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Assisting with Intake (Nutrition) and Excretion (Toileting)

Unit 5 Lesson 3

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Outline the elements of toileting assistance
Outline the methods of assisting clients who are incontinent of urine and stool
Explain the procedure for bowel and bladder training
Explain the cause, risk, and symptoms of urinary infections and their complications
Describe the observation and documentation of intake and output
Describe the process for collecting urine and stool samples

Student Learning Outcomes

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Elements of Toileting Assistance

Frequency of Assistance

Offer toileting help every two hours

Options Include

Toilet

For clients able to stand or use a mechanical lift

Bedpan

For those unable to leave bed
Includes standard and fracture pans
Prolonged use can lead to pressure sores

Sandquist-Reuter, 2023

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Bedpan Examples

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Elements of Toileting Assistance continued…

Options continued…

Commode

Portable solution for limited mobility or privacy needs

Incontinence Products

Briefs or pads for those with little control
Prolonged use can lead to skin breakdown

Sandquist-Reuter, 2023

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Critical Thinking Question

A resident requires assistance with toileting every two hours. The nurse’s aide notices that the resident becomes embarrassed and hesitant when asked if they need to use the bedpan. How should the nurse’s aide address this situation to maintain the resident's dignity and encourage cooperation?

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Assisting Clients with Incontinence

Causes of Incontinence

Physical Limitations

Mobility or neurological issues

Medical Devices

Use of urinary catheters or surgical options like urostomies

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Assisting Clients with Incontinence continued…

Preventive Care

Proper Hygiene

Maintain perineal care to prevent infections

Dignity in Care

Use respectful language
Example: "brief" instead of "diaper"

Sandquist-Reuter, 2023

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Critical Thinking Question

A resident with limited mobility is using a urinary catheter. What is a key practice to help prevent urinary tract infections in this resident?

A. Clean around the catheter insertion site once a week.

B. Encourage the resident to drink plenty of fluids.

C. Empty the collection bag when it is full.

D. Use a diaper to prevent leakage around the catheter.

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Bladder Training

Timed Voiding

Scheduled urination to train bladder control

Gradual Increase

Extend time between bathroom visits to four hours

Sandquist-Reuter, 2023

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Bowel Training continued…

Regular Scheduling

Align bathroom visits with natural urges

Dietary Support

Encourage fluids and dietary adjustments to prevent constipation

Sandquist-Reuter, 2023

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Critical Thinking Question

A resident undergoing bowel retraining is scheduled to use the toilet every morning after breakfast. What is the main reason for this timing?

A. To coincide with staff shift changes for convenience.

B. To prevent the resident from participating in morning activities.

C. To ensure the resident is supervised while eating.

D. To align with the resident’s natural digestive rhythm.

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Urinary Tract Infections (UTIs)

Causes

Bacteria Entry

From improper hygiene or structural issues

Risk Factors

Short urethra
Sexual activity
Aging
Low fluid intake

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Urinary Tract Infections (UTIs) continued…

Symptoms

Common Signs

Painful urination
Frequent urges
Cloudy or bloody urine

Serious Indicators

Fever
Back pain
Confusion in older adults

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Urinary Tract Infections (UTIs) continued…

Prevention and Management

Hydration

Encourage fluid intake to flush bacteria

Frequent Toileting

Reduce retention and provide proper hygiene

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Critical Thinking Question

A female resident is frequently experiencing pain and burning during urination. They also seem more confused than usual. What steps should the nurse’s aide take to address these symptoms?

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Observation and Documentation of Intake and Output

Food Intake

Documentation

Estimate consumption in 25% increments

Observation

Note any coughing or difficulty swallowing

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Observation and Documentation of Intake and Output continued…

Fluid Measurement

Conversion

1 oz = 30 mL
Document in milliliters

Include all melting substances like ice cream as fluids

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Observation and Documentation of Intake and Output continued…

Urine Characteristics

Normal vs. Abnormal

Color
Clarity
Odor
Sediment

Output Documentation

Use toilet hats and graduated cylinders

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Critical Thinking Question

When documenting a resident's food intake, the nurse’s aide notices they have consumed about half of their meal. How should the nurse’s aide record this in the resident's chart?

A. 25% intake

B. 50% intake

C. Mostly finished

D. Bites only

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Collecting Urine Samples

Urine Collection

Procedure

Use a toilet hat and specimen cup
Maintain cleanliness

Labeling

Ensure proper labeling for accurate testing

Specimen cup

Sandquist-Reuter, 2023

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Collecting Stool Samples

Stool Sample Collection

Occult Blood Test

Avoid red meat and certain medications before testing

Sample Handling

Use guaiac fecal occult blood test (gFOBT) and follow precise protocol for accurate results

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Toilet Hat

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Feeding and Nutrition Assistance

Mealtime Environment

Pleasant Atmosphere

Consider table setting and social aspects

Respectful Techniques

Avoid child-like feeding methods
Avoid feeding too fast

Can lead to choking or aspiration

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Feeding and Nutrition Assistance continued…

Adaptive Equipment

Utensils

Use built-up handles
Weighted silverware
Swivel spoons

Cups and Plates

Use covered cups
Nosey cups
Plate guards

Nosey Cup

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Built-Up and Weighted Silverware

Swivel Spoon

Covered Cup

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Feeding and Nutrition Assistance continued…

Dietary Adherence

Care Plans

Follow specific diet orders for texture and consistency

Observation

Report changes in appetite or swallowing difficulties

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References

Sandquist-Reuter, M. (2023). Nursing Assistant. WisTech Open. https://wtcs.pressbooks.pub/nurseassist/

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