GIVING AND REMOVING A BEDPAN AND URINAL

Equipments: Clean bedpan or urinal Toilet tissue Basin of water, soap, washcloth, towel Aerosol freshener Equipment for specimen collection (if required)

PROCEDURE RATIONALE 1 2 3 4 51. Assessment of the clients general strength and ability to turn

to sides or raise buttocks.

2. Tuck the bedpan cover under the mattress at the side of the bed. Warm the bed pan by running water inside the rim of pan or over the pan. Dry the outside of the pan, and place it on the foot of the bed or on an adjacent chair.

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PROCEDURE RATIONALE 1 2 3 4 53. A. For clients who can assist by raising their buttocks: Fold down the top bed linen on the near side to expose the

hip, and adjust the gown so that it will not fall into the bedpan.

a. Ask the client to flex the knees, rest the weight on the back and the heels, and then raise the buttocks. Assist the client to lift the buttocks by placing the hand nearest the person’s head palm up under the lower back, resting the elbow on the mattress, and using the forearm as a lever.

b. Place a regular bedpan under the buttocks with the narrow end toward the foot of the bed and the buttocks resting on the smooth, rounded rim. Place a slipper (fracture) pan with the flat end under the client’s buttocks.

c. Replace the top bed linen and the side rail as needed.

d. Provide the client with toilet tissue, and ensure that the call light is readily accessible. Ask the client to signal when finished. Leave only when, in your judgement, it is safe to do so.

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PROCEDURE RATIONALE 1 2 3 4 53. B. For helpless clients who cannot raise their buttocks on and

off a bedpan:

Assist the person to a side-lying position with the back toward the nurse.

Place the bedpan against the buttocks with the open rim toward the foot of the bed.

Hold the far hip with one hand and the bedpan with the other. Smoothly roll the client toward you and onto the back with the bedpan in place. Assume a wide stance and move weight from the front leg to back leg when moving client.

Elevate the head of the bed to a semi-Fowler’s position.

If the person is unable to assume a semi-Fowler’s position, place a small pillow under the back or help the client to another comfortable position.

Ensure that the call light is within reach.

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PROCEDURE RATIONALE 1 2 3 4 54. A. For people who can raise their buttocks:

a. Elevate the bed to the high position, and then remove the bedpan by again pie folding the top linen back and asking the client to raise his or her buttocks.

b. Cover the bedpan, and place it on an adjacent chair or at the foot of the bed.

c. If the client requires assistance to clean the perineal area:

Wrap the toilet tissue several times around the hand, and wipe the person from the public area to the anal area, using one stroke for each piece of tissue.

Turn the client on the side, spread the buttocks, and clean the anal area in the same manner.

Place the soiled tissue in the bedpan

Wash the anal area with soap and water as indicated and thoroughly dry the area.

Replace the draw sheet if it is soiled

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PROCEDURE RATIONALE 1 2 3 4 54. B. For helpless people:

a. Return the bed to the flat position if needed.

b. Fold the top bed linen down to the thighs

c. Holding the bedpan securely with one hand, gently roll the client to a side-lying position either facing toward or away from the nurse. If the nurse is alone, it is safer and easier to roll the client toward the nurse rather than away from the nurse. If planning to turn the client away from the nurse, raise the side rail on the far side or have another nurse present to prevent a fall.

d. Remove and cover the bedpan, and place it safely on an adjacent chair or at the foot of the bed.

e. Clean the perineal area as in step 5c

5. Offer the client materials to wash and dry the hands.

6. Spray the air with an air freshener if there is an unpleasant odor unless contraindicated because of respiratory problems or because it is offensive.

7. Acquire a specimen if required. Place it in the appropriately labeled container.

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PROCEDURE RATIONALE 1 2 3 4 58. Empty and clean the bedpan. Provide a clean bedpan cover, if

necessary, before returning it to the client’s unit.

9. Record any significant assessments.

Giving and Removing a Urinal10. Assist the client to an appropriate position, such as a semi-

fowler’s position or, for male, a standing position at the side of the bed if health permits.

11. Offer the urinal so that the client can position it independently or place a urinal between the client’s legs with the handle uppermost so that urine will flow into it.

12. Tuck the urinal cover under the mattress at the side of the bed.

13. Leave a signal cord within reach of the person.

14. Leave for 2-3 minutes or until the client signals, or remain if the client needs support to stand at bedside or other assistance.

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PROCEDURE RATIONALE 1 2 3 4 515. Remove and cover the urinal or place it in a urinal bag

16. If wet, wipe the area around the urethral orifice with a tissue.

17. Make sure the person’s perineum is dry.

18. Offer a dampened washcloth or water, soap, and a towel to wash and dry hands.

19. Change the draw sheet if it is wet.

20. Measure the urine if the client is on monitored intake and output, and provide a specimen if required.

21. Empty and rinse out the urinal, and return it to the bedside unit.

22. Record the amount of urine, if it was measured, and all assessment data.

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ADMINISTERING ENEMA

Equipments: Disposable enema unit or enema set containing the ff:

bottle to hold the solution tubing lamp

Rectal Tube #22-30 adults #14-18 children #12 infants

Lubricant (e.g. KY gelly)

Bath thermometer Soap Salt Drape Waterproof absorbent pad Tissue wipes Bedpan or commode Disposable/Clean Gloves

PROCEDURE RATIONALE 1 2 3 4 51. Assessment of the anus and rectal area for any unusualities

which may contraindicate the use of enema like warts or wound.

2. Explain the procedure to the client. Indicate that there may be a feeling of fullness while the solution is being administered.

3. Assist adult and school-aged persons to a left lateral position, with the right leg acutely flexed, and drape with the bath blanket.

4. Place the waterproof pad under the client’s buttocks to protect the bed linen.

5. Open the clamp, and run some solution through the connecting tubing and the rectal tube; then close the clamp

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PROCEDURE RATIONALE 1 2 3 4 56. Lubricate 5cm of the rectal tube if enema is for an adult and

2.5 cm if it is for a child. Some commercially prepared enema sets already have lubricated nozzles.

7. Don gloves and insert the rectal tube smoothly and slowly into the rectum, directing it toward the umbilicus. Insert the tube an appropriate distance. Note any sign of discomfort on inserting the tube and any obstruction to the passage.

8. If resistance is encountered at the internal sphincter, ask the client to take a deep breath, then run a small amount of solution through the tube. If the resistance persists, withdraw the tube and report the resistance to the nurse in charge.

9. If there is no resistance, open the clamp, and raise the solution container to the appropriate height above the rectum: 30-45 cm for an adult, 7.5 cm for an infant.

10. Administer the fluid slowly. If the client complains of fullness or pain, use the clamp to stop the flow for 30 seconds and then restart the flow at a slower rate. Ask the client to breathe slowly through the mouth to assist relaxation. If the nurse is using a plastic commercial container, roll it up as the fluid is instilled.

11. After all the solution has been instilled or when the client cannot hold any more and wants to defecate, close the clamp and remove the rectal tube from the anus.

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PROCEDURE RATIONALE 1 2 3 4 512. Apply a firm pressure over the anus with tissue wipes or press

the buttocks together to assist retention of enema. Ask the client to remain lying down. Encourage the client to hold the enema.

13. Assist the client to a sitting position on the bedpan, commode, or toilet. If a specimen of feces is required, ask the client to use a bedpan or commode.

14. Ask the client not to flush the toilet if he or she is using one.

15. Record the procedure: the amount, color and consistency of returns, the presence of unusual constituents (e.g. worms); and the overall status of the client before and after the procedure.

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PROCEDURE RATIONALE 1 2 3 4 516. Teach the client practices that develop regular and normal

defecation, such asa. Eating a balanced diet containing adequate bulk

(roughage and fiber content). Bulk is found primarily in unrefined breakfast cereals, whole wheat flour, raw fruits, and raw vegetables.

b. Maintaining an adequate fluid intake, eg. 1500 ml daily

c. Eating regular meals.

d. Establishing a regular time for defecation and allowing adequate time to defecate.

e. Doing regular and sufficient amounts of exercise.

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REMOVING A FECAL IMPACTION DIGITALLY

Equipments: Moisture resistant bedpad Bedpan and cover Toilet tissue Disposable gloves Lubricant

PROCEDURE RATIONALE 1 2 3 4 51. Assessment of the rectum and rectal area.

2. Explain to the client what you plan to do and why. This procedure is distressing, tiring and uncomfortable, so the person may desire the presence of another nurse or support person.

3. Assist the client to a right lateral or Sim’s position with the back toward you.

4. Place the disposable bedpad under the client’s hips and arrange the top bedclothing so that it falls obliquely over the hips, exposing only the buttocks.

5. Place the bedpan and toilet tissue nearby on the bed or beside chair.

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PROCEDURE RATIONALE 1 2 3 4 56. Put on gloves.

7. Lubricate the gloved index finger into the rectum moving toward the umbilicus.

8. Gently insert the index finger into the rectum moving toward the umbilicus.

9. Gently massage around the stool.

10. Work the finger into the hardened mass of stool to break it up. If you cannot break up the impaction with one finger, insert two fingers and try to break up the impaction scissor style.

11. Work the stool down to the anus, remove it in small pieces, and place them in the bedpan.

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PROCEDURE RATIONALE 1 2 3 4 512. Carefully continue to remove as much fecal material as

possible; at the same time assess the client for signs of pallor, feelings of faintness, shortness of breath, and perspiration. Terminate the procedure if these occur.

13. Assist client to a position on a clean bedpan, commode, or toilet.

14. Document the removal of a fecal impaction and all assessments, eg. the appearance and amount of stool, and vital signs.

15. If appropriate, teach the client measures to promote normal elimination. Alterations in diet and fluid intake and the use of stool softeners may be necessary.

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