Helping the patient with elimination is one of the most testing aspects of your nursing care. A difficult and embarrassing service for the patient to accept, he must never sense that it is difficult or embarrassing for you to give. Your priority is to maintain the patient’s dignity at all times, even if he is unconscious, and to provide privacy.
The normal elimination from the body is from the bladder, the bowel and the skin. Women also lose menstrual fluid from the vagina. The patient may vomit or have a cough and produce sputum. These excretions are often saved, as they may provide valuable information about the patient’s condition.
Basic care
To attend to the patient’s needs satisfactÂorily, you must know how much he is able to do for himself and when he is likely to need help. He may be able to walk to the lavatory, perhaps with just a steadying hand from you; but he may not be able to go as far as the lavatory, in which case he may either be allowed out of bed in the bedroom to use a commode or have to use a bedpan or urinal in bed.
The patient must be given the opportunÂity to follow his usual habits. Most people tend to pass urine soon after they get up in the morning and many have been in the habit from childhood of passing urine before a meal and before going to sleep at night.
Using a commode
Make sure the bedroom door is closed before helping the patient out of bed. Put his slippers on for him and place a dressing gown or shawl around his shoulders. If necessary, help the patient to move his pyjamas or her nightdress out of the way, then seat the patient carefully. Cover his legs with a blanket: this muffles the sound of urine and reduces embarrassment, both from the sound and from exposure. See that there is a toilet roll within the patient’s reach and leave him in peace – unless he is weak or unsteady, in which case remain nearby. Afterwards encourage him to wash his hands; if it is not possible for him to walk as far as the nearest basin, have ready a bowl of water, soap and a towel for his immediate use. Help him back into bed. Cover the pan and empty it down the lavatory; rinse in cold water and replace. Wash your hands. Eliminate smells with an air freshener, and return the room to normal as quickly as you can.
