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2026-09-24

PNUR1128 Week 2 — elimination: normal patterns, the assessment, and what goes wrong

PNUR1128 Nursing Concepts 1
PNUR1128 Nursing Concepts 1@jaylenstrating09
PNUR1128 Week 2 — elimination: normal patterns, the assessment, and what goes wrong

Ask a patient how her bowels have been this week, and watch what she does with her face. Most people look away, and you get the shortest answer they think they can get away with.

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Ask a patient how her bowels have been this week, and watch her face. Most people look away and give you the shortest answer they think they can get away with — which is exactly what makes this unit hard, because the assessment runs on questions nobody wants to answer, plus what you go and look at yourself.
This is Gordon's functional health pattern for elimination, worked end to end: what normal looks like on both sides, the Bristol scale, the questions and the physical exam, the numbers for urine, and what you do when the pattern is off.

The numbers to have cold

WhatValue
Bristol types that mean constipation1 and 2
Bristol types that mean diarrhea6 and 7
The ideal Bristol types3 and 4
Voiding interval to teachEvery 3 to 4 hours
Never hold urine longer than8 hours
Normal adult bladder capacity400 to 500 mL
First urge to void250 to 300 mL
Strong urge to voidAbout 500 mL
Fibre per day20 to 30 g
Fluid per day1500 to 2000 mL
Frequency, as a symptomMore than 8 times in 24 hours
OliguriaAround 400 mL in a day
Normal 24-hour urine volume800 to 2000 mL 1
Output to expect hour by hour in an adultAbout 30 mL 2

The Bristol Stool Form Scale

Seven types. The chart is what makes your documentation repeatable — you chart the type, not the word loose.
TypeWhat it looks likeBand
1Separate hard lumps, like nuts; hard to passConstipation
2Sausage-shaped, but lumpyConstipation
3Like a sausage, with cracks on the surfaceIdeal
4Like a sausage or a snake, smooth and softIdeal
5Soft blobs with clear-cut edges, passed easilyNeither
6Fluffy pieces with ragged edges, a mushy stoolDiarrhea
7Watery, no solid pieces, entirely liquidDiarrhea
Types 1 and 2 indicate constipation, 3 and 4 are the ideal stools, and 6 and 7 indicate diarrhea 3.

What you inspect, and what each finding points at

Stool findingWhat it points at
Brown, formed but soft, cylindrical, daily to 2–3 times a dayNormal
Black or tarryDigested blood from higher up; also iron or bismuth preparations
Bright redFresh blood from lower down; often hemorrhoids
White or clay-colouredAbsence of bile pigment
Thin or string-likeObstruction or a change in consistency
Hard, or liquidConstipation or diarrhea
More than 3 stools a day, or less than once a weekHypermotility or hypomotility
Pus, mucus, blood or excess fatBleeding, irritation, inflammation, malabsorption
Urine is inspected on four things: volume, colour, clarity and odour. Your unit measures volume with a urine hat, the graduated container that sits inside the toilet, so the number is measured rather than estimated. If you can see or feel a bladder, she is retaining — a normal bladder is not visible or palpable unless it is distended.

The two assessments, in the order you do them

Bowel elimination is assessed in three parts: a nursing health history, a physical examination, and inspection of the stool, alongside whatever the diagnostic tests showed. The history is where the marks are, and it needs discretion — her normal pattern and routine, what her usual stool is like, what she does to keep it regular, her use of laxatives, suppositories or enemas, recent changes in appetite and digestion, daily diet and fluid intake, past surgery or illness affecting the gut, family history, lifestyle and mobility, and the factors that quietly change a pattern: emotion, pain and privacy.
The physical examination covers the mouth, the abdomen and the rectum.
Urinary elimination follows the same shape. The history asks about the normal voiding pattern and frequency, the appearance of the urine, recent infections or injury, past or current problems, the presence of a urostomy, any history of catheterisation, and the environment. The physical assessment looks in four places: skin and mucous membranes for fluid and electrolyte imbalance such as edema or dehydration; the perineum for skin integrity, inflammation and the urethral opening; the kidneys for flank pain; and the bladder, which is normally impossible to see or feel unless it is distended.

What goes wrong

The bowel problems you meet are constipation, fecal impaction, diarrhea, fecal incontinence, flatulence, and hemorrhoids 2. On the urinary side the alterations are retention, infection, incontinence, and diversion — urine leaving through a surgically made opening.
The ten symptom words are exact, and they are what the assessment questions are written in:
TermMeaning
UrgencyA sudden, compelling desire to pass urine that is difficult to defer
DysuriaPain, burning or other discomfort during voiding
FrequencyVoiding more than 8 times in 24 hours
HesitancyA delay in initiating voiding when she is ready to pass urine
PolyuriaNoticeably more urine over 24 hours than she previously passed
OliguriaDiminished output relative to intake, around 400 mL in 24 hours
NocturiaThe number of times urine is passed during the main sleep period
DribblingLeakage of urine despite voluntary control
HematuriaVisible blood mixed with the urine
Elevated postvoid residualUrine left after voiding; points at neurogenic bladder, prostate enlargement, trauma, pelvic organ prolapse, urethral inflammation or stricture

What promotes a normal pattern

For regular defecation, the six measures are positioning, privacy, timing, nutrition, fluids and exercise. Positioning and privacy are mechanical rather than polite: sitting up or squatting lets the abdominal muscles and gravity work with her, while lying flat on a bedpan makes her push uphill. A routine at the same time of day teaches the body when to expect it. Fibre needs fluid — 20 to 30 g of fibre a day, with enough fluid for it to work, because fibre without fluid makes constipation worse. And movement moves the gut.
For urine, the measures are privacy; a regular pattern, neither too frequent nor held too long; a position that lets the pelvic floor relax, sitting or squatting; sensory stimuli such as running water or warm water over the perineum; adequate fluid, 1500 to 2000 mL a day, easy on caffeine and alcohol; and preventing infection. Teaching that reduces the stigma of incontinence earns its own line, because stigma is why patients stop asking for help and start quietly drinking less.

What changes with age

In the gut, the large intestine loses tone, which slows things down — the reason the fibre recommendation is 20 to 30 g a day, and the reason the constipation risk factors are a sedentary life, too little fibre and not enough fluid.
In the kidney, nephrons degenerate over time, but function usually holds unless something else is going on: repeated infections, trauma, diabetes, or hypertension.
The four kinds of incontinence carry their mechanism with them:
TypeMechanism
UrgeOveractive bladder
StressWeakened pelvic floor
OverflowProstate enlargement or diabetes
MixedA combination
Management is the same list for all four: medication, pelvic floor therapy, lifestyle modification, weight management, protective products, and surgery when nothing else holds.

What you ask a man, and what you ask a woman

What you ask
A manFrequency, urgency and nocturia; dysuria; hesitancy and straining; urine colour; past genitourinary history; the penis for pain, lesions or discharge; the scrotum for self-care and lumps; sexual activity and contraception; STIs and STI contact
A womanMenstrual, obstetrical and menopause history; urinary symptoms and whether she voids regularly; urine colour, clarity and amounts; self-care behaviours; vaginal discharge; past history; sexual activity and contraception; STI contact and risk reduction
Both change with age. In infants and children the questions cover urination, toilet training, abnormalities and molestation. In preadolescents and adolescents: puberty, nocturnal emissions, sexual activity, self-examination. In older adults: prostate enlargement, incontinence, nocturia and sexual function.

The terms, in the words the slides use

Micturition, voiding and urination all name the same process. The kidneys filter, urine collects in the bladder, sensory nerves carry the signal to the brainstem as it fills, and the forebrain keeps it voluntary. When she voids, the bladder contracts and the sphincter relaxes at the same time.
Constipation — infrequent or difficult passage of stool. Fecal impaction — a mass of hard stool that cannot be passed. Flatulence — gas in the bowel. Diversion — a surgically created opening, such as a urostomy.
Hypotonic bladder — the muscle loses tone after being overstretched by held urine, so it stops emptying properly. Small-capacity bladder — the opposite problem, from voiding too often.
Urine hat — the graduated container used to measure output. Bristol Stool Form Scale — the seven-type instrument for stool consistency.

The rapid-fire, in text

QuestionAnswer
Bristol types for constipation1 and 2
Bristol types for diarrhea6 and 7
The ideal Bristol types3 and 4
The six bowel problemsConstipation, fecal impaction, diarrhea, fecal incontinence, flatulence, hemorrhoids
Fibre a day20 to 30 g
Fluid a day1500 to 2000 mL
First urge, then the strong urge250 to 300 mL, then about 500 mL
How often to void, and how long may she hold itEvery 3 to 4 hours, never longer than 8
Frequency as a symptomMore than 8 times in 24 hours
OliguriaAround 400 mL in a day
Normal output over a full day800 to 2000 mL
Hesitancy, and urgencyA delay before starting; a sudden compelling need to go
The four kinds of incontinenceUrge, stress, overflow, mixed
The six measures that promote defecationPositioning, privacy, timing, nutrition, fluids, exercise

The things that get missed

  • Frequency is more than eight times in 24 hours — not eight trips in a day.
  • Fibre without fluid makes constipation worse. Fluid is not optional alongside it.
  • Privacy and position are mechanical. The reflex does not fire when she is braced, rushed or embarrassed.
  • A bladder you can see or feel means retention. A normal bladder is not palpable.
  • Type 5 is neither constipation nor diarrhea. It sits on its own in the middle of the scale.
  • Constipation causes urinary problems, because a full bowel presses on the urethra. The two halves are one pattern.

References

  1. 1
    Urine 24-hour volume, MedlinePlus

    medlineplus.gov

  2. 2
    Sharma and Bhutta, Assisting Patients With Elimination, StatPearls 2023

    ncbi.nlm.nih.gov

  3. 3
    Bowel Record (Bristol Stool Chart), Interior Health

    interiorhealth.ca

PNUR1128 Nursing Concepts 1
PNUR1128 Nursing Concepts 1@jaylenstrating09

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