Case study - Urinary retention: Nursing

Nurse. Tabatha works on an inpatient medical surgical unit and is caring for Richard a 61 year old with a history of benign prostatic hyperplasia or BPH who underwent a cholecystectomy three days ago.

In collaboration with the registered nurse, RN Jesse. Nurse, Tabatha goes through the steps of the clinical judgment measurement model to make clinical decisions about richards care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action and evaluating outcomes.

Nurse, Tabatha recognizes important cues including Richard's vital signs which are temperature 98.6 °F or 37 °C, heart rate, 100 BPM, respirations, 20 breaths per minute and BP.

130/80 of me. He also reports his pain as four out of 10 in his suprapubic region.

Nurse, Tabatha notices Richard appears restless and he states that he has an urge to urinate but can't next. Nurse, Tabatha analyzes these cues.

She reviews the electronic health record or EHR and sees that Richard received general anesthesia during his surgical procedure.

She realizes that this can lead to urinary retention due to disruption of the normal neuromuscular processes that control urination nurse Tabatha also realizes that Richards enlarged prostate is likely contributing to his urinary retention.

Since it can block the outflow of urine from the lower part of the bladder. And urethra nurse, Tabatha realizes Richard is likely retaining urine due to a combination of the anesthesia from his surgery and history of BPH and that he needs effective urinary elimination.

Next, she notes that Richard has a PRN order for bladder scans. Nurse, Tabatha then performs a bladder scan which reveals 900 ml of urine in Richards bladder.

Now using the information she has gathered along with richards', medical history. Nurse Tabatha reports her findings to RN Jesse and they choose a priority hypothesis of altered urinary elimination.

Then they generate solutions to address Richard's altered urinary elimination that will include nonpharmacologic interventions and establish the expected outcome that after intervening, Richard will have effective urinary elimination.

By the end of the shift. Nurse Tabatha then takes action to implement these solutions.

She notifies the health care provider of her findings and an indwelling urinary catheter is ordered while RN Jesse explains the procedure to Richard.

Nurse, Tabatha gathers the necessary supplies and re enter Richard's room. Hi, Richard.

I'm here to insert a urinary catheter. As RN Jesse explained to you, it's a small tube that'll go into your bladder to drain the urine.

Ok. But I'm scared it's gonna hurt insertion of the catheter can be uncomfortable but ill talk to you through the process and support you afterwards youll have relief from the pressure in your bladder.

I am looking forward to that nurse, Tabatha then performs the urinary catheter insertion. According to the facility policy, following insertion, clear yellow urine begins to flow through the tubing into the drainage bag.

Nurse Tabatha then secures the tubing to Richard's anterior thigh and hangs it below the level of Richard's bladder and ensures there are no dependent loops in the tubing.

At the end of the shift, nurse Tabatha enters the room to evaluate the outcome of her actions. She takes Richard's vital signs which are heart rate, 72 BPM, R 16 breaths per minute and BP, 130/68 millimeters of mercury.

Richard is no longer restless and he reports his pain is zero out of 10. Nurse Tabatha notes that his urinary catheter continues to drain clear yellow urine.

All right. As a quick recap, nurse, Tabatha recognized and analyzed cues related to Richards altered urinary elimination and in collaboration with RN Jesse prioritized hypotheses and generated solutions to address this problem.

Nurse Tabatha and RN Jesse then implemented measures and evaluated Richard's outcomes and compared them to the expected outcome.

Since Richard experienced effective urinary elimination. By the end of the shift, they determined that the plan of care was successful