Elimination and Toileting

1. Bedpans, urinals, commodes, and toilets

A bedpan is used by a resident who cannot get out of bed, and a urinal is a container for urine, often used by male residents in bed. A standard bedpan is the usual size; a fracture pan is smaller and flatter and is used for residents who cannot raise their hips or who have a fracture, so they do not have to be lifted or moved much. A commode is a portable bedside chair with a built-in pan, for residents who can get out of bed but cannot walk to the bathroom. A toilet transfer means helping a resident move to the toilet, done toward the resident's strong side and with the assistive equipment the care plan orders. With every method, the CNA protects privacy, keeps the resident covered and warm, and cleans and dries the skin afterward.

2. Incontinence care and catheter care

Incontinence is the loss of bladder or bowel control. Incontinent residents are checked and changed promptly, because urine and stool left on the skin break it down and lead to skin breakdown, irritation, and pressure injuries; perineal care and a dry barrier product protect the skin. A resident with a urinary catheter has a tube draining urine into a drainage bag. The CNA understands three safety concepts: the drainage bag is kept below the level of the bladder so urine flows down by gravity and does not flow back and cause infection; the tubing is secured so it does not pull on the resident and is kept free of kinks so urine drains freely; and the tubing is cleaned downward, away from the meatus (the opening where the catheter enters the body), so germs are not pushed toward the body. The CNA observes and reports — and never pulls on, disconnects, or performs sterile care on the catheter, which is outside scope.

3. Bowel elimination

Bowel elimination is the passing of stool. Constipation is infrequent, hard, difficult-to-pass stool; if stool becomes hard and stuck and cannot be passed, it is called impaction. The CNA observes and reports stool frequency, consistency, color, and any blood, and reports a resident who has not had a bowel movement for several days or who shows signs of impaction (such as liquid stool leaking around a blockage). An ostomy is a surgically created opening (stoma) on the abdomen through which stool or urine empties into a pouch. The CNA observes the stoma and the pouch, reports changes in color or drainage, and empties the pouch as directed — but never inserts anything into the stoma.

How it works

1. The CNA answers the call light promptly, offers the right equipment, and protects privacy.
2. The CNA observes and records urine and stool — amount, color, and character.
3. The CNA cleans the resident and changes soiled items promptly to prevent skin breakdown.
4. For a catheter, the CNA keeps the bag below the bladder, keeps tubing secured and unkinked, and cleans down the tubing away from the meatus, then reports any concern to the nurse.

Common confusions

Memory aids

Remember B.S.D. for catheter safety concepts: Bag below the bladder, Secure the tubing (and keep it free of kinks), Down the tubing, away from the meatus, when cleaning.

Quick review

Topic Recap

Elimination care helps residents manage urine and stool safely and with dignity. The CNA offers the right equipment — standard or fracture pan, urinal, commode, or toilet — protects privacy, and observes and reports output. Incontinent residents are changed promptly to prevent skin breakdown. For catheters, the CNA keeps the bag below the bladder, secures the tubing, and cleans down the tubing away from the meatus, while reporting rather than performing sterile care. Constipation, impaction, and ostomy care all depend on the CNA's observation and reporting.

Knowledge Check

1. Which bedpan is used for a resident who has a hip fracture and cannot raise their hips?
2. Why is the catheter drainage bag kept below the level of the bladder?
3. In which direction is catheter tubing cleaned relative to the meatus?
4. A resident has not had a bowel movement in four days and is uncomfortable. What should the CNA do?
5. Why is prompt changing of an incontinent resident important?

Answers and Rationales

1. A fracture pan. It is smaller and flatter than a standard bedpan, so the resident does not have to be lifted or moved much, which protects an injured hip.
2. To let urine drain by gravity and prevent it from flowing back into the bladder, which could cause a urinary tract infection.
3. Downward, away from the meatus. Cleaning away from the body keeps germs from being pushed toward the catheter opening, reducing infection risk.
4. Report the finding to the nurse. Four days without a bowel movement signals constipation that may need treatment; removing an impaction or giving an enema is outside CNA scope unless specifically delegated and trained.
5. Because urine and stool left on the skin break it down, causing irritation, skin breakdown, and pressure injuries. Prompt changing keeps the skin clean and dry.