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newSchoolWorks.com › VoTechWorks › Health & Personal Services › Nursing Assistant (CNA) › Patient Care Fundamentals for Nursing Assistants › Lesson 4
HLT-CNA36-02 · Lesson 4 · 5 clock hours · lab

Toileting Assistance, Elimination Observation, and Specimen Collection

Objective. The student will assist a simulated patient to and from the toilet and bedpan, observe and describe a simulated urine and stool specimen using correct CNA terminology, and complete an intake and output (I&O) documentation entry accurately

⚠ Pending professional review

This lesson, its worked examples and its practice questions has not yet been verified by a licensed clinician in the field or by a certification or approval body. It is a study draft and may contain errors. Do not use it to make decisions about any patient or medication. Always follow your instructor, your supervising professional, and current official references and regulations.

VoTechWorks program approval and accreditation are still in progress. Credentials are issued only by the certifying bodies named in each program, after their own exams.

Why Toileting Assistance Matters

Helping a patient use the toilet, bedpan, or urinal is one of the most frequent tasks a CNA performs. Done well, it preserves dignity, prevents skin breakdown, reduces fall risk, and gives you a direct window into the patient's health through observation of urine and stool. Done carelessly, it can cause injury, infection, or missed clinical changes. Every step—from knocking before entering to washing your hands after glove removal—reflects professional, patient-centered care.

Equipment You Will Use

Standard bedpan: A rounded, deep pan used for patients who can lift their hips. Position the patient on their back, ask them to bend their knees and push down with their feet to raise the hips, then slide the pan under the buttocks with the open end facing the foot of the bed.

Fracture pan (fracture bedpan): A flatter pan with a thin, beveled edge used for patients who cannot raise their hips—such as those with hip fractures or spinal injuries. The thin end slides under the buttocks from the side or while the patient is log-rolled. Less hip movement is required.

Urinal: A container used for male patients to void while standing, sitting, or lying in bed. Cap it after use before removing from the bed.

Bedside commode: A chair with a removable basin placed beside the bed for patients who can transfer but cannot walk to the bathroom safely.

Always place a waterproof pad under the patient before placing any pan. Place the call light within the patient's reach once the pan is in place, and give the patient privacy by drawing the curtain or closing the door. Never leave a weak or confused patient unattended on a bedpan; stay nearby and check frequently.

Hand Hygiene and Gloves

Put on gloves before handling any elimination equipment. After removing the pan or urinal, cover it with a waterproof pad or designated cover to transport it to the bathroom. Dispose of waste, rinse equipment according to facility policy, remove gloves, and perform hand hygiene immediately. Hand hygiene—soap and water or an alcohol-based rub—must occur before and after gloved contact with body fluids. This is a non-negotiable infection control step.

Observing and Describing Elimination

Your eyes are a clinical tool. Before discarding urine or stool, observe and mentally note the characteristics. Use the terms below (covered fully in Key Terms).

Urine: Note color (pale yellow to amber is normal), clarity (clear vs. cloudy or hazy), odor (slightly aromatic is normal; strong, foul, or ammonia-like is abnormal), and approximate amount. Report immediately: blood-tinged (pink, red, or tea-colored) urine; dark amber or brown urine in a patient who is not dehydrated; cloudy or foul-smelling urine; no urine output for several hours; or sediment (particles) in the specimen.

Stool: Note color (brown is normal), consistency (formed, soft, loose, liquid, hard/dry pellets), frequency, and odor. Report immediately: black, tarry stool (melena—possible upper GI bleeding); bright red blood in or on stool; pale, clay-colored, or gray stool; very hard stool with patient straining; liquid stool with high frequency (possible diarrhea and dehydration risk); or absence of stool for several days if that is a change from baseline.

Always use accurate, objective language when reporting: say "urine is dark amber and cloudy with a strong odor" rather than "looks bad."

Specimen Collection

When the nurse orders a urine or stool specimen, collect it using the labeled container provided by the facility. For a routine urine specimen, have the patient void into a clean bedpan or specimen collection device ("hat") placed in the toilet, then pour the required amount into the specimen cup using the correct technique and gloves. Label the cup with the patient's name, date, time, and room number before it leaves the room. Transport promptly to the designated area or refrigerate as directed.

For a stool specimen, use a wooden tongue blade or the scoop built into the specimen cup lid to transfer a small sample. Avoid mixing urine with the stool sample.

Never touch the inside of a specimen cup or lid. Keep specimens covered at all times.

Intake and Output (I&O) Documentation

Many patients require accurate measurement and recording of all fluids taken in (intake) and all fluids that leave the body (output). Intake includes oral fluids (water, juice, soup broth, ice chips measured as half the volume), tube feedings, and IV fluids recorded by the nurse. Output includes urine, emesis, wound drainage, and liquid stool.

Fluid volumes are recorded in milliliters (mL). Standard fluid containers have known volumes (for example, a typical juice carton may equal 120 mL—always use your facility's conversion chart). Measure urine from a urinal or bedpan using a graduated measuring container at eye level. Record each measurement on the I&O form under the correct column (intake or output) and the correct time slot. At the end of your shift, total each column and report the shift totals to the oncoming nurse.

Report to the nurse when output is significantly less than intake over your shift, when a patient has not voided in several hours, or when output contains abnormal characteristics noted above.

Safety Summary

Key terms8

Fracture panA flat, low-profile bedpan designed for patients who cannot raise their hips; requires minimal hip movement to position.
HematuriaBlood in the urine, causing pink, red, or tea-colored appearance; always reportable to the nurse.
MelenaBlack, tarry stool caused by digested blood from upper gastrointestinal bleeding; requires immediate reporting.
Intake and Output (I&O)The measurement and recording of all fluids entering and leaving a patient's body, documented in milliliters on an I&O form each shift.
ClarityThe degree of transparency of urine; described as clear, hazy, or cloudy using standard CNA terminology.
SpecimenA sample of urine, stool, or other body substance collected in a labeled container and sent to the laboratory for analysis.
Graduated containerA measuring cup marked in milliliter increments used to measure urine or other output accurately.
Perineal care (peri-care)Cleansing of the genital and rectal area provided after toileting assistance to prevent infection and skin breakdown.

Worked examples4

1. A patient drank 6 oz of orange juice, 8 oz of water, and had 4 oz of ice chips during your shift. Convert each to mL and find total oral intake. (Use 1 oz = 30 mL; ice chips count as half volume.)
  1. Convert orange juice: 6 oz × 30 mL/oz = 180 mL
  2. Convert water: 8 oz × 30 mL/oz = 240 mL
  3. Convert ice chips: 4 oz × 30 mL/oz = 120 mL total volume; ice chips = half, so 120 ÷ 2 = 60 mL
  4. Add all oral intake: 180 + 240 + 60 = 480 mL
Answer: Total oral intake for the shift = 480 mL
2. During your 8-hour shift the patient voided three times. You measured 325 mL, 210 mL, and 180 mL in the graduated container. What is the total urine output, and should you report a concern?
  1. Add all three voids: 325 + 210 + 180 = 715 mL
  2. Total output = 715 mL
  3. Compare to general guideline: normal urine output is roughly 30 mL or more per hour; over 8 hours that is approximately 240 mL minimum
  4. 715 mL exceeds the minimum—output appears adequate; no immediate volume concern, but always report any color, odor, or clarity abnormalities if present
Answer: Total urine output = 715 mL; volume is within a normal range; report any abnormal appearance to the nurse.
3. The I&O form shows intake of 950 mL and output of 350 mL for your shift. What is the difference, and what action do you take?
  1. Calculate difference: 950 mL intake − 350 mL output = 600 mL
  2. Intake is significantly greater than output (positive fluid balance of 600 mL)
  3. This imbalance—especially low urine output relative to intake—must be reported to the nurse before end of shift
  4. Document both totals accurately on the correct shift-total lines of the I&O form and note the report
Answer: Difference = 600 mL; intake greatly exceeds output. Report to the nurse before the end of the shift.
4. A patient used a urinal and produced urine that fills it to the 240 mL line. Later the catheter drainage bag shows 85 mL accumulated since the last emptying. What is the total output to record?
  1. Urinal output: 240 mL
  2. Catheter drainage: 85 mL
  3. Total output: 240 + 85 = 325 mL
  4. Record each source separately in the output column with the time, then sum for the running total
Answer: Total output = 325 mL; document each source with the time on the I&O form.

The math in this lesson1

Learners convert juice, water and half-volume ice chips to mL for 480 mL intake and total voids.
N-Q.1
Brush up in the math halls at newSchoolWorks.com:
In class: Instructor demonstrates bedpan placement and removal with correct positioning technique (standard and fracture pan), emphasizing patient privacy, call-light placement, and hand hygiene before and after; students practice on mannequin using both pan types · Specimen observation station: instructor sets up four labeled specimen cups with simulated urine (clear, dark amber, cloudy) and simulated stool descriptions on index cards; students use a CNA reference chart to describe color, clarity, odor, and consistency using approved terminology, then identify which findings must be reported to the nurse · I&O documentation exercise: students receive a sample shift scenario listing fluid intake events (juice, water, IV fluids noted by nurse) and output events (voiding, catheter bag drainage); students calculate and record totals on a standard I&O form and flag abnormal output for reporting
Materials: Standard and fracture bedpans, bedside commode, urinal, gloves, waterproof pad, simulated specimen cups (food coloring and water), CNA elimination observation reference chart, blank I&O forms, call light prop
Check: Bedpan placement scored 80% or higher on skill checklist; student correctly classifies all four simulated specimens and identifies reportable findings without error; I&O totals calculated without arithmetic error and documented on correct form lines

Practice check8

Answer each question, then check it. Nothing is recorded; this is your own practice.

Infection Control
1. You are about to place a standard bedpan under a patient. Which action should you take FIRST?
Patient Observation and Reporting
2. A CNA observes that the patient's urine is dark amber, cloudy, and has a strong foul odor. What is the MOST appropriate action?
Activities of Daily Living / Basic Nursing Skills
3. Which type of bedpan is MOST appropriate for a patient who has a hip fracture and cannot raise their hips?
Patient Observation and Reporting
4. A patient's stool is described as black and tarry. Which term correctly names this finding, and what does it suggest?
Basic Nursing Skills / Documentation
5. When measuring urine in a graduated container, the CNA should read the measurement at which level?
Basic Nursing Skills / Documentation
6. A patient drinks 4 oz of juice and 240 mL of water. Using 1 oz = 30 mL, what is the total oral intake in mL?
Safety and Emergency Procedures
7. After placing the bedpan and assisting the patient to a comfortable position, which action is ESSENTIAL before leaving the bedside?
Basic Nursing Skills / Infection Control
8. When collecting a routine urine specimen, which action BEST protects specimen integrity?
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