Elimination support
Introduction
Elimination is a basic human function, but when it’s impaired, dignity, safety, and comfort are all on the line. Nurses provide critical support in managing urinary and bowel elimination through catheter care, ostomy care, and bowel management programs, especially in postoperative and immobile clients.
On the NCLEX, you’ll be expected to know when interventions are needed, how to perform them safely, and how to educate clients with empathy and clarity.
Learning objectives
By the end of this section, you should be able to:
- Identify indications and care principles for urinary catheters
- Describe nursing care and education for clients with ostomies
- Implement bowel training and manage constipation or incontinence
- Recognize risks and complications of elimination devices
Urinary catheterization
Catheterization is a last resort. Indwelling urinary catheters should be used only when clinically indicated because they increase the risk of catheter-associated urinary tract infection (CAUTI). Nurses must understand insertion, care, and timely removal.
Types of catheters
| Type | Use |
| Indwelling (Foley) | For prolonged drainage (e.g., post-op, retention) |
| Straight (intermittent) | Temporary drainage, sterile sample collection |
| Suprapubic | Surgically inserted through the abdominal wall |
| External (condom or female external urinary collection device) | Non-invasive options for urinary incontinence |
Promoting voiding without a catheter
Before reaching for a catheter, try noninvasive measures to help a client void on their own:
- Run water or use another auditory cue to stimulate voiding.
- Pour warm water over the perineum.
- Provide privacy and position the client upright - on a commode or toilet if able - rather than supine.
- Encourage early ambulation.
- Use double voiding: void, wait a few minutes, then try again to fully empty the bladder.
- Apply gentle manual pressure over the bladder (the Credé maneuver) for a client with neurogenic bladder, if prescribed.
- Establish a timed or prompted toileting schedule.
Catheter care
- Maintain closed drainage system.
- Keep bag below bladder level to prevent backflow.
- Perform routine perineal hygiene daily and after bowel movements as needed (PRN).
- Secure tubing to prevent tension or accidental removal
- Empty bag when ½ to ⅔ full using clean technique.
- Remove the catheter as soon as it is no longer clinically indicated.
Irrigation
- Bladder irrigation: Continuous bladder irrigation uses a three-way catheter and sterile solution to flush clots and debris and keep the catheter patent, most often after urologic surgery. Intermittent irrigation clears an occluded catheter as needed. Use sterile technique and a closed system, and monitor the output until it runs clear.
- Eye and ear irrigation: Used to flush debris, foreign material, or discharge. Use the prescribed solution warmed to body temperature, irrigate gently, and never apply forceful pressure - direct flow from the inner to the outer canthus for the eye, and along the ear canal wall (never directly at the tympanic membrane) for the ear.
Ostomy care
An ostomy is a surgically created opening for stool or urine diversion. Depending on the underlying condition, clients may require a colostomy, ileostomy, or urostomy.
Types of ostomies
| Type | Output |
| Colostomy | Formed stool (descending or sigmoid colostomy) |
| Ileostomy | Liquid to semi-formed stool |
| Urostomy | Continuous urine output |
Stoma care
- Should appear pink, moist, and protruding slightly.
- Report pale, dusky, purple, or black stomas immediately because these findings may indicate impaired perfusion or ischemia. Report a newly retracted stoma promptly for evaluation and pouching management.
- Change the pouching system every 3 to 5 days or sooner if leakage occurs.
- Empty appliance when ⅓ to ½ full to prevent leakage.
- Clean the peristomal skin with warm water only; avoid soaps containing oils or moisturizers.
Client education
- Demonstrate how to change an appliance and assess the stoma.
- Promote individualized dietary adjustments (e.g., chew food thoroughly, introduce high-fiber foods gradually, and limit gas-producing foods if they cause discomfort or excessive gas).
- Support body image and adaptation.
- Teach signs of skin breakdown, blockage, or dehydration.
Bowel management
Bowel training programs
Used in clients with chronic constipation, neurological conditions (e.g., spinal cord injury), or post-surgical needs.
Key steps:
- Establish a consistent toileting schedule.
- Encourage fiber and fluid intake.
- Use stool softeners, laxatives as prescribed.
- Monitor the Bristol stool chart to evaluate consistency.
- Provide privacy and time during toileting.
Constipation and incontinence
| Condition | Nursing actions |
| Constipation | Increase fluids/fiber, ambulate, administer laxatives |
| Fecal impaction | Administer prescribed enemas or perform digital disimpaction if prescribed and appropriate |
| Incontinence | Prompt hygiene, toileting schedule, barrier creams |
| Diarrhea | Monitor for dehydration, impaired skin integrity, and signs of infection |
Clinical vignette
Mrs. Patel, 84, had hip surgery and now has an indwelling Foley catheter. On day 2 post-op, you note cloudy urine and sediment in the tubing, and the client reports lower abdominal discomfort.
Nursing action: Assess urine output and color. Ensure the tubing is not kinked. Assess whether the catheter is still clinically indicated. Perform perineal care, notify the provider, and anticipate an order for a urine culture. Emphasize the need for early catheter removal and review signs of CAUTI.
Client education
- Recognize signs of UTI: fever, suprapubic pain, cloudy or foul-smelling urine.
- Report constipation, bloating, or blood in stool immediately.