Acute Urinary Retention in 87 year old gentleman post stroke

[Honey Bee]

On arrival to a ward in hospital this 87 year old gentleman with acute urinary retention (AUR) had an indwelling catheter inserted by the Urology doctors. the patient was uncomfortable and aggressive and yelling out "I can't take the pain anymore, I'm so sore and I need to wee". His vital signs were RR 32 p/min, O2 sats 93% on RA, BO 112/60, Temp 37 and afebrile and HR 108 strong and regular. pain was 7-8/10. Patient observed to be in rigors. On examination indwelling catheter (IDC) patent and draining 150mls, urine concentrated with visible haematuria and blood clots. Glans tip of member red and excoriated with discharge. Groin area appears red with signs of beginning excoriation. patient pad wet with urine a diameter of approximately 10cm. patient faeces incontinent. patient dehydrated and not wanting to take fluids saying, I am not drinking because then I have to wee and that hurts. patient past medical history significant for previous TURP, mild cognitive impairment increasing memory loss, depression, episodes of dysarthria and left arm weakness. can anyone please determine what the patients eGFR would have been as this piece of data has been left out of the picture?

Are there any such Australian guidelines for managing an excoriated Glans tip of member and the skin breakdown for a male in this situation? At this age it is very distressing to see this.

[Esme12, ASN, BSN, RN]

I have asked on your other posts and you have not answered....are you a student?

We are happy to help you but we will not give answers.

If you are already a nurse....what protocols has your institution instituted for skin breakdown? Do you have a would nurse?

We need more information from you to know how to best help.

A simple Google search revealed

http://www.awma.com.au/journal/1602_01.pdf

http://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0004/155209/skin.pdf

http://www.nzwcs.org.nz/images/publications/wcansw-skincare-guidelines.pdf

http://www.nzwcs.org.nz/images/publications/wcansw-skincare-guidelines.pdf

[Honey Bee]

No.... I am not a student. A new grad left to their own practice more likely where some nurses still just do things without a good rationale for it. there is little time during work hours to search databases so do this research at home on days off.

[Esme12, ASN, BSN, RN]

Awesome...this link goes to Au resource on skin care. http://www.nzwcs.org.nz/images/publi...guidelines.pdf

Thread moved to Au nursing you might get better information there....:)

[Honey Bee]

Where is the Au nursing you moved this thread to?

[Silverdragon102, BSN]

you are in it. You can find the Australian forum under the world tab at the top of the page

[ANnot4me]

Hi HoneyBee

I am afraid to answer practically as it would seem the management of a cather here might not be appropriate.

[Honey Bee]

Why would a catheter not be appropriate? How would a condom catheter be better and why? from what I have read and been taught when a patient has urinary retention in a post-stroke patient and indwelling catheter is always used. the Urology team requested this and did. Maybe the catheter was not inserted adhering to sterile technique nor a guided-wire insertion used that would have allowed fro less trauma being able to see where the catheter was being guided. the patient sustained harm as he pulled the catheter out and caused himself urethral trauma. Also I note the RN's did not seek a medical order to hang fluids for dehydration instead encouraged and set the patient up with water jug and class in reach. Given that the patient had a previous ischaemic stroke, I would have been worrried about relying on patient to consume adequate hydration orally only. Surely the protocols are to start IV fluid resus. I wonder which fluid they would have hung if they thought this. It seems someone does not understand patient past and present medical histories. Glucose surely would have a been thought don't you think? Scarey what you see some RN's do at times. What is your thoughts now?