So you’ve gone through CNA training and while you’re awesome at cleaning theoretical poop on a mannequin, you are terrified of your first poopy patient experience. You don’t even know what step 1 is. Well, you are in luck my nursey friend! Here are some basics on getting your patient squeaky clean after a code brown.
So… how to clean an elderly person’s bottom?
First, take a look at the patient. Are we talking a full bed change? Do you need the fitted sheet and a new gown or just a new disposable pad? This is especially important if the patient is in an isolation room. You don’t want to take in a bunch of unnecessary supplies because they pile up quickly. Grab a coworker.
How to begin
Basically what will happen is the patient will roll on one side while one of you cleans/rolls sheets, and then they will roll to the other side to finish. Sometimes, it’s much easier for a patient to roll to one side the the other (in particular stroke patients who have hemiparesis). If the patient is verbal, ask them which way they prefer. The first time they roll to their side will take the longest
Each person stands on either side of the bed, roughly at the patient’s hip. Let’s say you’re going to be the first person to clean. Roll the patient away from you and have your coworker stabilize and hold them on their side. You can have them bend the leg closest to you 90 degrees, turn their hip towards your coworker and pick up their shoulder, turning them on their side.
Tip: if the patient is able, have the hang on to the side rail
Another tip: if the patient is pretty dirty, wait to turn them. Sometimes feces can sneak through to the front, especially it patients have diarrhea. If the is the case, clean the front first before turning. If there is a lot, you can push it down to their back side in between their legs and place a towel or more clean wipes on top of it to prevent it from getting dirty again while the patient rolls. Cleaning the front first is helpful because it’s hard to do that with a patient on their side. If the patient is able, you can also “frog leg” them, which exposes more, thus enabling you to clean better.
Make sure your coworker is good, stable and has a good grip and then get to work.
Get your clean on
First, use your wipes to clean all excrement off of their skin. Feel free to put your dirty wipes on the dirty pad because you’re going to throw it away anyway. (Don’t do this if you’re using washcloths though!) Clean. Clean. Clean. Once their skin is clean, you’ve got to make sure it won’t touch the dirty pad or linen as they turn. You also must roll all of the dirty linen up under them like you’re rolling up up a piece of paper to send a spitball flying at someone. If the pad isn’t too dirty, you can roll it so the dirty is completely covered up and the only thing touching their skin is the back of the pad. However, this may not be possible due to the amount of feces or where it is. If so, grab a towel to place in between their clean skin and the pad, then roll it up.
If you need to change the entire bed linen, fitted sheet and all, roll this up as well at this time.
Roll this up and push it as far as possible under the patient, while they are still on their side.
Put on your clean linen
Now grab your clean fitted sheet and pop it on the corners of your side. Push the clean sheet as far as possible under the patient. Then get your draw sheet, disposable pad, and/or brief (sometimes referred to as a diaper) and place it on the patient halfway, and pull it up in between their legs.
From your side, you should see: the patient’s clean backside, the sheet attached to the two corners on your side of the bed, the sheet halfway covering the bed and flatted out, and a disposable pad, rolled up and under the patient.
Turning the patient
Now, it’s time to turn the patient and have your coworker finish up. Tell the patient they’re going to roll over a big bump, and slowly roll them towards you.
Your coworker’s turn
Now, you will hold the patient in a comfortable position on their side. Your coworker will pull out all of the dirty linen carefully as to not dirty the new linen. They will clean any additional skin that is still dirty. Then, they will pull through all of the clean linen, attached the sheet corners to the bed and flatten out the pad. Then the patient can be laid on their back.
Once the patient is flat on their back, then change their gown. (If it was visibly soiled in the beginning, you’d want to remove it earlier and wait to put the new one on until they’re all squeaky clean.) They will naturally have sunk down into the bed and will need to be boosted up. Boost the patient, ask if they want just a sheet over them or also a blanket, place pillows where they would like, and spray some deodorizer if necessary.
Some people feel bad spraying deodorizer, but let’s be honest – the patient knows they had a bowel movement, knows you just cleaned it up, and spraying a little room deodorizer isn’t going to be what makes them upset or feel bad. They typically appreciate it. And, they probably don’t want to smell it either themselves. This is especially helpful if you had to ask guests to step out, and you know they’ll be back into the room. Do what you can to make it seem like you didn’t just do what you did. This may include taking out the trash as well.
Before you leave, make sure they’ve got their call light nearby, bed alarm back on, and all necessities within arm’s reach.
Tips to prevent injury
Patients can make unpredictable movements, or you can be in an uncomfortable position, or they can be quite heavy. It is CRUCIAL that you take the necessary steps to prevent injury. I know multiple nurses who can no longer work at the bedside due to an injury sustained at the bedside.
Adjust the patient’s bed so it’s at a comfortable height for you, ensuring you’re not bending over the entire time and straining your back.
When lifting/moving, patients, use proper ergonomics – lift with legs and not your back and all that jazz.
If you have lifts or assistive devices – USE THEM.
Remember, injury is never worth it. Protect your back and your health. If you get injured while caring for a patient, don’t try to stick it out. Go to Employee Health and get it taken care of as soon as possible. Don’t be a hero!
Now you know how to clean patient after bowel movement!
Cleaning up a bowel movement for an elderly patient follows the same guidelines outlined in the above. Since the elderly often have fragile skin, pay close attention to this and execute the procedure with the gentleness required to prevent skin tears or injury.
Generally, only bedridden patients will need to be cleaned. The steps outlined above will help you fulfill this task. If a patient is not bedridden and is requesting a nurse to clean this, it requires additional investigation. There may be legitimate reasons, but generally you need to encourage a patient to perform as many ADLs (activities of daily living) on their own as they can.
One of the most surprising things for many nursing students is that nurses do clean poop. Nursing students will often encounter many opportunities to clean poop. However, not all nursing specialities routinely clean poop. If you work in an office, perioperative, or other ambulatory setting, it decreases the likelihood that you’ll have to clean up poop, but never say never.
Need more tips for nursing school or your first year as a nurse?
Read about my first code brown, my first code blue, and more in my book published by the American Nurses Association, Anatomy of a Super Nurse: The Ultimate Guide to Becoming Nursey! Click below to purchase on Amazon.
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