Elimination Needs

• Elimination of urine and faeces


  Will be discussed in this section
• Characteristics and amount of urine and faeces

  • Can be an indication if the person is healthy or if there is a health problem in the body
• Characteristics of normal urine


  • Amount per 24 hours: 1200-1500 ml
  • Colour: Yellow, straw coloured
  • Clarity: Clear
  • Smell: Typically, not offensive
• Abnormalities of urine


  May indicate problems of the urinary tract
• Abnormalities found with chemical tests


  Must at all times be reported to the Professional nurse
• Causes that may increase the risk for developing problems related to elimination of urine


  • Not drinking enough fluids
  • Wiping from back to front after going to the toilet
  • Using vaginal deodorants or perfumed feminine hygiene products
  • Sexually transmitted diseases
  • Childbirth
  • Enlarged prostate in men
  • Aging
  • Immobility
• Immobility


  • In a mobile person, gravity plays an important role in the emptying of the bladder. In an immobile person the bladder is not emptied completely
  • The urine that stays in the bladder creates the ideal environment for organisms to grow, causing bladder infection
  • Loss of muscle tone can result in weaker control over the urinary sphincter leading to incontinence
• Health problems related to the elimination of urine


  • Urinary tract infection
  • Urinary incontinence
• Urinary tract infection (UTI)


  • Pain and/or burning while passing urine is associated with bladder infection
  • Pain in the lower back or kidney area may be an indication of an infection or injury to the kidneys or ureters
  • Passing small amounts of urine frequently (urinary frequency) may indicate bladder infection
• Urinary incontinence


  No control over passing urine
• Causes of urinary incontinence


  • Weakness of the muscles of the pelvic floor after childbirth
  • Paralysis (unable to use the muscles of part of the body because of damage to the nerves after an injury or a stroke)
  • Enlargement of the prostate in men
  • Use of drugs or alcohol in large quantities
• Basic care for patients with problems related to elimination of urine


  1. Observe the urine for any abnormalities and report to the Professional nurse

  2. Advise the patient to drink more water, at least 8 glasses per 24 hours

  3. Patient should avoid drinking alcohol and caffeine

  4. Warm bath may help to relieve pain and discomfort

  5. Avoid sexual intercourse until symptoms improve

  6. Patient needs to be referred to the Professional nurse and doctor

  7. Drink the medication as prescribed by the doctor

  8. Urinate when you feel the need, don't resist the urge to urinate

  9. Wipe from front to back to prevent bacteria around the anus from entering the vagina or urethra

  10. Take showers instead of tub baths

  11. Wash genital area once a day with plain water and mild soap. Rinse well and dry thoroughly

  12. Avoid using feminine hygiene sprays and scented douches, which may irritate the urethra
• Basic care of a patient with no control over passing urine (urinary incontinence)

  1. The patient should go to the toilet every 2-3 hours to keep the bladder empty

  2. If the patient is bedridden, a bedpan or urinal must be offered

  3. Observe the fluid intake and output. Make sure the patient drinks enough fluids

  4. Provide linen savers or nappies if incontinence cannot be controlled

  5. Keep the patient clean and dry. Special water repellent ointment such as zinc ointment can be used to protect the skin

  6. Ensure that bedclothes and linen are dry at all times to prevent bad odours and damage to the skin

  7. Prevent unnecessary exposure of the patient

  8. Keep surroundings clean and well ventilated at all times

  9. Identify the possible cause for incontinence, such as bladder infections, by testing the urine for possible infections and report abnormalities

  10. An exercise program for bladder control might be followed

  11. Report all abnormalities regarding urine to the professional nurse
• Basic care of a patient with an indwelling catheter

  1. The drainage tube should not be bent and the drainage bag must always be lower than the patient's body to prevent backflow of urine into the bladder

  2. The drainage tube should not cause any pulling on the opening of the bladder (meatus). The catheter must be affixed to the leg to avoid friction of the catheter to the urethra

  3. Encourage the patient to drink a lot of fluid except if there is a contra-indication. The patient should drink at least 2000-3000 ml fluids per 24 hours and most of the fluid must be water to rinse the bladder

  4. The drainage bag must be emptied at least every 12 hours or more often before the bag is full

  5. The genitals should be washed 4-6 hourly and ensure that there is no discharge around the catheter where it enters the body

  6. Monitor intake and output

  7. Report urinary output of less than 30 ml/h

  8. Professional nurse must replace catheter regularly according to the type of catheter and manufacturer's instructions
• Elimination of faeces (stools)


  Health problems related to the elimination of faeces include constipation, diarrhoea, flatulence and haemorrhoids. Abnormalities in stools may indicate problems of the digestive tract and organs e.g. the liver and gall bladder. Constipation is the most common problem related to the elimination of faeces.
• Unhygienic preparation or storage of food and/or water supply may lead to infection of the digestive tract and diarrhoea. If proper sanitation is not available the risk for infections also increases and may lead to an epidemic such as cholera. Lack of proper sanitation and knowledge of hygienic measures, e.g. washing hands after passing stools, increases the risk for infestation of intestinal parasites such as roundworm.
• Characteristics of normal faeces/stools

  • Colour: Brown
  • Consistency: Formed cylindrical
  • Odour: Characteristic
  • Regularity: 1 x day up to 3 xs per week
• General signs and symptoms of problems related to the elimination of faeces


  Any abnormalities of faeces i.e. abnormal colour, hard or watery stools or stools less than once a week or more than 3 times per day, should be reported to the Professional nurse.
• Diarrhoea


  • Abnormal increase in the number of stools, which are usually very fluid like
  • The intestinal tract is hyperactive and transports the faeces very quickly
  • A great deal of water, sodium and potassium is lost
  • Diarrhoea is a dangerous condition in infants and toddlers, because they dehydrate so easily
• Causes of diarrhoea


  • Certain medication
  • Food allergy or food poisoning
  • Bacterial and viral infections
  • Stress and emotional disturbances
• Infants and children under the age of four, and especially before six month of age, need special attention when they have diarrhoea or are vomiting. They can quickly become dehydrated and replacement of fluids is very important.
• Frequency of bowel movements

  • 1 x day up to 3 xs per week
• General signs and symptoms of problems related to the elimination of faeces


  Any abnormalities of faeces i.e. abnormal colour, hard or watery stools or stools less than once a week or more than 3 times per day
• Any abnormalities of faeces should be reported to the Professional nurse
• Diarrhoea


  • An abnormal increase in the number of stools, which are usually very fluid like
  • The intestinal tract is hyperactive and transports the faeces very quickly
  • A great deal of water, sodium and potassium is lost
• Diarrhoea is a dangerous condition in infants and toddlers, because they dehydrate so easily
• Causes of diarrhoea


  • Certain medication
  • Food allergy or food poisoning
  • Bacterial and viral infections
  • Stress and emotional disturbances
• Basic care of a patient with diarrhoea

  1. Drink more fluids than usual

  2. Continue to eat, even if the patient only consumes small amounts of nutritious foods at a time

  3. Recognise and treat dehydration early
• Constipation


  Refer to Immobility Related Health Problems: "Constipation"
• Anal incontinence


  Anal sphincter (muscle around the opening) has no control over the defecation process because of being paralysed or loss of muscle tone because of old age, i.e. the person has no control over passing of stools
• Basic care of a patient with anal incontinence


  1. Observe closely when and to what extent the patient seems to be incontinent

  2. Offer a bedpan before soiling takes place

  3. Provide linen savers or nappies if incontinence cannot be controlled. Special incontinence pads and/or adult napples can be used to prevent sciling of clothes and linen

  4. Ensure regular observation of the patient and ensure that bedclothes and linen are dry at all times to prevent bad odours and possible skin breakdown

  5. Prevent unnecessary exposure of the patient

  6. Ointment can be applied if stools are loose or the skin is burnt. Special care needs to be given to prevent the skin from breaking and causing pressure sores

  7. Monitor intake and output

  8. Keep surroundings clean and well ventilated at all times

  9. Air freshener can be sprayed around the room to prevent or remove unpleasant smells

  10. Give the patient emotional support if he/she is embarrassed

  11. Record and report all findings to the professional nurse

  12. Paralysed patients can be helped to control their bowel
• Nausea


  A sensation of sickness which generally leads to vomiting
• Vomiting


  A reflex action where the stomach contents are forced up to be expelled through the mouth
• Basic care of a patient with nausea and vomiting

  1. Offer a bowl when the patient wants to vomit

  2. If the patient has a wound, support the wound during vomiting, by placing hand or pillow over the wound area

  3. During vomiting ensure patient does not aspirate, and that items such as false teeth do not get in the way, or fall into basin

  4. Remove the bowl and observe the contents for amount, colour, smell and ingredients of vomit

  5. Provide clean bowl after each bout of vomiting and help the patient to rinse mouth and wash hands

  6. As soon as the vomiting stops, wipe the patient's face with a moist face cloth

  7. Make the patient comfortable and if any bedclothes or linen are soiled, change it

  8. Monitor intake and output carefully

  9. Provide small sips of water if patient is not kept Nil Per Mouth

  10. Provide small light meals if patient can tolerate them

  11. Report any abnormalities to the Professional nurse

  12. Professional nurse will give medication as prescribed

  13. Observe the patient for any other signs of nausea and vomiting and report it
• Refer to Practical Procedures Guide for procedures like offering the patient a bedpan or urinal, catheter care, and how to change an adult nappy