Bladder Scanning

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Hello!

For context, I work with high school students. I recently had a student complain that they had not urinated in 24 hours - they came to my office within the first 20 minutes of school telling me this. Parents were unaware of this issue. C/O some lower abdominal tenderness but nothing severe. Gave them a bottle of water, had them try to urinate in the clinic bathroom, did this a couple of times, no success. The parent couldn't come get the student for a couple of hours and had nobody else to come get them. In my hospital brain, I would bladder scan. One of our nursing programs actually has a bladder scanner. From what I've researched, bladder scanning is nursing assessment driven and does not require a doctor's order. I didn't end up doing it but had parent come get the student and emphasized they HAD to go get checked out. What would you have done? Should I have done something different?

I'm sure someone will probably say I should've called a squad since the parent couldn't come for a couple of hours. My rationale was, this has been going on for 24 hours, is 2 more hours that big of a difference? And the student wasn't complaining of severe pain, and after asking a few questions they are on a new medication that can cause some urinary retention. Also, we are out in the boonies - a squad call for bladder pain would've easily taken at least an hour before anyone came. 

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Specializes in ER, critical care.

I would not bladder scan at school. That could set you up for trouble down the road. Bladder scanning would require the student to pull their pants down just enough for this to possibly be an issue, and the parents did not give you permission to do that. I would call for an ambulance. Not urinating for 24 hours or more needs to be addressed sooner rather than later. That student has to be so uncomfortable, and he/she could possibly end up with pyelonephritis. 

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Specializes in pediatrics, school nursing.

I wouldn't bladder scan without an order - I might consider calling the kid's PCP and seeing if they'd give me a 1x verbal order though! Might be a waste of time, but you never know... I think it's only a nursing judgement if your facility has standing orders - like a nursing home might.

I don't think I would have called EMS unless vitals or presentation looked bleak. I would have however, let the parents know that based on the current situation, I was keeping the student with me, and rechecking VS every 30min-1hr, and if there was any kind of major change - subjective or objective - I would need to call EMS. 

I've never been faced with this exact scenario, but with other situations where a kiddo is likely to end up in the ED anyway (think suspicious ortho injuries or concussion symptoms), the parents sometimes say to just call EMS and they'll meet the kid at the hospital, or miraculously, they've suddenly been transported home and can be to the school in 10 minutes. 

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I feel like it would be a miracle to even have a bladder scanner LOL.

If the student was feeling fine but hasn't peed in 24 hours I'd worry about pyelonephritis as well, and pain, but they seem fine. I'd definitely encourage reaching out to the PCP or urgent care, or ER if that is not available. They may need a straight cath.

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Jollysox said:

Update: parent called after taking the kid to be seen. Magically they were able to pee almost immediately after getting home before getting seen by a Dr. and all labs and tests were perfectly fine. 

Not saying they were faking but, I have seen a recent uptick in kids coming to my office with wild, vaguely critical complaints - my ER/critical care brain is looking at them thinking "If you actually had these symptoms you are describing, you'd be on the floor..." - but they seem to know exactly what to say to get me to send them home and get seen by a doctor. I just don't want to have that one time where I blow them off and then it actually ends up being an emergency, but I'm tired of feeding into all of this. Not sure if its social media where they're getting these ideas or what. 

 

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Specializes in pediatrics, school nursing.

My cynical brain is thinking these kids asked chatgpt to come up with such scenarios.....

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Chat gpt, tiktok...IDK. My cynical take is that this generation loves the victim roll. They all have "trauma", and all have some sort of health problem - this is not to take away from the children that absolutely do have these things. But it's become a trend to self-diagnose based off things they've seen online. We have several kids this year telling our school psychologist that they have dissociative identity disorder, that's this year's trendy mental health diagnosis. It affects roughly 1% of the population....

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Specializes in kids.

Oye  self diagnosis... When they say they have anxiety ( and I am not aware of any diagnosis) my first question is to ask "When did the doctor made that decision diagnosis? I wasn't aware that you were having  issues...I'll check in with mom/dad/guardian for an update so I can best help you here."

The walk backs on the Dx are pretty frequent... (I am inHS)

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Yes, I have also noticed this. I had kids give me a laundry list of things they're "diagnosed" with and respond with "Wow, none of that is listed in your forms. I will call mom/dad and discuss this with them because it's important that I clarify these." and am usually met with "No! Don't call them." hmm....

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