Elimination and
Bowel/Bladder Care
Master the nursing fundamentals of urinary and bowel elimination, catheter care, and patient-centered toileting support.
What Is Elimination?
Elimination is the body's process of removing waste through two main routes: the urinary system (bladder) and the gastrointestinal system (bowel). Nurses promote safe, dignified, and regular elimination as a core part of basic care.
Key Terms to Know
Two Routes of Elimination
Normal Output Values
A foundational rule: adequate urine output reflects kidney perfusion. The minimum acceptable rate is:
Calculating Minimum Output
To verify a patient is producing enough urine, multiply weight by the minimum rate by the number of hours:
Example: An 80 kg patient over 4 hours should produce at least:
Retention vs. Incontinence
| Urinary Retention | Incontinence | |
|---|---|---|
| Problem | Cannot empty bladder | Cannot hold/control output |
| Bladder | Distended, full | May empty unexpectedly |
| Key Risk | UTI, distension, damage | Skin breakdown |
| Intervention | Catheterization, bladder scan | Toileting schedule, skin care |
How to Assess Elimination
Indwelling Catheter Care
Example 1: Output Check
Scenario: A 60 kg post-op patient is monitored for 8 hours and produces 200 mL of urine. Is this adequate?
Example 2: Bladder Distension
Scenario: A patient who hasn't voided in 8 hours reports lower abdominal discomfort. A bladder scan shows 600 mL.
Example 3: Constipation
Scenario: An older adult on opioids has not had a bowel movement in 4 days and reports bloating.
Common Mistakes
Quick Reference Summary
| Finding | Meaning | Priority Action |
|---|---|---|
| \( \text{Output } < 0.5 \ \text{mL/kg/hr} \) | Oliguria | Assess, notify provider |
| \( \text{Bladder scan } > 400 \ \text{mL} \) | Retention | Non-invasive, then cath |
| No BM 3+ days + opioids | Constipation | Fluids, fiber, softener |
| Involuntary leakage | Incontinence | Schedule, skin care |
Question 1 of 5
A nurse cares for a patient with an indwelling urinary catheter. Which action best prevents a catheter-associated urinary tract infection (CAUTI)?
Question 2 of 5
A 72 kg patient is monitored for 6 hours. What is the minimum acceptable urine output?
Question 3 of 5
A patient has not voided in 8 hours and a bladder scan reads 550 mL. What is the nurse's first action?
Question 4 of 5
A patient on long-term opioids reports no bowel movement for 4 days. Which intervention should the nurse anticipate first?
Question 5 of 5
A patient with urinary incontinence is at greatest risk for which complication?