A patient's urinary output has been 25 mL/hour for the past 3 hours. What should the LPN/VN do?

Report to the RN immediately as this indicates oliguria. Urinary output less than 30 mL/hour indicates oliguria, which may signal kidney dysfunction, dehydration, or other serious conditions. This requires immediate reporting to the RN for assessment and intervention.

When administering a cleansing enema, what position should the LPN/VN place the patient in?

Left Sims' position. Left Sims' position (left side-lying with right knee flexed) uses gravity to facilitate flow of the solution into the descending colon. The sigmoid colon is on the left side of the body.

Which nursing intervention is most important to prevent catheter-associated urinary tract infections (CAUTI)?

Maintain a closed drainage system. Maintaining a closed drainage system is the most critical intervention to prevent CAUTI. Opening the system introduces bacteria. The bag should be kept BELOW bladder level, routine irrigation is not recommended, and catheters are not changed on a schedule.

6.4 Elimination | NCLEX-PN (Practical Nurse) | Free Exam Prep

Elimination

Elimination is a basic physiological need that affects comfort, dignity, and overall health. LPN/VNs must assess elimination patterns, identify problems, and implement appropriate interventions for both urinary and bowel elimination.

Urinary Elimination

Normal Urinary Output: 1,500-2,000 mL/day (approximately 30 mL/hour minimum)

Characteristics of Normal Urine:

Color: Pale yellow to amber
Clarity: Clear
Odor: Slightly aromatic
pH: 4.5-8.0 (average 6.0)
Specific gravity: 1.010-1.025

Urinary Elimination Problems

Condition	Definition	Nursing Interventions
Urinary Retention	Inability to empty bladder	Bladder scan, catheterization, assess for obstruction
Urinary Incontinence	Involuntary urine loss	Toileting schedule, pelvic floor exercises, continence products
Dysuria	Painful urination	Increase fluids, report to RN/provider, possible UTI
Frequency	Voiding often in small amounts	Assess for infection, monitor I&O, bladder training
Nocturia	Excessive nighttime urination	Limit evening fluids, assess for underlying cause
Oliguria	Urine output < 400 mL/24 hours	Monitor I&O closely, report immediately, assess kidney function
Anuria	Urine output < 100 mL/24 hours	Medical emergency, report immediately

Types of Urinary Incontinence

Type	Cause	Characteristics
Stress	Weak pelvic floor	Leakage with coughing, sneezing, laughing
Urge	Overactive bladder	Sudden, intense urge with involuntary loss
Overflow	Bladder overdistension	Frequent dribbling, incomplete emptying
Functional	Physical/cognitive barriers	Normal urinary function but unable to reach toilet
Mixed	Combination	Features of multiple types

Urinary Catheter Care

Indications for Catheterization:

Acute urinary retention
Accurate output measurement in critical illness
Perioperative management
Wound care for incontinence (sacral wounds)
Comfort at end of life

Catheter Care Responsibilities:

Maintain closed drainage system
Keep bag below bladder level at all times
Secure catheter to thigh to prevent tension
Empty bag every 8 hours or when 2/3 full
Perform perineal care at least twice daily
Monitor for signs of CAUTI (cloudy urine, fever, flank pain)
Document output accurately

CAUTI Prevention (HOUDINI Protocol):

Hematuria evaluation complete
Obstruction relieved
Urology procedure completed
Decubiti need protection
Input/output no longer needed
No longer immobile
Inappropriate placement initially

Bowel Elimination

Normal Bowel Pattern: Ranges from 3 times/day to 3 times/week

Characteristics of Normal Stool:

Color: Brown
Consistency: Soft, formed
Shape: Tubular
Amount: Varies with diet

Bowel Elimination Problems

Condition	Definition	Nursing Interventions
Constipation	Infrequent, hard, difficult stools	Increase fluids/fiber, activity, stool softeners
Fecal Impaction	Hard mass of stool in rectum	Manual disimpaction (per facility policy), enemas
Diarrhea	Frequent, loose, watery stools	Fluid replacement, BRAT diet, skin protection, identify cause
Flatulence	Excessive intestinal gas	Ambulation, positioning, simethicone, dietary modification
Fecal Incontinence	Involuntary stool loss	Bowel program, skin care, continence products

Enema Administration

Type	Solution	Purpose
Cleansing Enema	Tap water, saline, soapsuds	Empty lower bowel
Retention Enema	Oil-based	Soften stool, facilitate evacuation
Medicated Enema	Varies (lactulose, etc.)	Treat specific conditions
Return-Flow (Harris Flush)	Tap water	Relieve gas

Enema Administration Guidelines:

Position in left Sims' position (allows gravity to aid flow)
Lubricate tube well
Insert 3-4 inches for adults (1-1.5 inches for children)
Raise container 12-18 inches above rectum
Instruct patient to hold solution as long as possible (5-15 minutes)
Provide privacy and easy access to toilet/bedpan

Ostomy Care

Types of Ostomies:

Colostomy - Created from colon (sigmoid, descending, transverse, ascending)
Ileostomy - Created from ileum; output is liquid and continuous

Ostomy Care Responsibilities:

Assess stoma for color (should be pink/red, moist)
Change appliance every 3-7 days or when seal breaks
Measure stoma and cut opening to fit
Clean peristomal skin and protect from effluent
Empty pouch when 1/3 to 1/2 full
Document output characteristics
Provide patient education for self-care

NCLEX-PN

1Introduction to the NCLEX-PN

2Chapter 2: Coordinated Care

3Chapter 3: Safety and Infection Prevention and Control

4Chapter 4: Health Promotion and Maintenance

5Chapter 5: Psychosocial Integrity

6Basic Care and Comfort

7Pharmacological and Parenteral Therapies

8Reduction of Risk Potential

9Physiological Adaptation

Key Takeaways