Assessing the individual’s ability to eliminate

Obtaining an assessment of a client’s elimination pattern can be quite a challenge. The client may feel very uncomfortable with the idea of talking about this subject, and differences in the use of words to refer to a wish to pass urine or defecate can mean that information is misinterpreted. Issues surrounding menstruation are also generally considered private. The nurse therefore needs to be sensitive to these issues during the assessment of this activity of living. As with other aspects of assessment a private room, away from other people, is the ideal place to undertake exploration of a client’s elimination patterns and needs. Whilst such a venue is often difficult to find on a busy ward, a setting that provides as much privacy as possible should be sought to promote client comfort when talking to the health care professional.

When eliciting information about the clients’ normal elimination patterns, this information needs to be specific so you should avoid using vague words such as ‘regular’ without clarifying the meaning with the client.

Remember that assessment of elimination is only part of a holistic nursing assessment and should not be undertaken in isolation without reference to or consideration of the client’s other activities of living.

Specific points to consider when assessing an individual’s ability to eliminate are:

• Physical
How often do they pass urine?
Do they have to get up in the night to pass urine; if so how often?
How often do they have a bowel movement? Is this their norm?
Would they say they were constipated?
Do they have diarrhoea?
What colour is the faeces? Is there any blood, fat or mucus present?
Does the faeces float?
Do they experience any pain/burning when passing urine or faeces?
Does their urine smell or is it offensive?
Does their faeces smell more offensively than normal?
Does the client experience any other difficulties when attempting to pass urine or faeces, for example frequency, urgency, difficulty initiating flow?
Have they noticed any other significant changes in their elimination habits?
Are they taking any medication that might affect elimination, for example codeine compounds?
Are they receiving adequate dietary and fluid intake to promote normal functioning?
Any evidence of incontinence, dribbling, retention?
Does the client have any changes in mode of elimination such as a stoma or catheter?
Are there any other factors that may influence their ability to eliminate, for example reduced mobility?
What is the client’s usual menstrual cycle and where are they in that cycle (if X-rays are to be undertaken)?
Is bleeding generally normal/heavy/light/painful?
Does the client get particularly emotional at this time?
Does the client take any medication that is prescribed for or that might affect their elimination patterns, for example laxatives, water tablets, HRT, contraception?

• Psychological
Is the client anxious, depressed, worried or frightened?
Are they embarrassed?
Does the client require any toilet training or assistance in re-establishing elimination patterns?

• Sociocultural
Does the client follow any particular religious, social or cultural rituals associated with elimination?
Does the client use any particular words or phrases for urine, faeces, defecation, etc.?
Does the client have an established hygiene ritual following toileting?
Does the client take regular exercise? Reduced mobility can lead to constipation.

• Environmental
Do they have access to toilet facilities?
Are these satisfactory and/or appropriate?
Do they have any adequate facilities for storing, cooking and handling food?
Do they have any educational needs in relation to food storage, cooking and handling?
Does the client have adequate equipment to meet their hygiene needs in
relation to their menstrual cycle?
Do they know where to dispose of tampons/sanitary towels, etc.?

• Politico-economic
Does the client have adequate finances for a healthy, well-balanced diet?
Has the increasing closure of public toilet facilities impacted on the client in any way?
Do they have adequate funds for menstrual protection?