Elimination and Toileting Assistance
Toileting as a routine
Most residents have a bladder or bowel pattern that can be learned from the care plan and from their own history. Scheduled toileting, prompting, and bladder retraining reduce incontinence and preserve dignity. Offer the toilet or bedpan before and after meals, before sleep, and on awakening. Provide privacy, close the door or curtain, and give time; rushing produces accidents. Never leave a resident on a bedpan longer than necessary, and never leave a dependent resident sitting on the toilet alone.
Equipment and perineal care
Use a fracture pan for a resident who cannot lift the hips. Nudge the pan under the hips rather than dragging. After toileting, clean front to back with a fresh cloth for each stroke, dry well, and report any redness or skin breakdown. For an indwelling catheter, keep the drainage bag below the level of the bladder, keep tubing unkinked and free of loops, empty the bag when it is about half full, measure the output, and provide daily perineal care.
Look before you flush
Urine and stool are data. Note urine color, clarity, odor, sediment, and blood; note stool color, consistency, frequency, and any blood or black tarry appearance. Report no bowel movement in three days, diarrhea, burning on urination, or a sudden change in pattern. Empty an ostomy pouch, note the contents, and report changes.
Traps on exams
Hanging the catheter bag on the side rail above the bladder, forcing fluids to "flush the system," or discarding output before looking at it are wrong. So is ignoring a resident's request for the toilet because it is not the scheduled time.
Rule of thumb
Every trip to the bathroom ends with a look at what was produced and a note if it is different.