Hello Again - I am a new RN and have been working at a SNF for about one month now. I have two questions:
1) I work the NOC (night shift) and I have a patient on our med-rehab unit with a foley drainage bag filled with 300mL of red colored urine, and it was obviously r/t to blood and not a medication causing discoloration. After emptying the bag...she filled it with about 200mL clear, yellow urine. The AM shift charted she had cranberry colored urine and the EVE shift charted clear yellow urine. So, on my NOC shift she had red urine again. Does anyone know what would cause a person to pee urine with blood and then normal clear, yellow urine? Is she passing blood clots? The foley was inserted 3 days ago. Also, as far as my responsibilities go - A UA had been ordered and collected the previous shift. I received the results and faxed them to the Dr. with a note stating she had 300mL red colored urine my shift. And I charted my findings and that I faxed the Dr. the UA results and informed him of my findings. Should I be doing anything else?
2) I received an order to D/C a peripheral IV in a patient and then immediatley start a new peripheral IV. It stated the IV was placed 3-days ago. Are peripheral IV's usually replaced every 3 days?
Thanks in advance for your feedback. Being a new RN and in a SNF with limited training and nurses who rather not take a few minutes to try and answer my questions..or just don't know the answer to my questions - this communication site is so very helpful! :-)
The problem with the urine is probably caused by the patient moving, tugging on the tube, causing it to bump around in the bladder. Try to secure it to her leg. Also, if your patient is on blood thinners (coumadin, heparin, even asa or plavix) is enough to cause some bleeding in that situation. Peripheral IV sites are usually only good per policy for 3 or 4 days- after that it hightens your risk of infection.
These long term patients are usually multisystem and very complex. Unfortunately there is so much variance with meds and day to day issues it's difficult to pin down, but you've been given excellent advice.
1. movement... that alone if the foley is not secured to the leg can cause urethral trauma and infection
2. A UTI causes red blood cell degredation, but is unusual to cause a change in color as you described
3. med interactions... what meds are being excreted through the kidneys and what is the BUN/CREATININE
4. foley placement, deflate the balloon and advance to the hub with sterile technique
5. What is the PSA lvl? I thought it was a male I may been mistaken
6. kidney U/s for renal carcinoma
7. Male patient that is self ejaculating and causing trauma when un-noticed.
8. poor assessment skills of the prior nurse that simply documents a normal urine without assessing.
There are many variables and I don't know if I've answered your question, but have given your more to assess with the situation. I hope that can help.
The IV bit, follow your facility policy, not what people state here. Example, we'll leave a negative assessment IV for 5 days, but change the dressing daily after 72 hours... assuming it's a negative hot IV. That is very different from what others have suggested, but my policy that I'm bound to. You follow your policy with that type of thing.
Never, ever, much or mess around with a foley placed by urology without calling them first. Food for thought. I hope I helped.
THANK YOU ALL!! Your feedback is so appreciated and it gives me much food for thought for future situations as well. As a new RN I notice that we new RN's tend to jump the gun on many things for fear of not doing due diligence. The feedback you have all provided allows me to build my knowledge base to crticical think through these situations first. And now I know what "Occam's razor" means. ;-)
JDougRN, BSN, RN
181 Posts
The problem with the urine is probably caused by the patient moving, tugging on the tube, causing it to bump around in the bladder. Try to secure it to her leg. Also, if your patient is on blood thinners (coumadin, heparin, even asa or plavix) is enough to cause some bleeding in that situation. Peripheral IV sites are usually only good per policy for 3 or 4 days- after that it hightens your risk of infection.