Assisting with Elimination
Assisting with a Bedpan
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Safety
- Use Standard Precautions when handling body fluids.
- Promote comfort when the patient uses the bedpan.
- Answer the call light promptly to prevent the patient from trying to get out of bed unassisted.
- Older adults, obese patients, patients who have had hip or knee surgery, those with spinal injury, and patients who are debilitated often require assistance of two or more nurses to help them onto or off of the bedpan.
- Incorrect placement of a bedpan causes discomfort for the patient and spillage of contents. Forcing a bedpan under a patient increases the risk of friction injury to underlying skin and tissues.
- If a patient has had a total hip replacement, be sure not to dislodge the abduction pillow placed between the patient's legs to prevent dislocation of the new joint. Use a fracture pan.
- When placing a patient on a bedpan, raise the side rail on the opposite side of the bed to protect the patient from falling out of bed.
- Reduce the transmission of C. difficile spores by using a bowel management system. The system includes an intrarectal catheter equipped with a retention cuff, intraluminal balloon, inflation port, silicone tubing, and a collection bag. Contraindications to the use of a bowel management system are included on the package insert and should be carefully considered before insertion.
Equipment
(Roll cursor over items to see labels)
Clean gloves
Bedpan
Toilet tissue or disposable washcloths
Specimen container (if necessary)
- Zip-sealed transport bag
- Label with date/patient name/ID number
Basin
Towel and washcloth
Soap
Antiseptic wipes or hand gel
Waterproof, absorbent pads
PrintableDelegation
The skill of assisting a patient with a bedpan can be delegated to nursing assistive personnel (NAP). Be sure to inform NAP of the following:
- Review correct positioning guidelines for patients with mobility restrictions and for those who have therapeutic equipment, such as wound drains, intravenous catheters, or traction.
- Emphasize the need to provide perineal and hand hygiene for the patient as necessary after using a bedpan.
Preparation
- Assess the patient’s normal bowel elimination habits: routine pattern, character of stool, effect of certain foods/fluids and eating habits on bowel elimination, effect of stress and level of activity on normal bowel elimination patterns, current medications, and normal fluid intake.
- Auscultate the patient’s abdomen for bowel sounds, and palpate the lower abdomen for distention.
- Assess the patient’s level of mobility, including the ability to sit upright, lift the hips, and turn onto his or her side.
- Assess the patient’s level of comfort. Note the presence of rectal or abdominal pain, hemorrhoids, or perianal skin irritation.
- Determine need for urine or stool specimen.
Follow-up
- Assess the characteristics of the patient’s stool. Note the color, odor, consistency, frequency, amount, shape, and constituents. Assess the characteristics of the patient’s urine if the patient voided his or her bladder into the bedpan.
- Evaluate the patient’s ability to use the bedpan.
- Inspect the patient’s perianal area and surrounding skin while removing the bedpan.
- Evaluate the patient’s overall activity tolerance and comfort.
Documentation
- Record the type of assistance the patient needed and how well he or she tolerates getting on and off the bedpan.
- Document the character and amount of stool and the urine output if the patient also voids.
- If intake and output are being monitored, document the output data.
- Document any alterations in the patient’s elimination patterns.
- Complete the laboratory requisition if you collected a stool or urine specimen, and send it to the laboratory. Record the type of specimen you sent.
Review Questions
1. The nurse has delegated to nursing assistive personnel (NAP) the skill of assisting with a bedpan for a patient who has had discomfort when walking to the bathroom. Which statement made by the NAP requires the nurse’s follow-up?
“Do you still need a stool sample for the lab?”
“If I can get someone to help, I’ll walk her to the bathroom.”- “The patient reports that moving is uncomfortable for her. Has she had pain medication recently?”
- “The patient told me that she’s had problems with hemorrhoids in the past.”
INCORRECT. It is appropriate for the NAP to ask whether a stool sample is required.
CORRECT. The NAP is not qualified to determine whether it is appropriate to ambulate the patient. The nurse has delegated the skill of assisting with a bedpan, and the NAP should carry out that responsibility as instructed.
INCORRECT. It is appropriate for the NAP to share the patient’s report of pain and to inquire about medication. Since walking is known to be painful for the patient, it stands to reason that she might be uncomfortable simply moving about in bed.
INCORRECT. It is appropriate for the NAP to share with the nurse any information pertaining to the patient’s toileting.
2. A patient with a nasogastric tube, an intravenous infusion line, and an indwelling urinary catheter needs to be placed on the bedpan. Which action would the nurse take first to ensure the patient’s safety?
- Close the bedside curtain.
- Raise the side rail on the side opposite that on which the nurse is working.
- Obtain help to place the patient on the bedpan.
- Raise the bed to a comfortable working height.
INCORRECT. Closing the bedside curtain is appropriate but provides for the patient’s privacy, not her safety.
INCORRECT. Raising the side rail to keep the patient from falling out of bed as she rolls on or off the bedpan is an appropriate safety measure but is not the first action the nurse would take.
CORRECT. For a patient with a drain, tube, or intravenous line, the nurse’s first action to ensure the patient’s safety would be to obtain help to place her on the bedpan.
INCORRECT. Raising the bed to a comfortable working height provides for the safety of the nurse, not the patient.
3. A dependent, confused patient is being given a bedpan. How can the nurse best ensure the patient’s safety?
- Respond promptly to the call light.
- Raise the side rails on the bed before leaving the room.
- Slide one hand under the patient’s sacrum to help the patient lift off the bedpan.
- Check in on the patient every 5 minutes until the bedpan can be removed.
INCORRECT. Responding promptly to the call light is important for patient safety, but this patient is confused and may not know how to use the device.
CORRECT. Raising the side rails on the bed is the best safety intervention to minimize the risk of falling if the patient attempts to get out of bed without assistance.
INCORRECT. The patient is dependent but confused, and he or she can participate in the effort to move on or off the bedpan. The technique selected to help the patient off the bedpan is irrelevant to the patient’s safety.
INCORRECT. Checking the patient is appropriate but does not ensure safety while the patient is alone. Five minutes is plenty of time for the patient to try to get out of bed unassisted if one or both side rails are left down.
4. The nurse is assisting with a bedpan for a patient who had knee surgery 24 hours ago. What is the best way for the nurse to maximize comfort while the patient uses the bedpan?
- Raise the knee gatch.
- Offer a dose of the patient’s prescribed oral pain medication.
- Evaluate the patient’s ability to move in bed.
- Elevate the head of the bed to between 30 and 60 degrees.
INCORRECT. Raising the knee gatch is probably contraindicated by the patient’s recent knee surgery.
INCORRECT. It is appropriate for the nurse to assess the patient’s pain and provide medication as ordered; however, the effect of oral pain medication is delayed, and administering a dose just before the patient uses the bedpan would not affect the patient’s comfort level.
INCORRECT. Evaluating the patient’s ability to move in bed helps determine the technique required to place the bedpan but does not necessarily pertain to the patient’s general comfort.
CORRECT. Elevating the bed to a more natural position is the best way for the nurse to improve the patient’s comfort. Doing so prevents hyperextension of the neck, supports the upper torso as the patient raises the hips, and promotes defecation.
5. After assisting with a bedpan, the nurse notes that the patient’s stool is streaked with bright-red blood. What would the nurse do first?
- Notify the patient’s health care provider.
- Ask if the patient has a history of hemorrhoids.
- Check the medical record to see if the patient has a history of blood in the stool.
- Document the observation in the medical record, indicating a need for follow-up.
INCORRECT. Although the nurse would promptly report this observation to the patient’s health care provider, doing so would not be the nurse’s first action.
CORRECT. Asking whether the patient has a history of hemorrhoids is the most appropriate initial response, followed by documentation of the observation and notification of the patient’s health care provider.
INCORRECT. Although it is appropriate for the nurse to review the patient’s record to see if this observation is a new finding, doing so would not be the nurse’s first action.
INCORRECT. Although the nurse would promptly document this observation, doing so would not be the nurse’s first action.
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