Patient Needs
Support safe, comfortable urinary and bowel elimination while preserving dignity, hygiene, independence, and skin integrity.
Residents may require assistance because of:
- Limited mobility or difficulty reaching the toilet.
- Urinary or fecal incontinence.
- Constipation, diarrhea, or difficulty voiding.
- Cognitive or communication difficulties.
- Medical devices or prescribed elimination programs.
Goal: Encourage independence whenever possible while providing appropriate assistance and recognizing changes from the resident’s normal elimination pattern.
What Should I Assess?
Urinary Elimination
Observe:
- Frequency and amount of urination.
- Urine color, appearance, and unusual odor.
- Pain, burning, or difficulty urinating.
- New or worsening incontinence.
- Possible urinary retention or incomplete bladder emptying.
- Changes from the resident’s usual pattern.
Urinary Retention: Inability to empty the bladder completely. Acute retention, particularly with pain or bladder distention, requires prompt nursing evaluation.
Bowel Elimination
Observe:
- Frequency of bowel movements.
- Stool consistency, amount, and appearance.
- Straining or difficulty passing stool.
- Constipation or diarrhea.
- Abdominal discomfort or distention.
- Visible or suspected blood in stool.
Important: Bowel movement frequency varies between individuals. Compare findings with the resident’s baseline rather than relying solely on the number of days since the last bowel movement.
Concerning Stool Findings
- Melena: Black, tarry stool that may indicate gastrointestinal bleeding.
- Hematochezia: Visible red or maroon blood passed from the rectum.
- Occult Blood: Blood not visible to the eye, detected through testing.
Report suspected bleeding promptly. Stool appearance alone does not establish a diagnosis.
How Do I Provide Care?
Toileting Assistance
- Review the care plan and determine the assistance required.
- Explain the procedure and provide privacy.
- Perform hand hygiene and use appropriate PPE.
- Help the resident reach or use the appropriate toileting equipment.
- Position the resident comfortably and safely.
- Provide the call light and follow supervision or fall precautions.
- Allow adequate time and encourage independence.
- Assist with hygiene and clothing as needed.
- Clean and store equipment according to facility policy.
- Perform hand hygiene and document required observations.
Common Elimination Equipment
| Equipment | Purpose |
|---|---|
| Bedpan | Allows elimination while remaining in bed |
| Fracture Bedpan | Lower-profile bedpan for residents who cannot tolerate typical positioning |
| Bedside Commode | Portable toilet used near the bed |
| Urinal | Handheld urine collection container |
| Commode Hat | Fits into a toilet or commode to collect output or specimens |
Select equipment according to resident needs, mobility restrictions, the care plan, and facility procedures.
Supporting Regular Elimination
- Offer toileting assistance according to the individualized schedule.
- Respond promptly to toileting requests.
- Encourage appropriate hydration, dietary fiber, and mobility when permitted.
- Support prescribed bowel or bladder training programs.
- Observe and document elimination patterns.
- Provide timely Perineal Care and protect the skin from prolonged exposure to moisture.
- Respect privacy, preferences, and cultural needs.
Incontinence
For individualized toileting schedules, skin protection, and continence support, see Incontinence Care.
Urinary Collection Devices
Some residents use urinary collection devices:
- Indwelling catheters: Drain urine directly from the bladder; see Urinary Catheter Care.
- External urinary collection devices: Collect urine externally, including condom-style catheters and some suction-assisted systems.
For external devices:
- Follow the care plan and manufacturer instructions.
- Observe for leakage, discomfort, or skin irritation.
- Avoid pulling or kinking tubing.
- Maintain hygiene and protect surrounding skin.
- Report equipment problems or unexpected changes in output.
- Do not independently adjust suction settings or perform unfamiliar device procedures.
Ostomies
For residents with surgically created urinary or bowel diversions, see Ostomy Care.
Intake & Output
When intake and output monitoring is ordered:
- Observe and record measurable fluid intake and output as assigned.
- Use the appropriate measuring equipment.
- Document values accurately in milliliters.
- Report unexpected changes or missing output.
For measurement steps, calculations, and documentation, see Measuring Intake & Output.
Safety & Precautions
Constipation & Bowel Interventions
Laxatives, suppositories, and enemas may be used as part of a prescribed bowel management plan.
- Laxatives: (usually ~3 days) Medications that promote bowel movements through different mechanisms.
- Suppositories: (usually ~4 days) Preparations inserted into the rectum to produce a local or systemic effect.
- Enemas: (usually ~5 days) Fluids introduced into the rectum for a prescribed purpose.
- High-volume enema (~800 mL tap water and castile soap) can be administered by CNA, inserting lubricated tube 2-4”.
- Fleet enema injection of medicinal fluid into rectum.
There is no universal three-, four-, or five-day schedule for these treatments. Decisions depend on symptoms, medical history, orders, and the resident’s individualized care plan.
CNA Responsibilities for Bowel Interventions
California’s nurse assistant training curriculum includes laxative suppositories and certain enemas as demonstrated clinical skills.
- Observe and report bowel patterns, abdominal discomfort, and changes from baseline.
- Provide toileting, hygiene, positioning, and comfort assistance.
- Never independently decide that a resident requires a laxative, suppository, or enema.
- Perform these procedures only when permitted in the specific care setting, appropriately ordered or directed, and supported by required training, competency, and supervision.
- Confirm the correct treatment and resident with the licensed nurse before proceeding.
- Report severe pain, rectal bleeding, vomiting, abdominal distention, or difficulty during an intervention immediately.
- Follow the instructor’s approved skills checklist and facility procedures.
Important: Inclusion in the California CNA curriculum does not authorize independent medication administration or treatment decisions.
Source: CDPH Nurse Assistant Training Program Skills Checklist (CDPH 276A)
Infection Prevention
- Follow Standard Precautions when handling urine, stool, or contaminated equipment.
- Wear gloves when contact with bodily waste is anticipated.
- Perform hand hygiene after glove removal.
- Avoid contaminating clean equipment and environmental surfaces.
- Clean and disinfect reusable equipment according to facility procedures.
Resident Safety
- Follow transfer and fall-prevention precautions.
- Never leave a resident unsupported when supervision is required.
- Do not force elimination or ignore reports of pain.
- Respect prescribed fluid restrictions, activity restrictions, and toileting schedules.
What Should I Report?
Notify the nurse promptly about:
- Inability to urinate, particularly with pain or abdominal distention.
- New pain or burning during urination.
- Unexpectedly low or absent urine output.
- Blood in urine or stool.
- Black, tarry stool.
- New or worsening constipation or diarrhea.
- Severe abdominal pain, swelling, or vomiting.
- Significant changes from the resident’s normal elimination pattern.
- New skin irritation or breakdown related to elimination.
- Problems with prescribed elimination equipment.
Activate the appropriate emergency response for severe symptoms or sudden deterioration according to facility policy.
Related
- Incontinence
- Incontinence Care
- Perineal Care
- Urinary Catheter Care
- Ostomy Care
- Measuring Intake & Output
- Specimen Collection
- Fluid Balance
- Dehydration
- Skin Integrity & Breakdown Prevention
- Standard Precautions
- Patient Positions
Sources
- CNA Module 9 — Patient Care Procedures, Sections 9A–9E
- Facility elimination-care and bowel-management protocols
Flashcards
What findings during elimination should be reported promptly?03-application / patient-care
Blood, inability to void, severe pain, or major pattern changes.
Why is there no universal 3/4/5-day bowel treatment schedule?03-application / patient-care
Interventions depend on individual needs, orders, and care plan.