Critical thinking exercise

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I used this case study with my students today, and got quite a few different answers. What do you guys think?

Mrs. M was admitted four days ago with CHF. She has a long hx of the disease, and is usually admitted several times a year. She has been treated with IV lasix and dig, and has been diuresing well. When you get shift report from the daylight nurse, she tells you that Mrs. M's urine output has been dropping, and she emptied 500 ccs from her foley at 1400. You have to give a pain med to another patient, then answer phone calls from two other patient's families before you get in to see Mrs. M. When you go into her room at 1600, she is sleeping, but you notice immediately that there is no urine in her foley bag. What is the first thing that you do?

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OKay I will bite..the VERY first thing I would do is make sure that the foley is patent by checking to see that the tubing is not kinked, since many times when pts are in bed they can lay on the tubing etc.

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Specializes in Critical Care.

I would be checking vs along with the foley tubing. BMP and Mg. It sounds like the pt may be dry. What was the last dig. level? Lung sounds? Any edema?

Noney

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See if the tubing to the foley is kinked.

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I'm with Erin - the VERY first thing I would do would be to check the tubing.

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The key to the question is "the first thing I would do". Yes, check for kinks and placement of the foley catheter.

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Specializes in Inpatient Acute Rehab.

You say she was sleeping?? Well, the first thing I would do would be to make sure she was just sleeping, and not unconscious. Then, I would check to see if there was a kink, all the while checking for edema,Kussmaul respirations, color of skin, etc...

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Specializes in LTC, assisted living, med-surg, psych.

And if no problems are found with any of the above........ask the aide if s/he just emptied the bag!;)

I mention this only because I made that very mistake in my 'rookie' year as a nurse:imbar

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Specializes in Critical Care.
Originally posted by mjlrn97

And if no problems are found with any of the above........ask the aide if s/he just emptied the bag!;)

I mention this only because I made that very mistake in my 'rookie' year as a nurse:imbar

:roll :roll :roll :roll

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scream at the top of my lungs

oh my god there is no urine

lol first thing wake her and ask her if she feels the urge to relieve her bladder and then palpate her bladder, then check for kinks and then see when her bag was emptied.

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originally posted by ccu nrs

scream at the top of my lungs

oh my god there is no urine

omg! :roll roflol you sooooooooooooo crack me up!

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check for kinks..................if there has truly been no urine for 2 hours I would call doc for orders.......................

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