bladder spasms and foleys

  1. I am a new charge in LTC. We have a male post TURP that suffers from severe bladder spasms. No Ditropan order: MD made aware. Ordered see urologist if continues or worsens. Vicodan one given q 4 hours prn. The second vicodan was somewhat effective.
    My questions are as follows: If the foley is patent and draining, is there a need to irrigate the foley? Can an irrigation of 30 cc be expected to return, or can it pool in the bladder of a resident in a supine position?
    Do I remember correctly from nursing school that bladder spasms used to be treated with belladonna and opium suppositories? Is this outdated now?
    Thanks for being there for me guys!
    Carrie
    Last edit by cargal on May 18, '02
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  2. 25 Comments

  3. by   Fgr8Out
    We get standard orders for our TURPS that always include B&O suppositories... sounds like this patients doctor needs some pain management education.
  4. by   willie2001
    Our urologist orders B&O supp. on all his postop TURPS.
  5. by   cargal
    There may be some history of drug seeking. I will look into it on Monday. I'm off for the weekend. Here comes the sun?
    I asked around today, but nobody heard of B&O for bladder spasms! Wish me luck. Thanks allnurse.com! Nice to have a world wide sounding board-LOL!
    Last edit by cargal on May 17, '02
  6. by   NRSKarenRN
    Might be that foley balloon too large irritating bladder...try to decrease air by 5cc. Get thy B+O supp STAT since post TURP...get someone to call doc Saturday...that's cruel behavior.
  7. by   cargal
    Thanks NurseKaren, I'll make that call tomorrow when full time charge is on. Good suggestion and appreciated.
  8. by   JillR
    B&O suppositories are appropriate, and work well for bladder spasms. If the patient does have a hx of drug seeking, does that mean that we hold appropriate intervention because it happens to have a narcotic in it? That would be cruel.
  9. by   Fgr8Out
    Not to jump up on my soapbox but...

    Drug seeking is no reason not to medicate someone. Does this patient have a history of drug abuse or other similar history? People in pain are going to "seek" medication to help alleviate pain... period.

    In any case... a TURP is painful and the bladder does spasm. He deserves something other than vicodin, as that does not address the spasms... which are very real... and for which B&O supps ARE the appropriate medication. http://www.sykart.com/keenie/turp/Meds.html

    I agree with the suggestion of checking the inflation of the balloon, as well. Just don't let it slip out or you'll have a heck of a time getting it back in...LOL
    Last edit by Fgr8Out on May 17, '02
  10. by   MollyJ
    Originally posted by JillR
    B&O suppositories are appropriate, and work well for bladder spasms. If the patient does have a hx of drug seeking, does that mean that we hold appropriate intervention because it happens to have a narcotic in it? That would be cruel.
    I have a step daughter in recovery and my greatest fear is that someone will put prescription narcotics in her hand without discussing it with her and with her support system. She has abused narcs in the past. Still I can envision MANY circumstances when she may legitimately need narcs. Here is what I would want for her:

    Tell her the options
    Try non-narcotic pain relief as appropriate
    Let her/her family activate her support system (AA buddies)
    Especially if she is going home on the narcs, have a plan for who will hold the narcs. I'd probably be willing to do this. I'd want a no refill RX. We'd take it day be day if we needed refills.
    AA buddies will need to be activated for when/if she experiences drug cravings
    Some recovering individuals DO NOT wants narcs. Their voices should be heard. They deserve the finest in non-narcotic pain management.

    Bottom line: Include the patient and the family in the decision making.
  11. by   NRSKarenRN
    Remember: This is a LTC facility patient is in!
  12. by   LilgirlRN
    The guy is already on Vicodin, I fail to see how a B&O suppositry is gonna change things from a seeking stand point. Even drug seekers have legitimate pain sometimes, pain that tylenol, NSAIDS won't help. I don't take care of post-op TURP's as I am in the ED. Would pyridium or uro-spaz help at all?
  13. by   MollyJ
    Nrs Karen, I respect your opinion above all, but "even" LTC patients deserve to be included in their care plan. And their families. I guess you're objecting to the homegoing part of my post. I am trying to generalize the knowledge.

    You know I've seen so many posts here where nurses complained about drug seeking behavior, so it only seems natural that nurses would want to include the patient/family to create a plan that is consistent with what the patient/family wants. Some recovery people have a very adversarial view of HCP's just because they unsure if they can trust the HCP to consult them on their pain management wishes. The key wish here is _communication_.
  14. by   cargal
    Just to clarify things, I am still finding my way around this facility. I would not let a patient suffer if I could help it! Sometimes it takes more than one day! I called the doctor and deferred to at least four seasoned nurses that knew that resident and the doctor. I am trying to figure it out, but rest assured, I would not let a patient suffer if I could help it. I probably should have consulted a drug manual and let my instints be my guide, but instead, called the MD and talked to at least four other nurses. I am still learning. I believe he had spasms before his TURP, maybe he has more than TURP The day was like a hurricane hit. If I am guilty of anything, it is not consulting the drug manual and his chart. I was too busy checking his foley, palpating his bladder and trying to figure out what was wrong, and finding our what they for him before and what worked. I have no problem with B& O supppositories, that is why I was asking. I am always a patient advocate and I want to help him! I am not here to judge if the man was drug seeking. I am trying to find out why the MD would not order B&O suppositories. I am here to learn from you guys!
    Lilgirl, what is uro-spaz and isn't pyridium rifampin?
    You see, I don't see alot of post TURPs in LTC or personal care. But I would NEVER let a man suffer. I am trying!
    Last edit by cargal on May 18, '02

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