Content check — Fundamentals of Nursing, Chapter 26: Urinary Elimination

Case Study 26.4.1 §26.4 source ↗

Refer to Chapter 19 Oxygenation and Perfusion, Chapter 22 Activity, and Chapter 24 Skin Integrity for Unfolding Case Study #4: Part 1, Unfolding Case Study #4: Part 2, Unfolding Case Study #4: Part 3, Unfolding Case Study #4: Part 4, Unfolding Case Study #4: Part 5, and Unfolding Case Study #4: Part 6 to review the patient data. Mrs. Jenson, a 72-year-old female, presents to the emergency room with worsening shortness of breath, fatigue, and swelling in her lower extremities over the last week. She reports increasing difficulty performing activities of daily living due to weakness and increased dyspnea. She has been admitted to the telemetry unit.

Past Medical History	Medical history: Hypertension, type 2 diabetes, heart failure (class III), osteoarthritis Family history: No significant family history reported. Social history: Widowed ten years ago, currently living in an assisted care facility. No children. Current medications: • Lisinopril 20 mg PO once daily • Metformin 500 mg PO twice daily • Metoprolol 50 mg PO once daily • Aspirin 81 mg PO once daily • Furosemide 40 mg PO once daily • Losartan 25 mg PO once daily • Ibuprofen 400 mg PO Q6 hours PRN mild arthritic pain
Provider’s Orders	1145: • Admit to telemetry unit • Twelve-lead electrocardiogram • Oxygen therapy to maintain oxygen saturation at greater than 92 percent • 20 mg Furosemide IV STAT
Nursing Notes	1200: Twelve-lead ECG completed; results show sinus tachycardia. 2 L oxygen via nasal cannula applied, patient reports improvement in dyspnea. IV placed in right AC, 20 mg Furosemide IV administered. Patient instructed to call before getting up to use bathroom. Patient has not voided since admission. Patient admitted to room on cardiac unit, and handoff given to telemetry nurse.
Nursing Notes	1800: Patient pressed call light to request to use the bathroom. Ambulated with ×1 assist from nurse due to unsteady gait. Patient was unable to void.

Recognize cues: What cues are most important for the nurse to recognize?

Answer

The most important cue for the nurse to recognize is that the patient is unable to void. This is concerning since the patient has been in the hospital for over six hours at this point.

Case Study 26.4.2 §26.4 source ↗

Refer to Chapter 19 Oxygenation and Perfusion, Chapter 22 Activity, and Chapter 24 Skin Integrity for Unfolding Case Study #4: Part 1, Unfolding Case Study #4: Part 2, Unfolding Case Study #4: Part 3, Unfolding Case Study #4: Part 4, Unfolding Case Study #4: Part 5, and Unfolding Case Study #4: Part 6 to review the patient data. Mrs. Jenson, a 72-year-old female, presents to the emergency room with worsening shortness of breath, fatigue, and swelling in her lower extremities over the last week. She reports increasing difficulty performing activities of daily living due to weakness and increased dyspnea. She has been admitted to the telemetry unit.

Past Medical History	Medical history: Hypertension, type 2 diabetes, heart failure (class III), osteoarthritis Family history: No significant family history reported. Social history: Widowed ten years ago, currently living in an assisted care facility. No children. Current medications: • Lisinopril 20 mg PO once daily • Metformin 500 mg PO twice daily • Metoprolol 50 mg PO once daily • Aspirin 81 mg PO once daily • Furosemide 40 mg PO once daily • Losartan 25 mg PO once daily • Ibuprofen 400 mg PO Q6 hours PRN mild arthritic pain
Provider’s Orders	1145: • Admit to telemetry unit • Twelve-lead electrocardiogram • Oxygen therapy to maintain oxygen saturation at greater than 92 percent • 20 mg Furosemide IV STAT
Nursing Notes	1200: Twelve-lead ECG completed; results show sinus tachycardia. 2 L oxygen via nasal cannula applied, patient reports improvement in dyspnea. IV placed in right AC, 20 mg Furosemide IV administered. Patient instructed to call before getting up to use bathroom. Patient has not voided since admission. Patient admitted to room on cardiac unit, and handoff given to telemetry nurse.
Nursing Notes	1800: Patient pressed call light to request to use the bathroom. Ambulated with ×1 assist from nurse due to unsteady gait. Patient was unable to void.

Analyze cues: What is the significance of the recognized cue in the previous question?

Answer

Since the patient was given a diuretic six hours prior, the nurse would have expected the patient to void by now. This is concerning for urinary retention.

Case Study 26.4.3 §26.4 source ↗

Refer to Chapter 19 Oxygenation and Perfusion, Chapter 22 Activity, and Chapter 24 Skin Integrity for Unfolding Case Study #4: Part 1, Unfolding Case Study #4: Part 2, Unfolding Case Study #4: Part 3, Unfolding Case Study #4: Part 4, Unfolding Case Study #4: Part 5, and Unfolding Case Study #4: Part 6 to review the patient data. Mrs. Jenson, a 72-year-old female, presents to the emergency room with worsening shortness of breath, fatigue, and swelling in her lower extremities over the last week. She reports increasing difficulty performing activities of daily living due to weakness and increased dyspnea. She has been admitted to the telemetry unit.

Past Medical History	Medical history: Hypertension, type 2 diabetes, heart failure (class III), osteoarthritis Family history: No significant family history reported. Social history: Widowed ten years ago, currently living in an assisted care facility. No children. Current medications: • Lisinopril 20 mg PO once daily • Metformin 500 mg PO twice daily • Metoprolol 50 mg PO once daily • Aspirin 81 mg PO once daily • Furosemide 40 mg PO once daily • Losartan 25 mg PO once daily • Ibuprofen 400 mg PO Q6 hours PRN mild arthritic pain
Provider’s Orders	1145: • Admit to telemetry unit • Twelve-lead electrocardiogram • Oxygen therapy to maintain oxygen saturation at greater than 92 percent • 20 mg Furosemide IV STAT
Nursing Notes	1200: Twelve-lead ECG completed; results show sinus tachycardia. 2 L oxygen via nasal cannula applied, patient reports improvement in dyspnea. IV placed in right AC, 20 mg Furosemide IV administered. Patient instructed to call before getting up to use bathroom. Patient has not voided since admission. Patient admitted to room on cardiac unit, and handoff given to telemetry nurse.
Nursing Notes	1800: Patient pressed call light to request to use the bathroom. Ambulated with ×1 assist from nurse due to unsteady gait. Patient was unable to void.

Prioritize hypotheses: What other findings should the nurse assess for that would be consistent with a diagnosis of urinary retention?

Answer

Patients with urinary retention may be asymptomatic, so it can be difficult to assess for. However, the nurse could assess for bladder distension on palpation, lower abdominal discomfort, and an inability to initiate or sustain a stream of urine.

Case Study 26.4.4 §26.4 source ↗

Refer to Chapter 19 Oxygenation and Perfusion, Chapter 22 Activity, and Chapter 24 Skin Integrity for Unfolding Case Study #4: Part 1, Unfolding Case Study #4: Part 2, Unfolding Case Study #4: Part 3, Unfolding Case Study #4: Part 4, Unfolding Case Study #4: Part 5, and Unfolding Case Study #4: Part 6 to review the patient data. Mrs. Jenson, a 72-year-old female, presents to the emergency room with worsening shortness of breath, fatigue, and swelling in her lower extremities over the last week. She reports increasing difficulty performing activities of daily living due to weakness and increased dyspnea. She has been admitted to the telemetry unit.

Past Medical History	Medical history: Hypertension, type 2 diabetes, heart failure (class III), osteoarthritis Family history: No significant family history reported. Social history: Widowed ten years ago, currently living in an assisted care facility. No children. Current medications: • Lisinopril 20 mg PO once daily • Metformin 500 mg PO twice daily • Metoprolol 50 mg PO once daily • Aspirin 81 mg PO once daily • Furosemide 40 mg PO once daily • Losartan 25 mg PO once daily • Ibuprofen 400 mg PO Q6 hours PRN mild arthritic pain
Provider’s Orders	1145: • Admit to telemetry unit • Twelve-lead electrocardiogram • Oxygen therapy to maintain oxygen saturation at greater than 92 percent • 20 mg Furosemide IV STAT
Nursing Notes	1200: Twelve-lead ECG completed; results show sinus tachycardia. 2 L oxygen via nasal cannula applied, patient reports improvement in dyspnea. IV placed in right AC, 20 mg Furosemide IV administered. Patient instructed to call before getting up to use bathroom. Patient has not voided since admission. Patient admitted to room on cardiac unit, and handoff given to telemetry nurse.
Nursing Notes	1800: Patient pressed call light to request to use the bathroom. Ambulated with ×1 assist from nurse due to unsteady gait. Patient was unable to void.

Generate solutions: What are the priority actions by the nurse?

Answer

First, the nurse should report the findings to the provider. It is likely the provider will order a bladder scan to measure how much urine is in the bladder. This is done with a bladder scanner (ultrasound) at the bedside by the nurse.

Case Study 26.4.5 §26.4 source ↗

Refer to Chapter 19 Oxygenation and Perfusion, Chapter 22 Activity, and Chapter 24 Skin Integrity for Unfolding Case Study #4: Part 1, Unfolding Case Study #4: Part 2, Unfolding Case Study #4: Part 3, Unfolding Case Study #4: Part 4, Unfolding Case Study #4: Part 5, and Unfolding Case Study #4: Part 6 to review the patient data. Mrs. Jenson, a 72-year-old female, presents to the emergency room with worsening shortness of breath, fatigue, and swelling in her lower extremities over the last week. She reports increasing difficulty performing activities of daily living due to weakness and increased dyspnea. She has been admitted to the telemetry unit.

Past Medical History	Medical history: Hypertension, type 2 diabetes, heart failure (class III), osteoarthritis Family history: No significant family history reported. Social history: Widowed ten years ago, currently living in an assisted care facility. No children. Current medications: • Lisinopril 20 mg PO once daily • Metformin 500 mg PO twice daily • Metoprolol 50 mg PO once daily • Aspirin 81 mg PO once daily • Furosemide 40 mg PO once daily • Losartan 25 mg PO once daily • Ibuprofen 400 mg PO Q6 hours PRN mild arthritic pain
Provider’s Orders	1145: • Admit to telemetry unit • Twelve-lead electrocardiogram • Oxygen therapy to maintain oxygen saturation at greater than 92 percent • 20 mg Furosemide IV STAT
Nursing Notes	1200: Twelve-lead ECG completed; results show sinus tachycardia. 2 L oxygen via nasal cannula applied, patient reports improvement in dyspnea. IV placed in right AC, 20 mg Furosemide IV administered. Patient instructed to call before getting up to use bathroom. Patient has not voided since admission. Patient admitted to room on cardiac unit, and handoff given to telemetry nurse.
Nursing Notes	1800: Patient pressed call light to request to use the bathroom. Ambulated with ×1 assist from nurse due to unsteady gait. Patient was unable to void.

Take action: The nurse performs a bladder scan and determines that the patient has 500 mL of urine in the bladder. What order does the nurse anticipate receiving from the provider after relaying this information?

Answer

The nurse should anticipate that the provider will order a straight catheterization to empty the bladder. The provider might order an indwelling Foley catheter if the patient requires strict input and output documentation, or if the patient’s condition worsens.

Case Study 26.4.6 §26.4 source ↗

Refer to Chapter 19 Oxygenation and Perfusion, Chapter 22 Activity, and Chapter 24 Skin Integrity for Unfolding Case Study #4: Part 1, Unfolding Case Study #4: Part 2, Unfolding Case Study #4: Part 3, Unfolding Case Study #4: Part 4, Unfolding Case Study #4: Part 5, and Unfolding Case Study #4: Part 6 to review the patient data. Mrs. Jenson, a 72-year-old female, presents to the emergency room with worsening shortness of breath, fatigue, and swelling in her lower extremities over the last week. She reports increasing difficulty performing activities of daily living due to weakness and increased dyspnea. She has been admitted to the telemetry unit.

Past Medical History	Medical history: Hypertension, type 2 diabetes, heart failure (class III), osteoarthritis Family history: No significant family history reported. Social history: Widowed ten years ago, currently living in an assisted care facility. No children. Current medications: • Lisinopril 20 mg PO once daily • Metformin 500 mg PO twice daily • Metoprolol 50 mg PO once daily • Aspirin 81 mg PO once daily • Furosemide 40 mg PO once daily • Losartan 25 mg PO once daily • Ibuprofen 400 mg PO Q6 hours PRN mild arthritic pain
Provider’s Orders	1145: • Admit to telemetry unit • Twelve-lead electrocardiogram • Oxygen therapy to maintain oxygen saturation at greater than 92 percent • 20 mg Furosemide IV STAT
Nursing Notes	1200: Twelve-lead ECG completed; results show sinus tachycardia. 2 L oxygen via nasal cannula applied, patient reports improvement in dyspnea. IV placed in right AC, 20 mg Furosemide IV administered. Patient instructed to call before getting up to use bathroom. Patient has not voided since admission. Patient admitted to room on cardiac unit, and handoff given to telemetry nurse.
Nursing Notes	1800: Patient pressed call light to request to use the bathroom. Ambulated with ×1 assist from nurse due to unsteady gait. Patient was unable to void.

Evaluate outcomes: What findings would indicate that the nurse’s actions were effective?

Answer

If performing straight catheterization, the nurse would expect to remove 500 mL of urine from the patient. If less is excreted, there may have been a problem with the catheter that warrants follow-up. The patient should also report less abdominal discomfort and lower abdomen distension if the interventions were effective.