Renal/Urinary
patient has a suprapubic catheter that is draining cloudy, foul smelling urine. What can the nurse do about this?
A suprapubic catheter (SPC), or suprapubic cystostomy, is a surgically created connection between the urinary bladder and the skin. This connection is used to drain urine from the bladder in individuals with obstruction of normal urine flow; ex. benign prostatic hypertrophy, traumatic disruption of urethra, congenital defects, kidney stones passed into the urethra, and/or cancer. Spinal cord injury patients are also candidates for SPCs due to inability to void, self-catheterization is not possible (eg. tetraplegia), or the patient is unwilling to do so. A catheter is placed through the skin just above the pubic bone into the bladder, often with the assistance of ultrasound imagining. The catheter remains in place for up to one month while the tissue around it scars and forms a tract between the bladder and the body exterior. After formation of scar tissue, the catheter is replaced periodically to help prevent infection. Cloudy and foul-smelling urine are signs indicative of a urinary tract infection. Bacteria is introduced into the patient by either migrating through urine within the catheter, entering the catheter system through the emptying tube of the drainage bag, and/or through the tract in the suprapubic region. When a patient has a SPC, catheter-associated UTIs are often asymptomatic and may not be recognized until the client has developed manifestations of a systemic infection. The common signs/symptoms of a UTI are not manifested in a patient with a SPC (dysuria, urgency, nocturia, pyuria, hematuria), so assessing the patient for signs of sepsis is important. Look for fever, hypotension, tachycardia, tachypnea, nausea and vomiting, warm/flushed/dry skin, bruising, bleeding, altered mental status, lethargy, and behavior changes. After assessing the patient, a urine sample can be collected to detect the presence of bacteria in the urine. In order to obtain a specimen from the SPC, clamp the proximal drainage tubing for 15 minutes or less, then withdrawal 30-60mL of urine directly from the catheter port using sterile technique and a sterile syringe. A specimen is not collected from the collection container because this urine is more likely to be contaminated by bacteria from outside the body. The urine can then be sent for a urinalysis and a culture and sensitivity test. A CBC with differential can also be ordered to assess for any systemic responses to infection. After establishing the presence of a bacteria and the type, administer antibiotics per MD order. Sulfonamides are commonly administered to treat UTIs - assess for allergies to sulfa drugs, DC immediately and notify MD if rash develops, administer on a empty stomach: 1 hour before or 2 hours after meals, with a full glass of water, assess for other drugs that may interact with sulfonamides, and closely monitor diabetic patient's taking other sulfa meds (oral hypoglycemia agents). Urine may turn orange - this is harmless. Other interventions include: Promote fluid intake - 3000mL/day Always position the urine drainage bag below the bladder Wash hands when handling/emptying the drainage bag and/or suprapubic site Do NOT allow the drainage bag port to touch any surfaces - bacteria may be introduced into system. Check catheter site a few times a day - check for redness, pain, swelling, or pus. Cleanse the suprapubic site with aseptic technique Hold the end of the catheter tube near the insertion site so you do not pull it out while you clean your skin. Wash the catheter with a washcloth or sterile gauze bandage as directed to remove blood or other material. Start at the end near your stoma and move up the catheter, away from the stoma. Clean the skin around your stoma by moving your hand in a circle away from the stoma as you clean. Clean off any mucus. Rinse the stoma and the skin around it with the washcloth or sterile gauze bandage Pat the area gently with a clean towel or gauze bandage to dry it Apply pre-cut drain gauze on site Make sure the catheter is draining appropriately and the tubing is free of kinks. Promote vitamin C supplementation Dietary changes to prevent UTIs such as reduced intake of sugar, alcohol, and fat.
What is the relationship between anemia and chronic renal failure?
Anemia is defined as a condition in which the hemoglobin concentration or the number of circulating RBCs is decreased. In a client with CRF the kidneys are unable to secrete adequate amounts of erythropoietin (EPO). Erythropoietin stimulates RBC production in the bone marrow. Low levels of EPO result in decreased RBC production in bone marrow. With the bone marrow producing fewer RBCs the concentration is decreased in the blood leading to anemia. So when you notice that your patient's RBC, H & H is off, look at their BUN and creatinine. Most often there is a correlation there.
A patient is complaining of foul smelling urine and burning on urination. The nurse suspects a UTI and obtains a urine analysis. What part of the analysis should be reported to the physician if it is positive for UTI?
Anything other than normal results of a UA should be reported to the physician. Normal results of a UA are: Color: should be light straw to dark amber and clear Odor: should be aromatic, not foul smelling or pungent Specific gravity: anything different from 1.005-1.030 should be reported pH: anything outside of 4.5-8.0% should be reported Protein: anything more than negative or more than a trace should be reported Glucose and Ketones: Should be negative. If not, report it RBC: 1-2/low-power field (LPF) Report abnormal WBC: 3-4/LPF Report abnormal Casts: negative to occasional is normal Bacteria: should be negative, report if not. Blood: any blood in urine should be reported While all abnormal results can be reported to the HCP, the nitrates, leukocytes and blood can all indicate the presence of a UTI and should be reported.
Why are diabetics at increased risk for UTI's?
Diabetics are at an increased rick of getting UTI's because of a potential complication of neurogenic bladder. Neurogenic bladder is the inability to empty the bladder completely. The urine then remains in the bladder (urine retention) and that increases the risk for a UTI. Other factors that increase the risk for UTI in a person with diabetes is diabetic neuropathy. This develops as a result of high glucose levels in the blood that cause nerve damage and cause bladder dysfunction. As well as glucose present in the urine allows for bacteria to grow in the urethra and up into the bladder. Another factor is immune compromised due to poor circulation from diabetes. This reduces the inability of WBC to get to bacteria appropriately, thus increasing their risk of infection.
Explain the priority nursing management in treating someone with glomerulonephritis?
Glomerulonephritis is an inflammatory condition that affects the glomerulus. It may be acute or chronic. Glomerulonephritis; is kidney disorder that develop secondarily to a systemic disease. When capillary membranes are damaged it causes blood cells and proteins to escape into the filtrate. It causes: Hematuria - blood in urine - cola/coffee colored urine Proteinuria - protein in the urine Hypoalbuminemia -low levels of albumin in the urine which is caused by loss of plasma protein in urine Edema- which results caused by decreased osmotic draw with blood vessels. With the glomerular filtration being disrupted, azotemia, which is an increase blood level of nitrogenous wastes (along with BUN/creatinine) occurs as well as the GFR decreases. When GFR falls the renin-angiontensin-aldosterone system is initiated and causes hypertension and water/salt retention. Acute Glomerulonephritis occurs after a group A beta-hemolytic Streptococcus infection (i.e. strep throat) S/S: Nausea, malaise, arthralgia, proteinuria, HTN, edema (periorbital/facial; dependent-upper extremities), fatigue, anorexia, headache, increased BUN/creatinine which subside within 10-14 days. Chronic Glomerulonephritis is when there is kidney damage which is caused by a systemic disease (i.e. DM) S/S are often not recognized till renal failure is apparent. Priority Nursing Mgmt in treating this is to focus on identifying and treating the disease and preserve kidney function. There typically is no specific TX since there is not a cure. DX testing helps to determine the cause and evaluates its effects on the kidney function. o Throat/skin cultures - id Streptococcal infection o Antistreptolysin-O (ASO) titer - id antibodies to group A beta-hemolytic streptococci o Erythrocyte Sedimentation Rate (ESR) - inflammation indicator, usually elevated o BUN/creatinine levels along with eGFR and creatinine clearance o Serum electrolytes levels o Urinalysis Medication therapy- Glycocorticoids (prednisone) or other immunosuppressive drugs given for acute glomerulonephritis to reduce kidney failure risks. Penicillin or ABX ordered with post streptococcal glomerulonephritis to kill bacteria. Antihypertensives/diuretics to lower blood pressure and reduce edema. Plasma Exchange Therapy- (plasmapheresis) removal of harmful antibodies in the plasma. This is done by passing the blood through a blood cell separator and reinfusing the RBCs with and equal amount of albumin/plasma. Procedure is done in a series as opposed a one time only treatment. Ensure you get informed consent. This is done to treat acute glomerulonephritis. Dietary Mgmt- Restriction of sodium, dietary proteins are increased when the protein is lost in the urine. If azotemia occurs than dietary proteins are restricted. When proteins are restricted it includes complete protein (meats, fish, eggs, soy and poultry. Nursing care focuses on the how this disorders affects the body and ensuring the client's comfort ad ability to maintain ADL's.
Explain the teaching involved with someone with a fistula in their arm.
Hemodialysis burke 771. I did not find fistula teachings in the book, however. Perform fistula strengthening exercises to make ready for hemodialysis according to doctor. It may take months for fistula to be ready to be used for treatments. Fever is sign of infection, call doctor. If fistula is painful, contact your doctor. Wash & dry arm prior to treatments. Keep clean as a general rule for all times. Do not wear tight clothing on extremity with fistula. Do not bear weight onto fistula; carrying groceries for example. Do not sleep or apply constant pressure to fistula. Avoid mechanical and chemical irritation to fistula. Watch for bleeding from fistula - high flow vessel. Fistula should have palpable pulsation and audible bruit (if Pt auscultates their own fistula). BP/venipunctures should be done on non-fistula arm. Management of fistulas p. 772 Burke
Explain the relationship between hypertension and renal failure?
Hypertension and renal failure create a dangerous cycle, on the account that one can cause the other. Hypertension causes glomerular pressure that can eventually impair the glomerular filtration and damage the blood vessels in the kidneys due to the constant vasoconstricted pressure(renal failure). If the kidneys are not able to filter the blood of wastes, fluids, and electrolytes, the fluid volume will increase, therefore causing the BP to rise (hypertension).
How would you teach someone to perform Kegel exercises? How often?
Kegel's are pelvic floor exercises that help to reduce the incidence of urinary incontinence. To identify the pelvic muscles you should try to do the following: 1-try to stop the flow of urine while voiding and hold for a few seconds 2-tighten the muscles of vagina around a gloved finger or tampon 3-tighten the muscle of anus like you are trying to pass gas While performing the exercises, you should tighten pelvic muscle, hold 10 sec and then relax 10-15 sec; continue to the cycle of tighten, hold, release 10X Keep abdominal muscles and breathing relaxed during the exercises Perform the exercises 2X/day working up to 4X/day Perform exercises at the same time each day to establish a good routine as the exercises should be done for life
What are some changes the elderly go through in terms of their kidney function?
Kidney function decreases as people get older, more specifically nephrons(the functional unit of the kidneys that process blood into urine) in the kidneys are lost. This reduces the kidneys mass along with the GFR (glomerular filtration is a passive process in which fluid and solutes are move from the blood in the glomerulus into Bowman's capsule. The amount of fluid filtered from the blood into the capsule per minute is called the Glomerular filtration rate GFR). By age 80 the GFR maybe less than 1/2 of what it was at age 30. The kidneys are less able to concentrate urine along with diminished thirst older adults are at a higher risk for dehydration. Also, the kidneys do not excrete K+ as effectively and retains more which could cause an increased risk for electrolyte imbalance. Cause: Decreased GFR Effect: Decreased excretion of drugs primarily eliminated by the kidneys; increased risk of drug toxicity NI: Monitor clients carefully for signs of toxicity, especially when giving DIGOXIN, certain antibiotics, CIMETIDINE, & CHLORPROPAMIDE. Cause: Decreased number of nephrons; changes in aldosterone LvL's and response to ADH Effect: Decreased ability to conserve H2O and Na+, increased risk of fluid. electrolyte, & acid-base imbalances. NI: Monitor for fluid, electrolyte, & acid-base imbalances. Promote fluid intake of up to 2500 ml/day unless contraindicated (CFH, CRF) Cause: Decreased number of functional nephrons Effect: Increased risk of kidney failure NI: Avoid nephrotoxic drugs if possible; monitor urine output and signs of renal failure
What are the significant labs that need to be monitored for someone with renal failure? Be specific.
Lab Tests Used to Evaluate Renal Function: Blood Urea Nitrogen (BUN): normal value 5 - 25 mg/dL; slightly higher in older adults Serum Creatinine: normal value 0.5 - 1.5 mg/dL; slightly lower in older adults Estimated Glomerular Filtration Rate (eGFR): > 60 mL/min/1.73 m2 Creatinine Clearance (blood specimen and 24 hr urine): Normal value Female 85 - 120 mL/min Male 85 - 135 mL/min; values lower in older adults Serum Albumin: Normal value 3.5 - 5 g/dL Burke p. 734 For end-stage renal disease arterial blood gases and CBC are also monitored. A urinalysis is done, looking at the specific gravity. Abnormal substances like protein, blood cells, and cell casts (protein and cellular debris molded into shape of tubular lumen). The urine albumin to creatinine ratio is also monitored (only a time urine specimen, more accurate than 24 hr protein collection). Also, a kidney biopsy may be done to look at underlying disease process. Burke p. 771 In addition you want to also look at electrolytes such as serum Na, K, phosphorus, Mg.
What are the pre and post assessment findings in a patient undergoing hemodialysis?
Like healthy kidneys, dialysis keeps your body in balance. Dialysis does the following: removes waste, salt and extra water to prevent them from building up in the body keeps a safe level of certain chemicals in your blood, such as potassium, sodium and bicarbonate helps to control blood pressure Pre assessment findings include: vital signs, including orthostatic blood pressures, apical pulse, and respirations, lung sounds, and weight. Assess vascular access site for a palpable pulsation or vibration (thrill), audible bruit, and signs of inflammation. When getting a blood pressure or venipuncture, do not use the arm with the vascular access site. Post assessment findings include: VS, weight, vascular access site assessment. Monitor for orthostatic hypotension, tachycardia, and weight loss. Monitor BUN, serum creatinine, serum electrolytes, and hematocrit. Look for and report muscle cramps, headache, nausea and vomiting, altered level of consciousness, seizures, or hypotension; these are adverse effects of dialysis. Assess access site for any bleeding. Some pt. experience depression or anxiety after starting hemodialysis; provide psychological support. People receiving hemodialysis often have trouble sleeping. Hypotension may occur during hemodialysis. Bleeding may also occur d/t altered clotting and use of heparin. Infection may occur as well. Dialysis dementia is PC that is fatal and may affect clients on long-term hemodialysis. Transfusions may be given during dialysis, if so, pt may show symptoms of transfusion reaction. Report: chills and fever, dyspnea, chest, back or arm pain; hives/itching. Burke p.772 Box 29-19
Explain the priority nursing management in treating someone with nephritic syndrome?
Nephrotic syndrome is not a disease but a group of symptoms, it results when glomerular tissues are damaged and there is significant protein lost in the urine . There is no one cause of nephrotic syndrome. In adults , it may result from a primary kidney disorder or a systemic disease such as diabetes or lupus. Clients with nephrotic syndrome have proteinurea, low serum albumin levels , high blood lipids, and edema. Edema maybe severe affecting the face and the preorbital area as well a dependent tissues. Thromboemboli mobilized blood clots are a relative complications of nephrotic syndrome. Peripheral veins, arteries, pulmonary arteries, and renal veins maybe occluded. The priority nursing management is to relieve symptoms, prevent complications and control kidney damage by keeping blood pressure at or below 130/ 80 mm Hg to delay kidney damage, angiotensin converting enzymes inhibitors or angiotensin receptor blockers are the medications most often given Ace inhibitors may also help decrease the amount of protein lost in urine. Corticosteroid is given which suppress the immune system, Statins are given to reduce heart and blood vessel problem, a Diuretic is also given to help with water retention , client is also given a blood thinner to treat and prevent clots. Client is also placed on a low sodium diet. low fat, low cholesterol and low moderate protein diet. Nursing management also includes the monitoring of the client blood pressure, daily weights, intake and out put, monitoring of labs results such as albumin, potassium, sodium, bun, creatinine, gfr rate, triglyceride, cholesterol . PT, INR if patient is on Coumadin.
Anuria
Non passage of urine.
elderly patient has an elevated PSA. What does this mean? How can Flomax help?
PSA stands for Prostate-specific antigen. An elevated PSA level could indicate prostate cancer, benign prostatic hypertrophy (BPH), or prostatitis. Normal PSA levels should be 2.5-4.0 ng/mL. Flomax relaxes the muscles in the prostate and bladder. It helps to relieve symptoms such as difficulty beginning urine flow, weak stream, and the need to urinate often or urgently. PSA is not a reliable indicator for prostate cancer. The most reliable method of confirming prostate cancer is biopsy of prostate tissue
Someone with kidney or bladder stones is on pain meds, has to drink plenty of fluids and has to strain their urine. Explain the rationale behind each of these interventions?
Pain Medications: Pain relief is vital relief for kidney stones or bladder stones. Narcotic analgesics are used to provide analgesia and relieve uteral spasms. Pain meds are often administered via IV for rapid relief ** Indomethacin which is a suppository NSAID can reduce the amount of narcotic analgesia required. Side note: After stone analysis, meds may be proscribed to prevent further stone formation such as thiazide diuretics Fluids: Fluid intake is increased to 2.3-3 liters per day. This will prevent concentration of stone forming salts. Intake should be spaced throughout the day. The client may be advised to drink one to two glasses of water at night to maintain dilute urine during sleep. When fluid intake is adequate, no stone growth occurs. Urine Strain: Urin is strained to collect stones or sediment that passes into the urine. The stones then are able to be sent for analysis to identify their composition. You are correct with pain management and straining of the urine but in terms of encouragement of fluids, the rationale for this is to allows for increase in urine output which allows for the stones to move through the ureter and then hopefully pass them (Burke p759). Liberal fluid intake is important before a stone is formed but also once the stone is present.
Dysuria
Pain or discomfort when urinating.
Why do patients with chronic renal failure appear confused at times?
Patients on long term dialysis are at risk for developing dialysis dementia. The kidneys are not functioning properly and Uremia occurs. This actually means urine in the blood. This is a late sign of Kidney disease. Other symptoms of uremia are fatigue, nausea, lethargy, weakness. As it progresses, vomiting, increased weakness, lethargy and confusion occur. Some of the symptoms can be reversed but in chronic kidney disease GFR has been so greatly decreased that uremia symptoms may persist. Nephrotoxins must be removed from the blood. Some sort of Dialysis is required. It may be required daily. As the toxins are removed by way of dialysis, the confusion improves somewhat. If the patient has end stage kidney disease, the confusion may remain long term.
What type of diet needs to be taught in someone with chronic renal failure and why?
Patients who have CRF cannot effectively regulate fluid and electrolyte balance and eliminate metabolic waste products, so intake of these substances must be regulated. Fluid and sodium intake are restricted. Fluid intake may be restricted to 1 - 2 liters per day. Accurate weights and I&O records are essential. Patients should notify the physician of any weight gain of more than 5 pounds over a 2 day period. Sodium and potassium intake are regulated as well. Salt substitutes containing potassium are avoided. Protein intake is limited to reduce uremic symptoms and slow the progression of CRF. It also is decreased to prevent azotemia (increased blood levels of nitrogenous waste, including urea and creatinine). Carbohydrates are increased to maintain adequate calorie intake and spare protein breakdown. TPN may be ordered if client is unable to eat.
What medications are given and held on the day of dialysis?
Protein bound drugs and water soluble drugs should be held on the day of dialysis. Protein bound drugs such as synthroid will not pass through the dialysis filter. While water soluble drugs will just be quickly excepted during dialysis and perform no therapeutic effect. Also blood pressure is usually held since excess fluid is being removed through dialysis, the treatment will cause the blood pressure to drop. Some pain medication can be given. It is always good practice to check with pharmacist or the dialysis nurse what medications can be given or held.
What predisposes someone to a UTI? How can they be prevented?
Risk factors for UTI Catheterization, cystoscopy and other instrumentation of the urinary tract Structural abnormalities, obstructions or strictures Incomplete bladder emptying Chronic disease complications Female specific: Short, straight urethra Urinary meatus proximity to vagina and anus Tissue trauma and contamination during intercourse Use of diaphragm BC Hygiene practices Voluntary urinary retention Male: Enlarged prostate Older adults: Alkaline urine Higher instances of chronic disease complications Urinary retention Changes in vaginal pH Decreased prostatic secretions in men Prevention Complementary therapies: Blueberries Bilberry Saw palmento Bromelain Vit C Dietary changes to include less sugar, alcohol and fat Urinary anti-infectives to help prevent UTI's for clients with chronic infections Increase fluid intake Frequent voiding, go when the urge is felt Clean perineal area front to back Void after intercourse Avoid bubble baths, hygiene sprays, and vaginal douches Wear cotton briefs, avoid synthetic materials Drink 2 glasses low sugar cranberry juice Avoid excess milk and milk products, other fruit juices and sodium bicarbonate Know the S/S of a UTI and septic shock another risk factor are those with elevated blood sugars. If there is too much sugar in the blood, it spills into the urine and makes a happy medium for bacteria to grow
Oliguria
Scant or too little passage of urine due to diminished secretion.
A 24 hour urine collection is ordered for a patient. How should this be done? If the collection gets contaminated or forgotten to be placed in the container, how should the nurse proceed?
The appropriate steps for a 24 hour urine collection include: -obtaining a specimen container from the lab (which may or may not have a preservative in it) -ensure specimen container is properly labeled with patient identifier, the test being performed, start time, and end time -place a clean hat, urinal, or other collection device in the patient's room or bathroom -post notices on the chart and in the patient's room indicating that a 24 hour urine collection is in process, in order to prevent a urine occurrence from being dumped in the toilet instead of in the 24 hour urine collection container (Once the urine collection time has begun, any missed collections indicate restarting the 24 hour urine collection. Discard previous specimen container and obtain a new one from the lab. Replace collection container with a clean one from the supply room.) -at the start of collection have the patient empty their bladder, discard this occurrence -each time the patient voids over the next 24 hours the entire collection should be poured into the specimen container -the specimen container should be kept refrigerated or on ice -at the end of the 24 hour time frame, have the patient empty their bladder again, adding the collection to the specimen container, and thereby ending the 24 hour urine collection -Specimen, with requisition, should be delivered to the lab During the collection period instruct the patient try to urinate (and collect the occurrence) before moving bowels (this is to try and prevent any contamination of urine with feces). Also, teach the patient not to place toilet paper in the collection container. If contamination occurs the 24 collection period would need to begin again. Discard previous specimen and collection container. Obtain a clean collection container from supply room and a new specimen container from the lab.
Uremia
The presence of excessive amounts of urea and other waste products in the blood. AKA Azotemia
diabetic patient with nephropathy is undergoing several diagnostic tests with contrast. What teaching needs to be done post procedure? What should be avoided?
There are a few different diagnostic tests that involve contrast media. Intravenous pyelography (or IVP) uses contrast medium and x-rays to evaluate the urinary tract and general renal function. A patient needs to be taught to report signs of a reaction to the contrast post-procedure including: dyspnea, tachycardia, itching, hives, and flushing. The patient should also be taught they can apply warm packs to their injection site if they have issues with redness, pain, or warmth. Eight hours before the test the patient should restrict themselves to a clear liquid diet. IVP should not be used if the patient reports allergies to seafood, iodine, or x-ray contrast media. The patient should also be taught to monitor their blood glucose levels closely as they will be on a restricted clear liquid diet eight hours prior to the diagnostic test. Retrograde pyelography and a CT scan with contrast involve similar teaching and things to avoid as they also use contrast medium. Burke p. 733-6 If you have a diabetic patient with nephropathy, this means their kidney function is impaired. Since all contrast is nephrotoxic, this causes further injury to this patient's kidneys. In the ideal world, you would avoid contrast if at all possible, but since so many diagnostic tests require it to obtain a reliable image, the nurse needs to teach the patient to drink plenty of water after the test to flush the contrast out and minimize the toxicity to the patient's kidneys.
How does a 3 way irrigation Foley work in someone who just had a TURP? What should the urine look like after surgery?
Three way irrigation works by using irrigation fluid to carry resected tissue into the bladder. This is a low-risk procedure that causes tissue to be flushed out of the bladder easier. Urine could be light red with small clots up to 24 hrs after surgery, after 24 hours urine should gradually become light pink to yellow and have less clots. You'll want to monitor for any signs of hemorrhage for the first 24-48 hours (bloody urine, large blood clots, decreased urinary output, decreased H+H, hypotension, tachycardia, and bladder spasms) Burke p 801 A 3 way Foley following a TURP procedure is used for the purposes of irrigation. Normal saline is used as the irrigation solution. The Foley has 3 ports, 1 serves as the balloon, the second for the irrigation solution to go through and lastly the 3rd for the urine to drain out. What goes in must come out, therefore as a nurse you monitor intake and output, color of the urine and presence of clots. The goal is to titrate the flow of the irrigation solution so that the urine appears light pink, You do not want red urine as this will clot and obstruct the flow. There is no set rate, it is based on monitoring the patient frequently. Over a few days, the urine will return to pale yellow color.
Nocturia
Uncontrollable urge to urinate excessively during sleeping hours.
Micturition
Urinating or the process of excreting water from the body.
hour post surgical patient is not voiding. What are some causes for the urine retention? How would the nurse assess for bladder retention? And what are nursing interventions that could be done to address this problem?
Urine retention can be caused by abdominal or pelvic surgery, which can affect detrusor muscle function. Acute urinary retention can be caused by all types of anesthetics or operations. Many pain medications administered after surgery can also cause urinary retention. It can also occur from the pain itself. Postoperative positioning may cause retention, as well as inactivity and altered fluid balance after surgery. There are several ways a nurse can assess for bladder retention. Basic assessment would involve palpating the lower abdomen just above the symphysis pubis for distention and firmness. You can percuss the bladder, you will notice a dull percussion tone with a full bladder. Closely monitoring input and output is also a helpful way of monitoring for urinary retention. If allowed or ordered, a nurse can use a bladder scanner to scan the bladder to measure the amount of urine. Allowing the client to try to void in a normal voiding position, with privacy and adequate time can promote urination. A nurse can also provide a sitz bath, pour warm water over perineum, running warm water and allowing the client to place their hands in warm water may help them to void. Straight catheterization can also be done to relieve urinary retention and distention, if ordered by a doctor.
