Urinary Retention - Cause/Effects?

[Mommy TeleRN, RN]

I had an elderly pt with history of alzheimers in clinical. She had come in for bowel obstruction apparently a complication of diverticulitis. She had been in for a few weeks and had progressively worse confusion, her speech has become slurred and incomprehensible, she isn't sleeping, they have her on many meds inc. ativan, haldol, xanax, also on Flagyl/Zosyn assuming for UTI. (Other meds were dextrose/sodium solution, K-Dur, and some I don't know about: Razadyne, maxzide, risperdal)

Anyway, they took out her foley and I think because of UTI (her urinalysis showed 2 WBC, pH of 5, Spec grav 1.008) This is the only reason I can think because she is restrained in bed for fall risk so can't get up to use the bathroom and she is incontinent.

When I came in at 8 she was wet with a moderate amount of urine, but she hadn't gone again by noon and her stomach was very firm and distended despite having a BM (and I saw NO urine with the BM) Placed a bedpan which she seemed to try to use but couldn't (she sorta shook her head..like I said almost impossible to understand her)

She had a CT which said "distended bladder, patulous bilateral renal collecting system, possible bladder outlet obstruction"

It would seem the answer is a foley, but they took out a foley! I have as a nursing dx "acute urinary retention" but can't seem to find a R/T that isn't 1) a medical dx ie UTI or 2) really an AEB ie. bladder distension.

Any ideas? I'm SO confused on this pt. The underlying problem really seems to be the medical issue of "patulous renal collecting system" but a nurse can't fix that. What can I do to help the urinary retention if I can't place a foley? Intermittent catheritization maybe? Encouraging urination by placing bedpan q 2 hrs and giving pt adequate time to use? Adjust pt to have a better position for voiding? Stimulate voiding by running water over perineum?

If we went to straight catheritization how often do you do it? We haven't had our GU lecture yet

So hard to put puzzle together when you don't have all the pieces!

Any advice VERY much appreciated? I just can't put my finger on the missing piece. I think the R/T would be blockage but it's unclear what is blocking. I guess it could simply be R/T removal of foley 2nd to possible infection

[CoffeeRTC, BSN, RN]

Lots going on with this pt. Why the foley in the first place?

Sometimes after a cath is removed they will retain urine. Depending on how much their imput is I wouldn't wait long to take action. Some docs with write to st cath after 6-8 hrs. What was she like before she came to the hospital? Some confused pts won't go in a bed pan at all. (Heck, I won't either) If you can try sitting her on a toilet, that can help. I wouldn't run water on her perineum..esp if she is confused. If it is a try obstruction, then a cath may be necessary.

As far as the increase confusion and decline..it happens so quick when the elderly are admitted to the hosp, esp those with progressing alz. The slightest infection also makes it worse.

[Dorito, ASN, RN]

Not sure if some of the meds are new but some of the retention could be caused from medications. Look up all the meds she's on to determine. I agree with Michelle126- I would definately get her out of the bed and up to the commode if able. Also, with her history, she may have been pulling on the catheter and has caused some edema- she very well may have to be cathed or straight cathed. You don't want the retention to go too many hours.....

[Mommy TeleRN, RN]

Thanks for the help. I chose "Acute urinary retention r/t blockage 2nd to foley catheter removal AEB bladder distension, pt inability to void.

I put outcomes as "pt will void sufficient amt every 4 hrs" and that nurse will facilitate voiding by providing pt comfort and privacy and if pt able to assist to bedside commode, nurse will monitor i/o to determine adequate volume

Pt will have no palpable bladder distension within 72 hrs, Nurse will establish regular voiding schedule q 4 hrs (is that often enough? I couldn't find since we haven't had this yet) if pt is unable to void nurse will straight cath as ordered by dr. Nurse will observe signs of infection and send urine to lab q day.

Some other details but that is the basic gist. I dunno if I got the formats right or not...we'll see..I'm not very good at this yet!

Interesting about the edema, that could very well be. She had been in the hospital 2 weeks, unsure if she is still there. My guess is had foley most of the time d/t incontinence/confusion, etc. The week prior another student had her and she was having frequent diarrhea and was unaware of it even thought she was much more cognitive that week and coherent.

This pt has really deteriorated and at first I feel irritated because of all the meds and stuff but after giving it more thought I feel that she could just be deteriorating d/t her age and condition.

[JentheRN05, RN]

Straight cath q2-3 hours check residual with bladder scan. Can be caused by blockage, often leads to infection can (if as high as the kidney blockage) lead to electrolyte imbalances.

Just a few things I can think of on a little sleep