Elimination and Toileting Assistance
Normal and abnormal
Know each resident's usual pattern. Report changes: no bowel movement in three days, hard or small stools, diarrhea, blood in stool or urine, painful urination, cloudy or foul-smelling urine, or a sudden loss of continence. Constipation and urinary tract infection are among the most common problems in long-term care and often appear first as confusion or restlessness.
Toileting assistance
Offer the toilet or bedpan on a schedule - before and after meals, at bedtime, on waking, and every two hours for a resident on a bladder-training program. Answer call lights quickly; delays are a dignity issue and a fall risk. Provide privacy and never hurry someone.
Perineal care is always front to back so stool stays away from the urethra. Wash with warm water and mild soap, rinse, and dry well. Change soiled linens and clothing promptly and check the skin at every change.
Catheter care
Keep the drainage bag below the level of the bladder and off the floor. Do not kink or pull the tubing; coil it so it does not tug. Clean at the meatus with soap and water, from the meatus outward, daily and after each bowel movement. Empty the bag when it is about half full, measure, and record. Keep the system closed except when emptying.
Traps
- Wiping back to front.
- Hanging the bag on a bed rail above the bladder.
- Leaving a resident alone on a toilet or bedpan for a long time.
- Discarding a specimen or soiled pad without showing or reporting it.
Rule of thumb
Front to back, bag below the bladder, and report any change in pattern before it becomes a problem.