4.3 Bed Making, Room Supplies & Visual Inspection of Specimens
Key Takeaways
When making an occupied bed, raise the side rail on the side the patient turns toward and keep the patient covered and safe at every step.
A toilet hat (specimen pan) fits under the toilet seat to collect and measure urine or stool, and toilet paper must be kept out of it.
Black, tarry stool (melena) suggests upper GI bleeding, while bright red blood in stool suggests lower GI bleeding.
Coffee-ground emesis contains partly digested blood and must be saved and reported to the nurse.
An abnormal-looking specimen is saved for the nurse to see, not flushed, and its color, amount, consistency, and odor are documented.
Bed Making, Room Supplies & Visual Inspection of Specimens
NCCT's test plan lists two practical tasks together: prepare supplies for the patient (for example, toilet hat, linens) and visually inspect patient specimens for abnormalities (for example, stool, emesis). Both happen many times a shift, and both prevent harm. A wrinkled, wet bed contributes to pressure injuries, and a black stool flushed away without anyone seeing it can hide a gastrointestinal bleed.
Preparing Supplies
- Gather everything before you start so you never leave a patient exposed or unattended mid-procedure.
- Check packages for expiration dates, damage, and sterility indicators, and take supplies from the clean utility room.
- Take into isolation rooms only what you need; unused supplies may have to be discarded rather than returned.
- Elimination equipment:
- Toilet hat (specimen pan): a plastic collection pan that fits under the toilet seat to catch and measure urine or stool. Many units place it toward the front of the bowl for urine collection. Label it for the patient and remind them to put toilet paper in the wastebasket or toilet, not the hat.
- Standard bedpan for patients who can raise their hips, and fracture pan (flat, shallow end placed under the buttocks) for patients with hip fractures, casts, or limited movement.
- Urinal for male patients, emptied promptly and measured when intake and output is ordered.
- Bedside commode with the wheels locked.
Making the Bed
| Bed Type | When Used | Key Feature |
|---|---|---|
| Closed (unoccupied) | After discharge cleaning, awaiting a new patient | Top linens pulled up to the head |
| Open | Patient is out of bed but returning | Top linens fan-folded to the foot so the patient can get in |
| Occupied | Patient cannot get out of bed | Linens changed side to side with the patient in bed |
| Surgical (postoperative) | Patient returning from surgery by stretcher | Top linens fan-folded lengthwise to the far side for a lateral transfer |
Occupied Bed Technique
- Identify the patient, explain, provide privacy, and perform hand hygiene. Wear gloves if linens are soiled.
- Raise the bed to a comfortable working height, lock the wheels, and lower the head of the bed as the patient tolerates.
- Raise the side rail on the far side, then help the patient turn toward it. The rail protects the patient while you work on the near side.
- Loosen the bottom linens on the near side and roll or fan-fold the dirty linen toward the patient, tucking it snugly against their back.
- Place the clean bottom sheet and draw sheet on the near half, fan-fold the extra toward the patient, and tuck the near side with mitered corners.
- Raise the near rail, move to the other side, help the patient roll over the "hump" of linen, remove the dirty linen (rolled inward), and pull the clean linen through tight and wrinkle-free.
- Change the pillowcase, cover the patient with clean top linens, leave toe room, lower the bed, lock it, and place the call light within reach.
Use one breathable underpad if needed; stacking several pads or folded linens under a patient traps heat and moisture and raises pressure injury risk (Section 6.1). Handle soiled linen as described in Section 1.4: hold it away from your uniform and never shake it.
Visual Inspection: What Normal Looks Like and What to Report
Urine
| Appearance | Possible Meaning |
|---|---|
| Pale straw to yellow, clear | Normal |
| Dark amber | Concentrated urine; possible dehydration |
| Pink, red, or cola-colored | Blood (hematuria) or muscle breakdown; some foods and drugs also discolor urine |
| Cloudy, with a foul odor | Possible infection |
| Foamy | Possible protein in the urine |
| Visible clots or sediment | Bleeding or other abnormality |
Stool
| Appearance | Possible Meaning |
|---|---|
| Brown, soft, formed | Normal |
| Black, tarry, sticky (melena) | Bleeding in the upper GI tract; iron and bismuth products also darken stool, so report and let the nurse decide |
| Bright red blood | Bleeding in the lower GI tract or hemorrhoids |
| Pale, clay-colored | Possible bile obstruction |
| Watery diarrhea | Infection (including C. difficile), medications, or tube-feeding intolerance |
| Mucus or pus | Inflammation or infection |
| Hard, dry pellets | Constipation |
Many units describe stool with the Bristol Stool Form Scale: types 1–2 suggest constipation, types 3–4 are normal, and types 6–7 are diarrhea.
Emesis (vomit)
| Appearance | Possible Meaning |
|---|---|
| Coffee-ground material | Partly digested blood; upper GI bleeding |
| Bright red blood (hematemesis) | Active bleeding; urgent |
| Green or yellow | Bile |
| Fecal odor | Possible bowel obstruction; urgent |
| Projectile | Can signal increased intracranial pressure or obstruction |
Sputum that is pink and frothy (possible pulmonary edema), rust-colored, green or yellow, or blood-streaked is also reported.
What to Do With an Abnormal Specimen
- Do not flush or discard it. Save it covered so the nurse can see it and a specimen can be sent if ordered.
- Keep the patient safe first; for vomiting, turn the patient to the side to protect the airway.
- Report immediately to the nurse, describing color, amount, consistency, and odor.
- Measure it if intake and output is ordered, perform hand hygiene, and document objectively: "Emesis 150 mL, dark brown with coffee-ground particles, no odor; RN notified at 1420."
Clinical Trap: The Flushed Clue
A PCT helps a patient off the commode, notices the stool is black and tarry, and empties it into the toilet to keep the room clean. The patient's hemoglobin later drops sharply. Because no one else saw the stool, the bleed was recognized late. Save the specimen, report it, and document it.
While assisting a patient off a bedside commode, a PCT sees that the stool is black, sticky, and tarry. What does this finding most likely suggest, and what should the PCT do?
Normal stool after a meat-heavy meal; empty and clean the commode
Possible upper gastrointestinal bleeding; save the stool and report it to the nurse immediately
Constipation from dehydration; encourage fluids and document later
Possible bile duct obstruction; flush it and tell the nurse at the end of the shift
A patient vomits about 150 mL of dark brown material that looks like coffee grounds. What is the priority?
Discard the emesis to reduce odor and offer the patient a clean gown
Give the patient ginger ale to settle the stomach
Record it as normal gastric contents on the intake and output sheet
Turn the patient to the side, save the emesis, and notify the nurse immediately
When making an occupied bed, what should the PCT do before helping the patient turn onto their side toward the far side of the bed?
Raise the side rail on the far side so the patient is protected while the near side is changed
Lower both side rails so the patient can turn freely
Place the bed in its lowest position with the head fully elevated
Remove all linens from the bed before the patient turns
Sections you finish are checked off in the contents.