We recently had a pt. that went out for a cystoscopy and needle bx. of his prostate. When he returned to our facility he had a foley cath in. (He's had it since March but the approval for procedures and f/u is really slow)The inmate was able to tell me he expected to have some bloody urine after the procedure and he was going to drink lots of water as the MD. had told him to. Foley draining fine when I left work at 5pm. When I arrived to work the next morning @ 8 AM, a roomate of the pt. came to tell me that he was sick. The post cysto pt. said he had not drained urine all night. Night nurse said the pt. didn't complain of discomfort until late in his shift. He said he'd called the MD on call and was told to let the dayshift MD/PA see the pt. Mind you, we have a fill-in MD who was not coming until afternoon and this RN knew it. He said he was trying to get some "action", but the on call MD would not give an order. He also stated that there was no order to "flush" the catheter. I went to the supply closet and got a new catheter. Sure enough, there was a big,fat clot on the end of the old foley. I wound up having to irrigate the new foley to get it to drain. The drainage was a dark burgundy bloody urine that had been sitting in his bladder all night. During my shift I had to irrigate it a few times to keep it draining. When the MD came in at 1PM, the foley was still draining bloody urine. I got a total of appx 3000 ml drainage on my shift. My question is: Would anyone out there just wait for an MD to show up whenever or would you have taken action yourself? If I could not have corrected the problem, I would send the pt. back to the ER. Is it because he's an inmate he doesn't deserve care? The night nurse even wrote a verbal order in the chart to have the pt. seen by dayshift MD/PA.
You don't need a physician order to irrigate or change a catheter, unless there are specific orders not to do so. I would have irrigated it first, and if that yielded no results I would have changed it. If there was still no output I would have called the doctor for orders, and I would have insisted on an order to transport to the hospital.
You have to use good nursing judgment. I once received an order to give Lasix to an inmate with a severely swelled penis. I decided to wait until I inserted a foley before I gave it. Good thing: His urethra was blocked by the swelling. I had to send him to the hospital to have one inserted with a guide wire. Had I given him the Lasix his bladder might have ruptured before he got to the hospital (the facility was 50 miles away).
Last edit by Orca on Jun 2, '10
Jul 26, '10
Nurses often forget or feel uncomfortable "telling" on physicians to their supervisor or chain of command when the physician doesn't give an order for something, but we have to remember we are patient advocates. This is a very important part of our job, especially in corrections. If you remind the physician that you will document and/or notify the supervisor and/or make suggestions about what you think should be done, the physicians will change their tune and give you orders. Unfortunately, there are still health care professionals out there in corrections who believe all inmates are faking it and thus, they withhold treatment, sometimes to the detriment of the patient/inmate.
Last edit by shell911rn on Jul 26, '10
: Reason: Clarification of last sentence