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 Is this outdated now?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

[cargal]

Just to clarify things, I am still finding my way around this facility. I would not let a patient suffer if I could help it! Sometimes it takes more than one day! I called the doctor and deferred to at least four seasoned nurses that knew that resident and the doctor. I am trying to figure it out, but rest assured, I would not let a patient suffer if I could help it. I probably should have consulted a drug manual and let my instints be my guide, but instead, called the MD and talked to at least four other nurses. I am still learning. I believe he had spasms before his TURP, maybe he has more than TURP The day was like a hurricane hit. If I am guilty of anything, it is not consulting the drug manual and his chart. I was too busy checking his foley, palpating his bladder and trying to figure out what was wrong, and finding our what they for him before and what worked. I have no problem with B& O supppositories, that is why I was asking. I am always a patient advocate and I want to help him! I am not here to judge if the man was drug seeking. I am trying to find out why the MD would not order B&O suppositories. I am here to learn from you guys!

Lilgirl, what is uro-spaz and isn't pyridium rifampin?

You see, I don't see alot of post TURPs in LTC or personal care. But I would NEVER let a man suffer. I am trying!

[NRSKarenRN, BSN, RN]

Cargal:

Glad to see you posted about this problem. I saw you had called the doctor re spasm and ment that it was cruel of the Doc not to oder meds that would help control severe spams. I replied off the cuff and not with usual tact.

Strongest med to control problem is B+ O suppositories. Next would be Ditropan or Probanthine.

Found some info to post re problem. After 25 years nursing, learned something new today from LPN site below re injecting mineral oil into balloon to cause it to rupture if it won't deflate when removing a cath.

Perspectives - Transurethral Resection of the Prostate

http://www.perspectivesinnursing.org/v1n3/wasson.html

TURP FAQ

http://www.sykart.com/keenie/turp/FAQ.html

Intern On-Call: Foley Catheters

http://www.ohsu.edu/cliniweb/intern/3.html

PROCEDURES FOR LPN'S

http://www.cyber-nurse.com/lpn/lcfoley.htm

I'm sure you'll do your best to help this patient get some spasm relief. Follow-up next week re outcome.

[cargal]

Thank you NRSKarenRn,

This has all been very helpful.

[lisalau]

I have a question regarding B & O supositories, i hope its ok to ask for me, its not for a patient.

I have an unusual functional condition...continuous urethral spasm, caused by, it is thought, amylase deposits (I have FMF) in the pelvis, particularly, the urethra, bladder, ureters and kidneys.

the suppositories are not available in Australia. I have tried numerous alternative modalities and many help but there are times I think i am losing my mind.

What is your opinion of their success on patients with urethral spasm? I would be very greatful for any opinions shared...

lisa

[NRSKarenRN, BSN, RN]

B + O still used in US but short term24-48hrs only as addiction potential.

If current specialist not helpful, seek second opinion.

[lisalau]

oh no, my specialist is wonderful, thanks. He was the first to run urodynamics and confirm the condition exists, previous urologists denied it was possible, He is endo/gynae trained. He has exhausted himself trying to think 'outside the box' and find a solution for me.

He found this condition in animals (he gently called it more primitive species) but wasnt willing to adapt the vets solution...putting the animals down as its too cruel to allow them to live with such a condition..and for this i am greatful...well sometimes, lol.

Searching the internet for solutions came up with some ideas, we have tried botox injections, 2 units, 3 times but with no success...we have tried biofeedback, myofacial stretching, accupunture, moxibustion, chinese herbs, massage, cognitive therapy, visualisation, meditation, TENS, along with more traditional antispasmodics, muscle relaxants, narcotics, MS and parkinson's medications and antiepileptics and more...each with limited success.

Reading this thread gave me hope that perhaps belladonna along with some narcotics dissolved within the pelvis could be another solution to try.

Thanks for the feedback

[lisalau]

followup on my problem, if anyone was interested. 6 suppositories were sent to my doc and he gave them to me. They worked amazingly. The spasms reduced by about 60% to a tolerable pain level and the relief lasted about 5 hrs from onset. The doctor is working on a way to get a regular supply from the US. I posted this to conferm other posters opinions...B & O Suppositories are a very effective way to control spasms in the urethra and bladder.

[NRSKarenRN, BSN, RN]

Great to hear that you have found something that works for you. 5 hours of relief at a time impressive after your pain experiences. Hope you can obtain a regular supply as no one should have to suffer needlessly.

[lisalau]

thankyou

[NurseRiRi]

lately our docs have been prescribing levsin (spelling) SL for bladder spasms, its usually used to control oral secretions, but works very well and quickly for spasms!

[zacarias, ASN, RN]

Belladonna and Opium suppositories are VERY common in all great hospitals still. It sounds ancient but hey they work!

[lisalau]

unfortunantly for me, they are not available in australia at all!

what is levsin SL? i appreciate any ideas anyone would have to help control this!

My sanity is wavering!