stool Specimens
Wear gloves and follow Standard Precautions. Have the person void first to avoid urine in the sample; follow nurse instructions for handling and transport.
End of Chapter 15 — Elimination