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- by KC CHICK Feb 6, '03Got report for one of my patient assignments (out of six) and was told this elderly male patient had been complaining of "feeling the need to urinate" and "not being able to urinate very much at a time". The complaints had started around 1700 that afternoon. The nurse reporting to me ASSUMED that he had a UTI and got an order for UA+. OK, fine.
About 30 minutes into my shift, the wife of said patient comes to the desk complaining that patient is in serious pain and no one is doing anything about it. I go assess....pt. had foley taken out day before, said his probs started at 1400 (not 1700)....severe pain, severe urgency, and very little out at a time but a few drops. Pt. had never heard of a "bladder scanner" when questioned.
Bladder scanner sees 600ML in the bladder. Get order for foley...then place....and get back 800ML!!! YIKES! No wonder the poor man was in pain.
BTW....UA was negative. duh.
QUESTION: What's the most urine that you have seen retained in a patient??....please share.
AnneLast edit by KC CHICK on Feb 6, '03
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- Feb 6, '03 by HLR_RNYou won't even believe it!
The patient had a foley D/C'd earlier that day and hadn't peed yet. I came on at 1900 and was told by day nurse that the patient hadn't voided but she wasn't too concerned b/c pt was NPO and no IV. When I was doing my rounds asked pt if they needed to pee, if they felt pain. Answered no to both but was elderly and pleasantly confused. When I pulled back the covers to look at their abd. I couldn't believe it, this tiny little 85lb woman looked like she was 8mos. pregnant. Inserted a foley...1000cc return immediately and a total of 1800 in about 30 mins.
I thought only a nurse could hold that much urine in their bladder!
- Feb 6, '03 by RNCCRN9706Well, just last week, I had 850 out after replacing a foley but the most I've ever seen is 1200-1500, I was taught that you should never take out more than 1000cc as removing more than that can cause bladder spasms.
I wonder though, did the pt urinate after the foley was taken out? If a pt hasn't voided 6-8 hrs after foley removal then I usually will call for straight cath order if there wasn't one written already.
- Feb 6, '03 by KC CHICKHLR...It's just amazing what gets left in our laps sometimes, isn't it??? I'm usually start becoming concerned if they don't urinate 4hrs after foley dc'd.
Kelly, my patient had urinated...although VERY little at a time...100-200cc. The severe pain is what clued me in. I love bladder scanners. Gives me an idea of what's there and I don't end up straight cathing someone that doesn't need it.
You're absolutely right...I can't believe how much urine you got...1800!!!! Geeeesh. I hope I NEVER hold that much in my bladder.Last edit by KC CHICK on Feb 6, '03
- Feb 6, '03 by VivaLasViejasHere's one for Ripley's Believe it or Not: I once straight-cathed a 22 YO primipara for almost 2100cc. The poor girl hadn't peed since her 10-pounder was born around 11 AM, and I came on shift at 11 PM. Why no one had thought to do this earlier, I never knew, but she was hurting big time when I told her I needed to do the SC. She was afraid of the procedure, and I had to do some fancy talking to get her to agree to it, but I happen to be very good at this and she barely noticed when I inserted the cath. And then came this flood of urine! I couldn't believe it, her husband couldn't believe it, but it just kept flowing. The funny thing was, as the urine continued to flow, she became less agitated, then more animated---talking, then smiling, then actually laughing! By the time she was finally "empty", she was practically leaping out of bed and kissing my feet for making her feel so much better. I was fearful of letting her get OOB after such a drastic drop in fluid volume, but she never had so much as a dizzy spell.....she was just so happy to get rid of the pain. Man, I can't even imagine holding over 2000cc in my bladder........after my first baby, I couldn't pee either and I thought I was gonna die until they straight-cathed me, but all I had in there was a little over a liter. Now it's all I can do to hang onto 300-400cc for the length of time it takes me to get to the bathroom when I get the urge (love those Detrol commercials!!). Poise pads are my best friends these days. But if I had to choose between a little incontinence and having 2 quarts of urine on board that I couldn't get rid of, well, the pads aren't so bad.
- Feb 6, '03 by caroladybelleI got back 2100 cc from a dementia patient. Admitted earlier that day from LTC facility in Florida. Previous shift reported that she was having abdominal pain and been incontinent several times - there were no bladder scans in that hospital.
Got back 1800 from a 30 something, IDDM drug abuser in for multiple problems.
The most off the wall - an elderly female retiree - over 100 years old - was in for hip repair - was going to be bedridden for several days - went to start her IV, when noted that her bladder was firm and very distended (she was a teensy lady), previous shift said that they had attempted to put a foley in, but were unable to - but that it was no problem as she was incontinent of urine while they were trying to put it in (Hello, clue phone ringing?). When we attempted to place the foley, found "landmarks" missing/rearranged. Seems that she had only had one living child, born in the teens - she was torn badly - and the MD didn't think that she could/should have any more kids. Well, given the "repair" job, it wasn't likely (She said that the sex was awful - husband died in the forties). She also reported frequent UTIs. We finally had to call a urologist - placed a suprapubic - the bladder was so neurogenic, that we had to roll her (with hip FX) every so often, for it to drain, and the urologist had to pull the urine out via syringe for a while. It took a while, but got back 1500cc. She did okay and went home to care for herself after rehab. I'll always remember her independence.
- Feb 6, '03 by oramarIf a patient has those kinds of complaints an assessment should always include visual exaim of area and in most cases palpatation of the area. Yes, I have run into many cases where nurses don't take that obvious step. There are a lot of different reasons for this, sometimes ignorance, sometimes laxity and I have run into a few people who seem to be lazy or have a reluctance to touch patients. In the old days before bladder scans vision and touch were the only thing you had and in nine out of ten cases you could pick it up. PS In last stages of my career it was happening because people were busy to the point of insanity.
- Feb 6, '03 by RNCCRN9706Bladder scanners are nice but most hospitals don't have them. Last hospital I worked at didn't have one and neither does my current facility. The renal floor might but I don't know. I work in ICU so most of our pt's have foley's. When I worked urology, we had a bladder scanner and it was getting borrowed all the time so that when we DID need it, it wasn't there as sometimes the other floors "forgot" to bring it back. Oh well.
I'd rather straight cath someone and find out there's nothing or very little urine than have urine in the bladder as the longer it sits there the higher the risk of getting an infection.
- Feb 6, '03 by OBNURSEHEATHER1400.
We have standing orders for every patient to straight cath if no void 6 hours post delivery. I usually don't wait the entire 6 hours if the patient is getting uncomfortable, so then I don't get too much.
But the above number was obtained after the previous nurse "forgot" to do the procedure, and then the pt was so swollen she was impossibe to cath! (I'm tellin ya, UNRECOGNIZABLE landmarks) She was SO uncomfortable I just drained her. I didn't want to leave her any closer to getting full again.
- Feb 6, '03 by Nurse RatchedMale pt - 5500 cc. Admitting dx: "severe constipation" (and OCD.) If I hadn't seen it with my own eyes.....
He wound up with a suprapubic cath because years of purposely retaining his urine had completely destroyed his bladder tone, among other problems.Last edit by Nurse Ratched on Feb 6, '03