NUR 111 SKILL 34-1: ASSISTING A PATIENT IN USING A BEDPAN

1. NUR 111 SKILL 34-1: ASSISTING A PATIENT IN USING A BEDPAN

2. ASSISTING A PATIENT IN USING A BEDPAN - INTRODUCTION • A patient restricted to bed must use a bedpan for bowel elimination. • Two types of bedpans are available. The regular and most commonly used bedpan has a curved, smooth upper end and a tapered lower end. • The upper end (wide end) of the regular pan fits under a patient’s buttocks toward the foot of the bed. • A fracture pan, designed for patients with body or leg casts or those who are restricted from raising their hips (e.g., following total joint replacement), slips easily under a patient. The shallow upper end of the pan with a flat, wide rim fits under a patient’s buttocks toward the sacrum, with the deep lower open end toward the foot of the bed.

3. ASSESSMENT • 1. Assess patient’s normal bowel elimination habits; routine pattern, character of stool, effect of certain foods/fluids and eating habits on bowel elimination, effect of stress and level of activity on normal bowel elimination patterns, current medications, and normal fluid intake. • 2. Auscultate abdomen for bowel sounds, and palpate lower abdomen for distention. • 3. Assess patient to determine level of mobility, including ability to sit upright and left hips or turn – determines if patient can help in positioning on bedpan or if assistance is needed. • Determines whether to use regular or fracture bedpan. Older adults, obese patients, patients who have had hip or knee surgery or spinal injury, and debilitated patients often require assistance of two or more nurses to help them onto or off the bedpan.

4. ASSESSMENT – CONT’D • 4. Assess patient’s level of comfort. Ask about presence of rectal or abdominal pain, presence of hemorrhoids, or irritation of skin surrounding anus. • Pain limits patient’s ability to help with positioning. Rectal or abdominal pain reduces patient’s ability to bear down during defecation. • 5. Determine need for stool specimen • Provides opportunity to obtain specimen container before placing patient on the bedpan.

5. PLANNING • 1. Expected Outcomes following completion of the procedure: • Perianal skin is clean and intact. • Patient eliminates without pain or discomfort. • 2. Explain procedure to patient, including self-help tips (e.g., how to use a trapeze, how to move hips). • Promotes independence, reduces anxiety, and helps patient to assist during the procedure • 3. Obtain assistance from additional nursing personnel as warranted. • Adequate personnel resources minimize muscle strain for you and patient. Reduces patient’s discomfort.

6. IMPLEMENTATION • 1. Perform hand hygiene. • 2. Provide privacy by closing curtains around bed or door of room. • 3. Raise side rail on opposite side of the bed. • 4. Raise bed horizontally according to your height. • 5. Have patient assume supine position. • Clinical Decision Point: Observe for the presence of drains, dressings, IV fluids, and traction. These devices make it difficult for a patient to assist with positioning, and you will likely need more personnel to help place him or her on a bedpan.

7. IMPLEMENTATION – CONT’D • 6. Place patient who can help on a bedpan. • A. Apply clean gloves. Raise head of patient’s bed 30 to 60 degrees. • B. Remove upper bed linens so they are out of the way but do not expose the patient. • C. Teach patient how to flex knees and lift hips upward. • D. Place your hand, closest to patient’s head, palm up under patient’s sacrum to help lift. Ask patient to bend knees and raise hips. As patient raises hips, use other hand to slip bedpan under him or her. Be sure that open rim of bedpan is facing toward foot of bed. Do not force pan under patient’s hips. (Optional: Have patient use overhead trapeze frame to raise hips). • E. Optional: If using fracture pan, slip it under patient as hips are raised. Be sure that deep, open, lower end of the bedpan is facing toward the foot of the bed.

8. IMPLEMENTATION – CONT’D • 7. Place patient who is immobile or has mobility restriction on the bedpan. • A. Apply clean gloves. Lower head of bed flat or raise head slightly (if tolerated by medical condition). • B. Remove top linens as necessary to turn patient while minimizing exposure • Prevents embarrassment to patient; demonstrates respect for patient’s sense of dignity. • C. Help patient roll onto side with back toward you. Place bedpan firmly against the patient’s buttocks and down into the mattress. Be sure that open rim of the bedpan is facing toward foot of the bed.

9. IMPLEMENTATION – CONT’D • 7. Place patient who is immobile or has mobility restriction on the bedpan. • D. Keep one hand against bedpan; place other around far hip of patient. Ask patient to roll back onto bedpan, flat in bed. Do not force pan under patient. • E. Raise patient’s head 30 degrees or to a comfortable level (unless contraindicated). • F. Have patient bend knees or raise knee gatch (unless contraindicated).

10. IMPLEMENTATION – CONT’D • 8. Maintain patient’s comfort and safety. Cover patient for warmth. Place small pillow or rolled towel under lumbar curve of back. • 9. Have call bell and toilet tissue within reach for the patient. • Promotes safety by preventing patient from reaching over edge of bed for objects out of reach. • 10. Ensure that the bed is in lowest position and raise upper side rails. • 11. Remove and discard gloves and perform hand hygiene. • 12. Allow patient to be alone but monitor status and respond promptly. • 13. Perform hand hygiene and apply clean gloves.

11. IMPLEMENTATION – CONT’D • 14. Remove the bedpan: • A. Place patient’s bedside chair close to working side of bed. • B. Maintain privacy; determine if patient is able to wipe own perineal area. If you clean perineal area, use several layers of toilet tissue or disposable washcloths. For female patients clean from mons pubis toward rectal area. • C. Deposit contaminated tissue in bedpan if no specimen or intake and output (I&O) is needed.

12. IMPLEMENTATION – CONT’D • D. For mobile patient: • Ask patient to flex knees, placing body weight on lower legs, feet, and upper torso; lift buttocks up from the bedpan. At the same time, place hand farthest from patient on the side of the bedpan to support it (prevent spillage) and place other hand (closest to patient) under sacrum to help lift. Have patient lift and remove the bedpan. Place the bedpan on draped bedside chair and cover it.

13. IMPLEMENTATION – CONT’D • E. For immobile patient: • Lower head of the bed. Help patient roll onto side away from you and off the bedpan. Hold bedpan flat and steady while patient is rolling off; otherwise spillage will occur. Place bedpan on draped bedside chair and cover it.

14. IMPLEMENTATION – CONT’D • 15. Allow patient to perform hand hygiene. Change soiled linens, remove and dispose of gloves, and return patient to a comfortable position – this reduces the chance of skin breakdown when bedridden patient lies on dry, wrinkle-free linens. • 16. Place bed in its lowest position. Ensure that the call bell, phone, drinking water, and desired personal items (e.g., books) are within easy access. • 17. Option: Obtain stool specimen as ordered. Wear gloves when emptying contents of bedpan into toilet or in special receptacle in utility room. Use spray faucet attached to most institution toilets to rinse bedpan thoroughly. Use disinfectant if required by agency, then store pan. Remove gloves. • 18. Perform hand hygiene.

15. EVALUATION • 1. Assess characteristics of stool. Note color, odor, consistency, frequency, amount, shape, and constituents. Assess characteristics of urine if patient voided in the bedpan. • 2. Evaluate patient’s ability to use the bedpan. • 3. Inspect patient’s perianal area and surrounding skin while removing the bedpan. • Liquid stool predisposes patient to skin breakdown. • 4. Evaluate patient’s overall activity tolerance and comfort. • Defecation and the use of a bedpan can by tiring.

16. UNEXPECTED OUTCOMES • 1. Patient is unable to successfully use the bedpan. • If patient’s mobility allows, obtain order for use of bedside commode. • 2. Patient is incontinent of stool. Avoid use of adult briefs for bedridden patient. • Establish regular schedule of offering bedpan. Adult briefs mask toileting needs and may potentiate skin breakdown. • 3. Patient is constipated, resulting from pain of defecation, immobility, or unnatural position for defecation. • 4. Patient develops irritation and breakdown of skin around perianal area. • 5. Blood in stool or black stool. • Perform fecal occult blood test.

17. RECORDING & REPORTING • Record the type of assistance needed and if patient tolerates getting on/off bedpan; character and amount of stool, and urine output if patient also voids. • Complete laboratory requisition if you collected stool of urine specimen and send to laboratory. Record the type of specimen sent. • SPECIAL CONSIDERATIONS – TEACHING: • Some patients on complete bed rest have an overhead trapeze frame connected to bed to help lift them on and off the bedpan. Teaching this activity helps to maintain strength of patient’s arms.

18. END OF SKILL • This is the end of your skill • Your book has not provided a video for this skill, but if you practice this skill, in the nursing lab, you should be able to pass it! • I have provided a video that I found on you-tube, for you, but remember, I found this video and it was not provided to you by the school. • The video may not match the exact directions that the program wishes you to follow, so while you may want to watch this video, you must practice this skill as the book directed! • Bedpan – Video from you-tube: • http://www.youtube.com/watch?v=BzvzCOu_l5c