Textbook for Nursing Assistants

1. Textbook for Nursing Assistants Chapter 21: Assisting With Urinary and Bowel Elimination

2. www.cbsnews.com/videos/water-intoxication-death/ • https://youtu.be/1Vj5aYc5ZVg

3. Assisting With Elimination

4. Fluid Imbalance • Water is lost from skin, lungs, and GI tract • Dehydration- diarrhea, vomiting, bleeding, diaphoresis, poor PO intake Symptoms= fever?, decreased urine output, concentrated urine, decreased weight, mucous membranes dry • Edema- infections, increased sodium intake, kidney diseases, heart disease, sitting for too long in one position, Symptoms= decreased output, weight gain, swelling, SOB

5. Assisting With Elimination • Some patients or residents may only need a steady arm to lean on during their trip to the bathroom; others will need more help • The bathrooms in many health care facilities have special features that make them easier for people with physical disabilities to use

6. Assisting with Elimination • Modifications allow many patients or residents to use the toilet in the bathroom with very little assistance from a nursing assistant

7. Assisting with Elimination - Elimination Equipment • Some patients or residents may not be able to get out of bed at all, or they may be too weak or ill to walk to the bathroom. These people may need to use • Bedside commodes • Bedpans • Urinals

8. Elimination Equipment: Bedside Commodes • The bedside commode consists of a chair frame with a toilet seat and a removable collection bucket • For a person who is able to get out of bed but who is not able to walk to the bathroom, a bedside commode can make toileting easier

9. Elimination Equipment: Bedpans • A bedpan is used for elimination when a person is unable to get out of bed at all • A woman who cannot get out of bed uses a bedpan to urinate and for bowel movements. A man who cannot get out of bed uses a bedpan for bowel movements, and a urinal to urinate

10. Elimination Equipment :Fracture Pans • Arthritis can make using a bedpan very painful, as can fractures of the back or legs • In such cases, when using a bedpan is uncomfortable or dangerous, a special bedpan called a fracture pan is used

11. Elimination Equipment: Fracture Pans • The fracture pan, which is wedge-shaped, is placed underneath the person’s buttocks with the thin edge toward the person’s back

12. Fracture Pans and Bedpans: Useful Tips • Warm a metal bedpan before offering it to the patient or resident by wrapping the bedpan in a warm towel, or running warm water over the seat area and then drying it before use • Apply a small amount of powder to the rim of the bedpan to make it easier to slide under the person • Provide as much privacy as safely possible

13. Fracture Pans and Bedpans: Useful Tips • If the person’s condition allows, raise the head of the bed to promote a more natural elimination position

14. Elimination Equipment: Urinals • A man uses a urinal to urinate when he cannot get out of bed

15. Elimination Equipment: Urinals • To urinate, the man puts his penis in the opening of the urinal • If the man is very weak or disabled, you may need to place his penis inside the opening of the urinal for him

16. Difficulty With Normal Elimination • A patient or a resident may have difficulty with elimination, if elimination occurs under conditions that are not as private as the person would like • In a health care facility, people may share a bathroom or use a bedpan while only being separated from other people in the room by a curtain

17. Difficulty With Normal Elimination • Feelings of embarrassment and shame are made worse when patients or residents accidentally soil themselves, their bed linens, or their clothing with urine or feces. This might be due to: • The effects of medications • Being in a strange place • Reluctance to ask for help • Physical or mental disabilities

18. Promoting Normal Elimination • Kindness, empathy, and a professional attitude can go a long way toward easing the patient’s or resident’s embarrassment

19. Promoting Normal Elimination • Being in a health care facility can change a person’s normal elimination patterns, which can cause health problems • The most effective method of treating urinary and bowel problems is to prevent them from happening in the first place

20. Promoting Normal Elimination • Encourage plenty of fluids, unless the doctor has ordered against it • Answer call lights promptly • Encourage the person to call when he first feels the urge to void • Offer people the chance to eliminate frequently • Provide for privacy and comfort • The sound of running water may help some people to urinate • If a person is having difficulty moving his bowels, do not rush the person • Regular exercise and foods containing insoluble fiber help promote regular bowel movements

21. Obtaining Urine and Stool Specimens • The contents of a person’s urine or feces can provide a doctor with clues about the person’s overall health status • A nursing assistant may be asked to obtain a urine or stool specimen (sample) for laboratory study

22. Obtaining Urine and Stool Specimens • Before collecting any specimen—of urine, feces, or any other body fluid—ask yourself the following questions: • Do I have the right person? • Do I have the right laboratory requisition slip? • What method is to be used to collect the specimen? • Do I have the right type of specimen container? • Is the specimen container properly labeled? • What is the correct date and time? • What storage and delivery method must I use?

23. Obtaining Urine and Stool Specimens • Always remember to wear gloves when assisting with specimen collection and when handling the specimen containerss

24. Obtaining Urine and Stool Specimens: Urinalysis • Urinalysis, or examination of the urine under a microscope and by chemical means, is a commonly used diagnostic tool in the health care setting • Substances found in urine during urinalysis can help doctors diagnose kidney disease, certain metabolic diseases, and infections • To perform urinalysis, a urine specimen must be obtained

25. Obtaining Urine Specimens: Routine Urinalysis • For routine urinalysis, the person is asked to urinate directly into the specimen cup, if possible. If difficult, the person can urinate into a specimen collection device. • The person must not have a bowel movement at the same time the urine is being collected. Do not place toilet paper in the collection device. Either of these actions will change the urinalysis results.

26. Obtaining Urine Specimens: Midstream (“Clean Catch”) Urine Specimen • This method of collecting urine prevents contamination of the urine by the bacteria that normally live in and around the urethra • A midstream (“clean catch”) urine specimen is usually ordered when the doctor suspects a urinary tract infection • When a midstream (“clean catch”) urine specimen is requested, the person is asked to clean the area around the urethral opening with a special cleansing wipe • The urine flow is started, then stopped, then started again • The urine sample is collected from the restarted flow in a sterile specimen cup

27. Obtaining Urine Specimens: Testing • A type of routine urine testing involves dipping chemically treated paper strips into a urine sample • Chemicals on the paper react with certain substances that may be found in the urine, causing the chemical blocks on the paper to change color if these substances are present in the urine • The paper is then compared with a color chart that comes with the strips

28. Obtaining Stool Specimens • Stool is analyzed for the presence of blood, pathogens (such as parasites or bacteria), fat, and other things that are not normally found in feces • If a stool sample is needed, the person should be notified well in advance so that the specimen can be collected when it becomes available • Ask the nurse if there are any particular collection methods that should be used

29. Obtaining Stool Specimens • Stool can be collected in a bedpan, bedside commode, or in a collection device placed into a regular toilet. • The person must not urinate at the same time the stool sample is being collected. Toilet paper must not be placed in the collection device. Both of these actions will change the test results.

30. Urinary Elimination

31. Urinary Elimination: Urinary System • The urinary system consists of the kidneys, urinary bladder, ureters, and urethra • Blood is filtered by the kidneys, forming urine • The urine is stored in the urinary bladder • As the bladder fills, we begin to feel the urge to urinate • Urine leaves the body through the urethra

32. Urinary Elimination: Expressions • The process of passing urine from the body is known by several terms, including: • Urination • Voiding • Micturition • Patients or residents will have their own terms for urinating, such as “peeing” or “passing water” • When talking about urination, use words that the person is familiar with. This is especially important when talking with children.

33. Urinary Elimination: Color and Odor • In healthy people, urine is • Clear, without cloudiness or particles • Pale yellow, straw-colored, or dark gold (amber) in color, with a slight odor

34. Urinary Elimination: Color and Odor • Foods and drugs can affect the color and odor of urine • When you are helping a patient or resident with urination, observe the urine and report any abnormalities to the nurse • Urine with an unusual odor or appearance could be a sign of illness or infection

35. Urinary Elimination: Hematuria • A slight red tinge to the urine may indicate hematuria, or the presence of blood in the urine • Sometimes hematuria is occult and must be detected using urinalysis

36. Factors Affecting Urinary Elimination • Many factors influence a person’s urinary pattern, including • The amount of fluids the person drinks • The types of medications the person takes • The person’s age • The person’s lifelong elimination habits • A nursing assistant soon becomes aware of the urinary pattern that is normal for each person in her care • This knowledge allows her to recognize any changes that may occur

37. Urination: Frequency and Nocturia • Frequency is the term used to describe voiding that occurs more often than usual • Frequency is often accompanied by a feeling of urgency, or the need to urinate immediately • Nocturia is the need to get up more than once or twice during the night to urinate, to the point where sleep is disrupted

38. Urination: Dysuria • Dysuria is difficulty voiding that may or may not be associated with pain • Some people describe the discomfort they feel during urination as a “burning” or “cramping” sensation • Dysuria is often associated with bladder infections, prostate problems, and some sexually transmitted diseases (STDs)

39. Measuring Urine Output • In a person maintaining a good fluid balance, urine output is neither too high nor too low. Complications associated with urine output are: • Oliguria (the state of voiding a very small amount of urine over a given period of time) • Polyuria (the state of excessive urine output) • Anuria (the state of voiding less than 100 mL of urine over the course of 24 hours)

40. Measuring Urine Output • People who have illnesses or take medications that may alter their body’s ability to maintain a healthy fluid balance will need to have their urine output measured regularly • Some people who are critically ill will have their urine output measured and recorded every hour, but most people in the health care setting have routine orders for their urine output to be measured and recorded each shift

41. Measuring Urine Output: Process • If a person uses a regular toilet, you will need to remind the person: • To void into a specimen collection device (“commode hat”) • To call you after he or she has finished voiding so that you can measure and record the amount of urine • Specimen collection devices, urinals, and the drainage bags used with urinary catheters often have markings that make measuring urine output easy

42. Measuring Urine Output: Process • Urine output can also be measured by pouring it into a graduate

43. Measuring Urine Output: Process • If the urine output of one of your residents or patients is being monitored, you will need to keep a record of the amount of urine passed at each voiding • This can be done using an intake and output (I&O) flow sheet, which has spaces to record the amount of each individual voiding • To obtain the end-of-shift amount, simply add the individual amounts and record the total in the appropriate space

44. Urinary Catheterization • Urinary catheterization is done when a person is unable to urinate using a toilet, bedpan, urinal, or bedside commode • A urinary catheter is a tube that is inserted into the bladder through the urethra to allow the urine in the bladder to drain out

45. Urinary Catheterization: Situations When a Urinary Catheter Is Used • A urinary catheter is used in many different situations: • A urinary catheter may be inserted to drain the bladder before or during a surgical procedure, during recovery from a serious illness or injury, or to collect urine for testing • A urinary catheter may be used for a person who is incontinent of urine, if the person has wounds or pressure ulcers that would be made worse by contact with urine • A urinary catheter is necessary when a person is unable to urinate because of an obstruction in the urethra

46. Urinary Catheterization: Insertion of Urinary Catheter • Inserting a catheter is a procedure that requires sterile technique because it involves putting a foreign object (that is, the catheter) into a person’s body • Inserting a urinary catheter is usually beyond the scope of practice for a nursing assistant, although in some facilities, nursing assistants are provided with additional training that allows them to catheterize residents or patients • Regardless of whether or not you are trained to actually insert urinary catheters, caring for people who have urinary catheters in place will almost certainly be a part of your daily duties

47. Urinary Catheterization: Types of Urinary Catheters • You will see many different types of urinary catheters in use • A straight catheter, also known as a Robinson, Rob-Nel, or Red Rubber catheter, is used when the catheter is to be inserted and removed immediately • An indwelling catheter, also known as a retention or Foley catheter, is left inside the bladder to provide continuous urine drainage • A suprapubic catheter is a type of indwelling catheter. The suprapubic catheter is inserted into the bladder through a surgical incision made in the abdominal wall, right above the pubic bone

48. Catheters Straight Indwelling Suprapubic

49. Urinary Catheterization: Caring for a Person With an Indwelling Urinary Catheter • Indwelling urinary catheters are connected by a length of tubing to a urine drainage bag • The tubing is secured loosely to the person’s body near the insertion site using a catheter strap or adhesive tape • Securing the tubing to the person’s body prevents the catheter from being accidentally pulled out during repositioning

50. Urinary Catheterization: Caring for a Person With an Indwelling Urinary Catheter • A little bit of slack is left in the tubing to prevent the catheter from pulling against the bladder outlet and the urethral opening • The remaining length of tubing is then gently coiled and secured to the bed linens using a plastic clip