Elimination and Restorative Care
What you must know
Elimination is a normal function that residents lose privacy over - protect it. Know each resident's usual pattern and record bowel movements, describing character objectively (color, consistency, amount, unusual odor), because the nurse depends on that record to catch constipation, impaction, or diarrhea. Report blood in stool or urine, no bowel movement in several days with complaints of discomfort, and any new incontinence.
Catheter care: keep the drainage bag below the level of the bladder and off the floor, never let tubing loop or pull, empty the bag regularly and record the amount, and provide perineal hygiene daily and after each bowel movement. Keep the system closed - never disconnect tubing. Cloudy, foul-smelling urine, fever, or new confusion can signal a urinary tract infection; report it.
Bowel and bladder training uses scheduled toileting, prompted voiding, adequate fluids, and praise for success. Follow the schedule; do not scold accidents.
Restorative care means helping residents regain and keep function. Carry out the ordered range-of-motion exercises, encourage self-feeding and self-dressing with setup, apply splints as ordered, position correctly, and walk residents as the care plan directs. Progress is built on repetition - do not take over a task because it is faster. Report pain, new weakness, swelling, or a resident's refusal so the plan can be adjusted.
Traps
Letting the bag touch the floor; hanging the bag above the bladder; skipping documentation because "nothing happened"; doing a restorative walk only when you have time.
Rule of thumb: in restorative questions, choose the answer that has the resident do as much as possible for themselves safely.
Worked example: A resident on a bladder-training schedule is wet before the scheduled time. Change them, note the time, keep the schedule, and report the accident - the nurse may adjust the plan.