Wednesday, 31 March 2010

BEDPAN AND URINAL

Bedpans and urinals permit elimination by the bedridden patient and accurate observation and measurement of urine and stool by the nurse. A bedpan is used by the female patient for defecation and urination and by the male patient for defecation; a urinal is used by the male patient for urination. Either device should be offered frequently—before meals, visiting hours, morning and evening care, and any treatments or procedures. Whenever possible, allow the patient privacy.
Equipment
Bedpan or urinal with cover • toilet tissue • two washcloths • soap • gloves • towel • linen-saver pad • bath blanket • pillow • optional: air freshener, talcum powder.
Available in adult and pediatric sizes, the bedpan may be disposable or reusable (the latter can be sterilized). The fracture pan, a type of bedpan, is used when spinal injuries, body or leg casts, or other conditions prohibit or restrict turning the patient. Like the bedpan, the urinal may be disposable or reusable.
Preparation of equipment
Obtain the appropriate bedpan or urinal. If you're using a metal bedpan, warm it under running water to avoid startling the patient and stimulating muscle contraction, which hinders elimination. Dry the bedpan thoroughly and test its temperature because metal retains heat. If necessary, sprinkle talcum powder on the edge of the bedpan to reduce friction during placement and removal. For a thin patient, place a linen-saver pad at the edge of the bedpan to minimize pressure on the coccyx.
Implementation
  • If the patient's condition permits, provide privacy. Put on gloves to prevent contact with body fluids and comply with standard precautions.
Placing a bedpan
  • If allowed, elevate the head of the bed slightly to prevent hyperextension of the spine when the patient raises the buttocks.
  • Rest the bedpan on the edge of the bed. Then, turn down the corner of the top linens and draw up the patient's gown. Ask him to raise the buttocks by flexing his knees and pushing down on his heels. While supporting the patient's lower back with one hand, center the curved, smooth edge of the bedpan beneath the buttocks.
  • If the patient can't raise his buttocks, lower the head of the bed to horizontal and help the patient roll onto one side, with buttocks toward you. Position the bedpan properly against the buttocks, and then help the patient roll back onto the bedpan. When the patient is positioned comfortably, raise the head of the bed as indicated.
  • After positioning the bedpan, elevate the head of the bed further, if allowed, until the patient is sitting erect. This position, like the normal elimination posture, aids in defecation and urination. (See Using a commode.)
  • If elevating the head of the bed is contraindicated, tuck a small pillow or folded bath blanket under the patient's back to cushion the sacrum against the edge of the bedpan and support the lumbar region.
  • If the patient can be left alone, place the bed in a low position and raise the side rails to ensure his safety. Place toilet tissue and the call button within the patient's reach, and instruct him to push the button after elimination. If the patient is weak or disoriented, remain with him.
  • Before removing the bedpan, lower the head of the bed slightly. Then ask the patient to raise his buttocks off the bed. Support the lower back with one hand, and gently remove the bedpan with the other to avoid skin injury caused by friction. If the patient can't raise his buttocks, ask him to roll off the pan while you assist with one hand. Hold the pan firmly with the other hand to avoid spills. Cover the bedpan and place it on the chair.
  • Help clean the anal and perineal area, as necessary, to prevent irritation and infection. Turn the patient on his side, wipe carefully with toilet tissue, clean the area with a damp washcloth and soap, and dry well with a towel. Clean a female patient from front to back to avoid introducing rectal contaminants into the vaginal or urethral openings.
P.97

Placing a urinal
  • Lift the corner of the top linens, hand the urinal to the patient, and allow him to position it.
  • If the patient can't position the urinal himself, spread his legs slightly and hold the urinal in place to prevent spills.
  • After the patient voids, carefully withdraw the urinal.
After use of a bedpan or urinal
  • Give the patient a clean, damp, warm washcloth for his hands. Check the bed linens for wetness or soiling, and straighten or change them if needed. Make the patient comfortable. Place the bed in the low position, and raise the side rails.
  • Take the bedpan or urinal to the bathroom or utility room. Observe the color, odor, amount, and consistency of its contents. If ordered, measure urine output or liquid stool, or obtain a specimen for laboratory analysis.
  • Empty the bedpan or urinal into the toilet or designated waste area. Rinse with cold water and clean it thoroughly, using a disinfectant solution. (Some facilities use automatic bedpan washers as an alternative to hand washing these devices.) Dry the device and return it to the patient's bedside stand.
  • Use an air freshener, if necessary, to eliminate offensive odors and minimize embarrassment.
  • Remove gloves and wash your hands.
Special considerations
  • Explain to the patient that drug treatment and changes in his environment, diet, and activities may disrupt his usual elimination schedule. Try to anticipate elimination needs, and offer the bedpan or urinal frequently to help reduce embarrassment and minimize the risk of incontinence.
  • Avoid placing a bedpan or urinal on top of the bedside stand or overbed table to avoid contamination of clean equipment and food trays. Similarly, avoid placing it on the floor to prevent the spread of microorganisms from the floor to the patient's bed linens when the device is used.
  • If the patient feels pain during turning or feels uncomfortable on a standard bedpan, use a fracture pan. Unlike the standard bedpan, the fracture pan is slipped under the buttocks from the front rather than the side. Because it's shallower than the standard bedpan, you need only lift the patient slightly to position it. If the patient is obese or otherwise difficult to lift, ask a coworker to help you.
  • If the patient has an indwelling urinary catheter in place, carefully position and remove the bedpan to avoid tension on the catheter, which could dislodge it or irritate the urethra. After the patient defecates, wipe, clean, and dry the anal region, taking care to avoid catheter contamination. If necessary, clean the urinary meatus with povidone-iodine solution.
  • Documentation
    Record the time, date, and type of elimination on the flowchart and the amount of urine output or liquid stool on the intake and output record, as needed. In your notes, document the amount, color, clarity, and odor of the urine or stool and the presence of blood, pus, or other abnormal characteristics in urine or stool. Document the condition of the perineum.