Assisting with Elimination
Assisting with a Urinal
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Safety
- Use Standard Precautions when handling body fluids.
- Regularly assess and determine the patient’s functional status, such as the ability to safely stand, the ability to understand and follow directions, and the motivation to assist in self-care associated with use of a urinal.
- Respond promptly to any request for toileting assistance, to reduce the chance of the patient’s falling as he or she tries to reach the bathroom.
- Before having the patient stand to void, assess the patient’s lower extremity strength and mobility, and assess for orthostatic hypotension, especially if the patient has been on prolonged bed rest.
- Evaluate the patient’s normal pattern of micturition. A patient who is taking a diuretic medication should have a urinal close to the bed or chair.
- Patients who need assistance with elimination should have a call light within easy reach and should be offered assistance at regular intervals, especially in the morning after awakening, after meals, and before bedtime. Know the average output range for a patient.
- Adult urinary output averages 2200 to 2700 mL in 24 hours. An hourly output of 30 mL/hr in 2 hours indicates a need for further evaluation.
Equipment
(Roll cursor over items to see labels)
Waterproof pad
Towels and washcloth
Soap
Supplies for diagnostic urine tests and specimen collection
Urinal
Graduated cylinder (used for measuring volume if the urinal is not marked)
Antiseptic hand wipes or antiseptic hand gel for patient hand hygiene
Clean gloves
PrintableDelegation
The skill of assisting a patient in using a urinal can be delegated to nursing assistive personnel (NAP). Be sure to inform NAP of the following:
- Adjust for any special patient needs or adaptations, such as the need to hold a urinal for a patient.
- Provide personal hygiene as necessary after urination.
- Report the following immediately:
- Changes in urine color, clarity, or odor
- Development of incontinence (involuntary loss of urine)
- Patient’s report of dysuria, which could indicate an infection
- Changes in the frequency of urination or the amount of urine
- Explain the procedure to the patient and family, to promote understanding of and participation in care.
Preparation
- Consider the patient’s age when assessing his or her voiding habits. Frail older adults are at a higher risk of incontinence because of multiple health care problems and associated physiological changes.
- Know the signs of dehydration and fluid overload. Start measuring a patient’s intake and output (I&O) when an actual or anticipated change in fluid balance occurs.
- Assess the patient for a distended bladder by inspecting the lower third of the patient’s abdomen or by palpating gently above the symphysis pubis.
- Assess the patient’s most recent serum electrolyte measurements. Abnormal values reflect alterations in fluid balance that can lead to deterioration in the patient’s health.
- Explain the procedure to the patient, and explain the importance of adequate fluid intake in maintaining urinary health.
Follow-up
- Report immediately to a health care provider the following:
- An hourly output of less than 30 mL/hr in 2 hours
- Changes in urine color, clarity, or odor
- Changes in the frequency of urination
- Development of incontinence (the involuntary loss of urine)
- Patient's report of dysuria, which could indicate an infection
Documentation
If intake and output are being monitored, document urine output.
Review Questions
1. A male patient on bed rest is permitted to stand to use the urinal. Which action would the nurse take to ensure his safety before helping him to a standing position?
Determine his risk for orthostatic hypotension
Assess his genitals for signs of impaired skin integrity- Ask him to demonstrate proper use of a urinal
- Instruct him to use the call light when he is finished
CORRECT. Since the patient is on bed rest, he is at risk for orthostatic hypotension. Assessing for this condition would help ensure that the patient could stand safely to use the urinal.
INCORRECT. Assessing for impaired skin integrity is a nursing responsibility, but it does not pertain to patient safety while standing to use a urinal.
INCORRECT. This intervention pertains to patient education, not patient safety.
INCORRECT. The nurse is unlikely to give such an instruction, since it is not safe to leave the patient while he is standing at the bedside using the urinal.
2. The nurse is delegating to nursing assistive personnel (NAP) the task of assisting with a urinal. The nurse specifies to NAP that the urinal is to be used in bed, not in a standing position, for which patient?
- Patient admitted for hypertension and diabetes
- Patient with complete left-sided paralysis caused by a stroke
- Patient receiving diagnostic tests for esophageal strictures
- Patient being treated for dehydration from heat exposure
INCORRECT. The nurse would instruct the NAP not to allow the patient with complete left-sided paralysis to stand while using the urinal. A patient with hypertension and diabetes, however, can probably stand safely to use the urinal.
CORRECT. The nurse would instruct the NAP not to allow the patient with complete left-sided paralysis to stand while using the urinal. Helping this patient stand is not safe for either the patient or the staff.
INCORRECT. The nurse would instruct the NAP not to allow the patient with complete left-sided paralysis to stand while using the urinal. A patient with esophageal strictures, however, can probably stand safely to use the urinal.
INCORRECT. The nurse would instruct the NAP not to allow the patient with complete left-sided paralysis to stand while using the urinal. A patient with dehydration, however, can probably stand safely to use the urinal.
3. Why would the nurse assess a patient’s abdomen before helping with the use of a urinal?
- To determine if the patient needs a bed pan for bowel elimination
- To assess for abdominal pain
- To assess for bladder distention
- To determine if the patient will need help using the urinal
INCORRECT. The nurse would palpate the patient’s abdomen before assisting with a urinal in order to assess for bladder distention.
INCORRECT. The nurse would palpate the patient’s abdomen before assisting with a urinal in order to assess for bladder distention.
CORRECT. The nurse would palpate the patient’s abdomen before assisting with a urinal in order to assess for bladder distention.
INCORRECT. The nurse would palpate the patient’s abdomen before assisting with a urinal in order to assess for bladder distention.
4. The nurse is assisting a patient with the placement of a urinal. The patient tells the nurse, “I’ll call you when I’m done.” What is the nurse’s best response?
- “All right, my name is Robin, and I’ll be right across the hall. Just call me when you’re finished.”
- “Fine. Recap the urinal, hang it on your side rail, and use your call light to let me know you’re finished.”
- “I'll check on you as soon as I get a chance.”
- “I'll be back in 15 minutes. That should be enough time for you to finish up.”
INCORRECT. There is no guarantee that the nurse will hear and thus respond to the patient’s call. In addition, calling across the hall may be disruptive to other patients.
CORRECT. This is the safest response, since it encourages the patient to handle the urinal appropriately after use and to rely on the call light to communicate his needs.
INCORRECT. This response is unlikely to address the patient’s needs in a timely, appropriate manner. The patient might tire of waiting and try to get out of bed to empty the urinal himself.
INCORRECT. This response makes an assumption regarding the amount of time the patient will need to use the urinal. The patient may either feel rushed or get tired of waiting and try to get out of bed to empty the urinal himself.
5. Which action promotes infection control when assisting a patient with a urinal?
- Placing a clean urinal on the overbed table
- Using a waterproof pad to protect the linen from urine spillage
- Applying gloves before emptying and cleaning the patient’s urinal
- Asking if the patient would like to clean the genitals after using the urinal
INCORRECT. The urinal should not be placed on the overbed table.
INCORRECT. Although using a waterproof pad may be appropriate, it does not pertain to infection control.
CORRECT. Donning gloves before handling the urinal would promote infection control.
INCORRECT. The nurse should assist with perineal care after the patient uses the urinal, not just ask the patient if cleaning is desired.
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