bladder spasms and foleys

[cargal]

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 Is this outdated now?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

[Antikigirl, ASN, RN]

I would be calling the MD and working with them on a good plan of action for the spasms! Spasms are not good, and can be a sign of trouble big time...sure, you can medicate...but does that find the underlying probelm..no it hides it.

The pt needs more help with their physician to quell this probelm...and better managment for pain and discomfort. Not to mention the emotional toll that takes on people (urniation is seen as a simple act, and having a foley is taking away a lot of control of something they really never had to worry about when they were younger...so it tends to hit hard on the emotions and fears of people...they can think "well if I can't keep control of that...then I must really be sick or dying!".).

When there is bladder and bowel control probelms, I really investigate how my pt is feeling about it...most often there is much more going on than meets the eye as far as powerlessness, hopelessness, depression, anxiety, and fear for life.....that too needs to be addressed.

[curiousauntie]

I am right now trying to find info about bladder spasms due to bladder cancer. I am an RN(hospice nurse). My best friend was diagnosed with bladder cancer (stage 3) 5 of months ago. She has not been able to start BCG treatments as everytime she has a uroscopy the cancer has returned (the bladder has to be free from cancer in order to do those treatments). She had biopsies of the muscle wall in March that were negative for cancer, but that is when the spasms started. She had another TUR about a month ago that showed some cancer in the bladder muscle, so now she has a date for surgery to remove the baldder and have an Indiana Pouch constructed, but not until July. The problem is the intense bladder and urethreal spasms that do not respond to anything. She was taking handfuls of Percocet, as her urlolgist had not clue one how to deal with someone in that much pain. His office staff treated her like a drug seeker. He finely told her to see an onocologist for pain management when she broke down in sobs in his waiting room. I took her to the medical director of the hospice that I work for and he started her on Oxycontin CR 20mg BID and Percocet 7.5/325 1 to 2 every 4 hours for breakthrough. She was also on Urosed (spelling?) for the spasms. She continues to have spasms and now is using Belladonna and Opium suppositories 2 times a day.

My pleading question is...What else can we do? My medical director will do whatever it takes, he is a palliative specialist, and will give us scrips, but what else is out there???