Honey Bee

Why would a catheter not be appropriate? How would a condom catheter be better and why? from what I have read and been taught when a patient has urinary retention in a post-stroke patient and indwelling catheter is always used. the Urology team requested this and did. Maybe the catheter was not inserted adhering to sterile technique nor a guided-wire insertion used that would have allowed fro less trauma being able to see where the catheter was being guided. the patient sustained harm as he pulled the catheter out and caused himself urethral trauma. Also I note the RN's did not seek a medical order to hang fluids for dehydration instead encouraged and set the patient up with water jug and class in reach. Given that the patient had a previous ischaemic stroke, I would have been worrried about relying on patient to consume adequate hydration orally only. Surely the protocols are to start IV fluid resus. I wonder which fluid they would have hung if they thought this. It seems someone does not understand patient past and present medical histories. Glucose surely would have a been thought don't you think? Scarey what you see some RN's do at times. What is your thoughts now?

Where is the Au nursing you moved this thread to?

No.... I am not a student. A new grad left to their own practice more likely where some nurses still just do things without a good rationale for it. there is little time during work hours to search databases so do this research at home on days off.

On arrival to a ward in hospital this 87 year old gentleman with acute urinary retention (AUR) had an indwelling catheter inserted by the Urology doctors. the patient was uncomfortable and aggressive and yelling out "I can't take the pain anymore, I'm so sore and I need to wee". His vital signs were RR 32 p/min, O2 sats 93% on RA, BO 112/60, Temp 37 and afebrile and HR 108 strong and regular. pain was 7-8/10. Patient observed to be in rigors. On examination indwelling catheter (IDC) patent and draining 150mls, urine concentrated with visible haematuria and blood clots. Glans tip of member red and excoriated with discharge. Groin area appears red with signs of beginning excoriation. patient pad wet with urine a diameter of approximately 10cm. patient faeces incontinent. patient dehydrated and not wanting to take fluids saying, I am not drinking because then I have to wee and that hurts. patient past medical history significant for previous TURP, mild cognitive impairment increasing memory loss, depression, episodes of dysarthria and left arm weakness. can anyone please determine what the patients eGFR would have been as this piece of data has been left out of the picture? Are there any such Australian guidelines for managing an excoriated Glans tip of member and the skin breakdown for a male in this situation? At this age it is very distressing to see this.

eGFR What would an eGFR be on an 87 year old male who presents with Acute Urinary Retention (AUR) and has a history of stroke, previous TURP, acut on chronic confusion and episodes of dysarthria. Patient is in hospital and Urology Team have inserted a Foley catheter. Respiratory rate is 32 bpm, Sats 93% on RA, BP Manual 112/60 and HR 109 per minute. patient is shivering although afebrile. Pain score of 7-8/10 in severity. has an excoriated Glans tip of member and appears shiny red with visible discharge from orifice. Surrounding skin of groin i sintact but appears red with signs of beginning excoriation. Patinet wears a pad and is wet with urine and is faecal incontinent. Patient pulled catheter out leaving a urethra tear and is tugging on it again not drinking fluids saying it will make him wee and it is too painful. Blood stained and clot formation visible in IDC patent and draining. What would this patient eGFR look like does anyone know?

According to current ACC/AHA guidelines, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2814220/

Female patient presented with chest and a history of unstable angina for 2 years with GORD, dyslipidaemia, obesity and a previous smoker quit 12 months ago after a 12 year history. EF = 62%. Day 5 on ward and trying to mobilise and has dizziness, light-headedness, visibly pale, warm and clammy to touch and had been started on dopamine. Also has oxycodone 5mg and 1gram paracetamol for pain 4/24. Been told for this study to focus on hypotension related to fluid volume deficit third spacing shift as patient had low cardiac output and severe acute pain. Can these answered not in public forum? Can this case be removed from public domain?

I just want to say first, thank you for not stooping to his unprofessional level. I don't know about you but in my training we were constantly made aware of our professional ethics and the code on conduct not to mention so many other pieces of legislation we would be breaking by speaking like that. Every hospital in Brisbane, Australia these days hays posters and signs warning everybody not only patients, but staff also with "violence is not tolerated" and should this happen here we have a duty to report such behaviour. By not reporting this doctor his behaviour becomes accepted and that is not acceptable by any means. Please report this doctor. I just wonder how and what he says in patient communication hearing this because it sounds like when things don't go his way his/her way he/she throws a tantrum like a child. Help us ask for for protect professionalism by reporting this.

Ok! so how does post operative fluid deficit occur in relation to myocardial stunning and the patient back on the ward is found hypotensive with low cardiac output and receiving Endone 10mg with 1 gram Paracetamol every 6 hours? this is off why fentanyl and morphine are not given.

The phenomenon of myocardial stunning according to literature, is due to total coronary artery occlusion lasting anywhere from fifteen minutes or briefer (during a period that is not associated with cell death), an abnormality in regional left ventricular wall motion following reperfusion and that persists for hours or days after reperfusion. this is an assignment of interest. the cardiac system has the potential to affect many body systems such as renal and urinary systems. the patient had persistantly low cardiac output.

Hi Nurse zine can someone give me an answer to this reflective question please? Can you remember as a new graduate your pathophysiology with regards to third spacing fluid deficit? What do you think your answer might be as you learned more about it? What is the importance of fluid volume deficit, the associated risks and complications resulting post-op after cardiac surgery that carry a life threatening risk in somepne hypotensive, dehydrated, advanced age 69 and low cardiac output and myocardial stunning

Hi Miss Mollie here is a vague instruction for an assignment. In a discussion with some colleagues the comment is made that 'it doesn't really matter whether patients are experiencing nociceptive or neuropathic pain ‐ it's all pain anyway?' Outline your response to this comment including arguments for your key points which are supported by evidence from the literature.

In a discussion with some students recently a comment was made such as "it doesn't really matter whether patients are experiencing nociceptive or neuropathic pain - it's all pain anyway". How can I outline a written response and coment on this including arguments for kep points that can be supported by the best available evidence from literature. How would I respond to this argument? They are both two very different pain types. Obviously age, psychosocial elements affect pain levels.

It is obvious the amount of pain Mr Bee is in and the scenario is not saying that the man is using opioids for the wrong reason so you becoming crazy is not understood why this conclusion was made. I thought when anyone was prescribed these soughts of drugs, that the physician would have considered a bowel softener for constipation but often this is not done. So if a n SSRI such as amitriptyline was prescribed for Mr Bee how does wean him from his oral MS COntin and over what timeframe should this occur. Is this what is causing his pain and loss of sensation in the soles of his feet and in his joints? What are the priorities for a nurse in caring for Mr Bee? Firstly it is to review his medications and make adjustments to incorporate neuropathic medication. In educating Mr Bee about this how would a nurse go about this? Exactly what should be included in this education and how?

Patient Mr Bee is in his late sixties and admitted to hospital for a femoro-popliteal graft to this (L) leg. The surgery went well with no compications. Mr Bee has a PCA Morphine and also takes his regular medication of MS Contin for pain mamgement. (Check his Pain History Notes) below. Day 1 after surgery he is alert and oriented, with no nausea of vomiting or itching. He says his pain is 8/10 in both legs from the knee down. He also has pain 6/10 in his thigh wound. He said he did not sleep well. Day 2 he used 96mg Morphine Sulphate in the PCA. He is still alert and orientated with no morphine related side-effects. He now says he has pain in both legs and it is 8/10 and his thigh would pain is 4/10. He asks you to do something to relieve his pain. Patient Notes: Past medical history: Mr Bee has had a bilateral total knee replacement 5 years ago. He also has type 2 diabetes treated with metformin. He has used MS Contin for past 6 months for pain in both legs from the knees down. However his dose escalates from 30mg to 100mg BD in this time. He says it is not making any difference and it always burns from my knees down. He now reports pain in his joints whic is worse at night but improves with mobilisation and heat. Physical Nursing Assessment reveals: hig legs are skinny from the knee down with lots of visible varicose veins he has no ulcers observable his feet are visibley well cared for he states he has decreased sensation on the soles and toes of both feet. Nursing pain History : Mr Bee has used MS Contin for 6 months. Dose has escalated from 30mg to 100mg BD during this time. He says it is not making any difference as it always burns from the knee down. He reports pain in his joints that are worse at night but it improves with mobiliesatiopn and heat. What is wrong with Mr Bee and what are the nurses priorities? In what order would the priorities be carried out? Is this diabetic neuropathy and hyperanalgesia? Is he addicted to Morphine so much now that it has no effect? Please help. Honey Bee