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Discussion

How do you...? 2 questions.

1. How do you stimulate a patient to void when they are retaining urine? I can find lots directed at patients or the caregivers of patients who are alert enough to participate, but what about a minimally conscious patient? My patient survived a severe anoxic brain injury, which carries a risk of kidney failure secondary to urinary retention. We are waiting on a PRN cath order, but that could take several days. Retention triggers seizures.

2. How do you perform cough assist with a patient with an uncuffed trach? They can not close their mouth and have a large, protuberant tongue completely obstructing it. 

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    1. For your urine retention problem, if the patient is able, getting them up to the bathroom will help, running water, and I’ve had success with gently pouring warm water on their peri area. 
    - also suggesting the MD to order flomax? 

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    • Author

    @abbycdps, he can't do anything. Severe anoxic brain injury, classified as brainstem only functioning, although there is clearly brainstem injury too (pupils fixed) and some small things that point to minimal functioning above that level (crying from discomfort). No indication of awareness of surroundings. He only responds to touch/discomfort, and ALL stimuli is bad. Needing to void urine or BM and needing trach suctioning are significant triggers for seizure activity. 

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    19 hours ago, josie9toes said:

    Severe anoxic brain injury, classified as brainstem only functioning, although there is clearly brainstem injury too

    Was he/she sent to a rehab program? Although the patient has such massive injuries, a program would help with maintaining bodily functions. What were the discharge arrangements?

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    If this pt is significantly retaining and you can’t get a ISC order immediately, something is very wrong. Especially in this situation. That isn’t the kind of thing that can wait - he must void. 

    This is something that should have been addressed inpatient - was it not? 

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