Elimination and Toileting
Core concepts
Elimination care is about routine, dignity, and early recognition of change. Bladder and bowel training use scheduled toileting - offering the bedpan, toilet, or urinal at set intervals and after meals - rather than waiting for the call light. Answer call lights promptly; incontinence is not an emergency, but a resident left waiting may try to walk alone and fall.
Record what you see: amount, color, odor, consistency, and any blood. Report constipation, no bowel movement in several days, hard stool, or diarrhea - especially in a resident who is confused, since new confusion can accompany impaction or infection.
Catheter care: keep the drainage bag below the level of the bladder and off the floor, empty it regularly, keep tubing unkinked, and perform perineal care daily and after each bowel movement. Monitor for burning, cloudy or foul-smelling urine, and fever.
Traps
'Hold fluids to reduce accidents' - wrong. 'Hang the bag on the bed rail above the bladder' - wrong; urine backflows and causes infection. 'Ignore a small amount of blood' - wrong; report it. 'Force a resident onto the toilet who refuses' - wrong.
Rule of thumb
Any change in pattern - frequency, color, odor, consistency, or blood - is a reportable finding, not something to wait and see about.
Worked example
You empty a catheter bag and the urine is cloudy and strong-smelling, and the resident says it burns. Complete your care, record the observations, and report them to the nurse; those are classic signs of a urinary tract infection.