Elimination and Toileting Assistance
Normal patterns and routines
Know each resident's usual bowel and bladder routine and offer toileting on a schedule, before and after meals, at bedtime, and on waking. Prompted toileting and bladder or bowel training programs are restorative, not just convenience. Provide privacy, never rush, and stay nearby per policy. For a bedpan, warm the pan, raise the head of the bed, and use a fracture pan when the resident must stay flat.
Observation and reporting
Note and report the color, consistency, amount, and odor of stool and urine. Report black tarry stool, blood, clay-colored or white stool, very frequent watery stools, or no bowel movement for several days. Liquid oozing around a firm stool may signal an impaction, not diarrhea. Signs of urinary tract infection include burning, urgency, cloudy or foul urine, and new confusion in older adults.
Catheters and ostomy care
Keep the drainage bag below the level of the bladder and off the floor, tubing unkinked and without tension, and perform perineal care daily and after bowel movements. Never disconnect the system or empty the bag into a used container. Empty an ostomy pouch when it is about one-third to one-half full, check the seal and skin around the stoma, and report redness, swelling, or changes in output.
Specimens and equipment
Collect specimens as directed, label correctly, and send promptly. Clean and store bedpans and urinals properly; never place a container on the floor and then use it for a resident.
Traps
Exams test the impaction-versus-diarrhea distinction and the catheter bag held at waist height while walking. Also watch for aides who ignore a call light for toileting or who leave a resident alone on a bedpan longer than needed.
Rule of thumb
Schedule, observe, document, and report anything that looks or smells unusual.