jromeo93

Hi BrandonLPN, The output of 200cc is concerning because the resident typically has an output between 800-1200cc each shift. As for the patient voicing pain, he is nonverbal and a quadriplegic. He responds through eye blinking, and I can notice facial flushing during times of pain but it can be difficult to communicate and observe how much pain or distress the patient is in. Two fellow nurses voiced being upset and stating "you're over concerned, you're just new". I felt a PVR was justified with an indwelling catheter due to it being occluded with stones and when it was changed 1600cc of output was obtained. It concerned me because the resident went through an 8-hour shift without voiding, meaning the urine backing up in the renal system and becoming stagnant increasing the chances of UTI. I also felt it was necessary to place a PVR because we have many agency nurses and communication between shifts isn't always ideal, so adding the resident on alert with a TX, I was hoping everyone on the care team could be aware of the situation. I appreciate the feedback and insight!

Hi everyone! I sat for my NCLEX-PN in September, passed, and acquired a position at LTC with TBI/SCIs. I feel that I have been adapting well to my new role as a LPN. Previously, I was a CNA for 4 years. My pharmacology, time management, and prioritization have excelled over the past approx 5 months, though I am still struggling with necessary/unnecessary charting, if such a thing? Currently there is a resident with an indwelling catheter who has hard black stones/sand which occluded the catheter requiring it to be changed and the stones/sand is noticeable at the bottom of the collection bag. It is noted he had a 5mm non obstructing kidney stone 2 weeks ago. Due to increase of stones/sediment causing urinary retention and catheter changes, I placed him on 72 hr. alert with strict I&O with temp. and a PVR at the end of each shift to monitor for urinary retention, fever, or pain. I notified guardians and on-call doctor of situation. Resident is in no apparent distress or pain, though is nonverbal with TBI. Several nurses voiced that it was unnecessary to place him on alert and include additional treatments/monitoring each shift because guardians are aware and will schedule any needed appt. so there is no need to put him on alert. They also said kidney stones are "no big deal because he's passing them". This has been going on a week, maybe 2, and no one has charted in progress notes of any change in condition. They also are not doing the PVRs I added to treatment flowsheets. He is afebrile but output was 200mL in 8 hours, possible obstruction?? Can't these rough stones cause damage to urinary tract if it continues? I don't know if I did the right thing or if I'm just over concerned due to being a "newbie". What are others experiences/insights into kidney stones or hard/rough sediment in urine? Or LTC charting and monitoring? Thanks!

I just began working at a Rehab facility in Washington specializing with brain injury. The ratio of NAC/CNA is 1 to 14-18 residents. All of them are incontinent and highly dependent.