5.3 Toileting, Elimination, and Incontinence Support

Toileting, Elimination, and Incontinence Support

Elimination care includes urination, bowel movements, toileting routines, bedpans, urinals, commodes, briefs, catheter drainage observation, and reporting changes. It is personal care, but it is also safety care. Many falls happen when residents hurry to the bathroom, try to transfer alone, or are embarrassed to ask for help.

Respect starts with language. Do not call a resident dirty, lazy, a bedwetter, or difficult because of incontinence. Incontinence can be caused by illness, mobility limits, medications, confusion, infection, constipation, weak pelvic muscles, poor access to the toilet, or inability to communicate. The CNA's role is to respond promptly, protect skin, follow the toileting plan, and report patterns.

Structured Aid: Elimination Decision Check

• Can the resident walk to the toilet safely with the assigned assistance and device?
• Is a bedside commode safer because urgency, weakness, oxygen tubing, or distance makes bathroom use risky?
• Is a bedpan or fracture pan required because the resident must stay in bed or has movement restrictions?
• Does the resident need privacy but still need supervision for safety?
• What should be measured, documented, or reported after elimination?

For bathroom toileting, check footwear, gait belt instructions, assistive devices, oxygen tubing, floor hazards, and call light access. Lock wheelchair or commode wheels. Help the resident sit securely and keep toilet paper, wipes, and call light within reach. If the resident is safe to be left alone, provide privacy and stay close enough to respond. If the resident is not safe alone, maintain privacy as much as possible while supervising.

A bedside commode can preserve dignity and reduce falls when the bathroom is too far. Position it near the bed, lock wheels if present, and ensure the resident's feet touch the floor or foot support. Empty and clean the commode promptly according to facility policy. Use standard precautions because urine and stool can contain pathogens even when the resident does not look sick.

For a bedpan, explain the task and provide privacy. Raise the bed for your body mechanics, lower it when leaving the resident, and use side rails according to the care plan. Place a regular bedpan under the buttocks with the wider end aligned correctly. A fracture pan has a flatter end and is often used for residents who cannot lift their hips well or have movement restrictions. Never force a pan under the resident. If the resident has pain or cannot tolerate the position, stop and get help.

After toileting or incontinence, clean from front to back when applicable, dry the skin, apply barrier cream only as assigned, replace linens or briefs, and position the resident comfortably. A brief is not a substitute for toileting. Check residents on the schedule and answer call lights promptly. Leaving a resident wet or soiled can cause skin breakdown, infection, odor, emotional distress, and allegations of neglect.

Observation is a major part of elimination care. Report burning, pain, urgency, frequency, difficulty starting urine, very dark urine, blood, strong new odor, cloudy urine, low output, no output, diarrhea, constipation, hard stool, black or tarry stool, bright red blood, mucus, new incontinence, abdominal swelling, vomiting, or complaints of pressure. Also report repeated refusal to toilet, sudden confusion, or a pattern of accidents after a medication change.

For intake and output assignments, measure accurately and use the facility unit, often milliliters. Do not estimate if a measurement container is available. If urine or stool must be saved for nurse review or specimen collection, follow directions. Do not discard output when the nurse has asked you to measure or observe it. Elimination care is successful when the resident is safe, clean, heard, and not rushed.