Foley ordered for patient able to void on own?

Okami_CCRN, BSN, RN · May 21

I would have bladder scanned q4h - q6h and done post-void residual checks and avoided placing the foley and explained my rationale to the medical team with data from bladder scans as supporting evidence.

feelix, RN · May 29

You answered your own question. When in doubt, call the doctor, ask for explanation and document it if you follow orders. If you still don't agree with the doctor, inform the charge and ask for someone else to do it. If you were 'unable to' after trying, and nobody else helped, call the doctor and inform them and charge nurse. Document everything in the chart.

offlabel · May 29

that she could/did void in the time you had her doesn't then mean that is her norm. She developed bilateral hydronephrosis from the condition. There's a problem there that the physician specialist is trying to treat. We rarely have the whole picture and not understanding doesn't mean there's a problem.

FolksBtrippin, BSN, RN · May 30

offlabel said:

that she could/did void in the time you had her doesn't then mean that is her norm. She developed bilateral hydronephrosis from the condition. There's a problem there that the physician specialist is trying to treat. We rarely have the whole picture and not understanding doesn't mean there's a problem.

I agree. That's why I think you should always call to question an order. If the physician wants you to proceed then they can explain why, and you understand your patient better.

offlabel · May 31

FolksBtrippin said:

I agree. That's why I think you should always call to question an order. If the physician wants you to proceed then they can explain why, and you understand your patient better.

At what point do you not question orders? It's not the physicians role to teach nurses. Always? Not understanding something doesn't mean something is wrong. There have to be nurses around that can give a reasonable answer, I'd hope.

feelix, RN · May 31

Nurse education is the responsibility of the nursing department, not providers.

I think a nurse has a right to question orders that don't seem right. A doctor has the duty to explain any off label or unusual orders. Beyond that, evidence based resources should be available for reference. Nurses should not depend solely on other nurses for knowledge either.

The hospital should also have protocols and standing orders to prevent confusion and omission.

FolksBtrippin, BSN, RN · Jun 1

offlabel said:

At what point do you not question orders? It's not the physicians role to teach nurses. Always? Not understanding something doesn't mean something is wrong. There have to be nurses around that can give a reasonable answer, I'd hope.

I'm not really sure what you mean by "at what point do you not question orders"
I agree that not understanding something doesn't necessarily mean something is wrong. If the order makes sense to you, you don't question it. If it doesn't, you question it. The physician has a professional responsibility to explain to you the reasoning by the order if you have questioned it. That's professional communication. The physician could be missing information or you could be missing information. That's why we communicate with each other.

Tenebrae, BSN, RN · Jun 1

Would I insert a catheter into a patient that is able to pee and is having a 0ml post void residual.

Absolutely not. And have no problems documenting and telling a doctor why their catheter didn't go in. Catheters are a source of potential trauma and infection and it makes no clinical sense to put a catheter into someone who is peeing urethrally. Also make sure I clearly document my reasoning

Measure output, get them to pee into a bedpan and then measure

If doc really wants the catheter in, their arms arent painted on

FolksBtrippin, BSN, RN · Jun 5

offlabel said:

At what point do you not question orders? It's not the physicians role to teach nurses. Always? Not understanding something doesn't mean something is wrong. There have to be nurses around that can give a reasonable answer, I'd hope.

To be clear my point was that you should always call the doc when you question an order. Obviously we don't question every order.

Home Health Columnist / Guide · Jun 5

Issue here is neurogenic bladder

Quote

With neurogenic bladder, a person does not have bladder control because of brain, spinal cord, or nerve problem

with bilateral hydronephrosis

Quote

Hydronephrosis is a condition of the urinary tract where one or both kidneys swell. This happens because pee (urine) doesn't fully empty from your body

When patient is voiding (?amount) and bladder scan 0# post void does not mean urinary system fully working as Hydronephrosis DX by urologist (painful condition, can lead to renal failure). They needed q 3-4hr scans to get clearer picture re determining foley placement + Urologist should have been called to discuss above concerns then f/u with attending as this can lead to Kidney failure which can be prevented if stent was placed if severe case. Physicians need complete picture to make best medical treatment decisions. Always keep them in the loop + discussion why temp withholding medical care.

offlabel · Jun 5

FolksBtrippin said:

To be clear my point was that you should always call the doc when you question an order. Obviously we don't question every order.

right...but there are legitimate, relevant questions and questions that should be run by more experienced people first. You know as well as I do that answering the phone for questions that are seen in the same category as 'what's your favorite color?' will get a grouchy response.