Urinary Retention R/T ?

[Pquig]

I had an 80 yo patient that was admitted for a COPD exacerbation who was also dehydrated. Urine specific gravity was 1.025. He was in a weakened state and remained so three day past DOA. He has a history of CRD, CHF, COPD, and was diagnosed with bacterial pneumonia as the cause of his recent problem with dyspnea and acute lt sided chest pain. He's been on IV NS for the past three days at 125/hr. He's been on 4mg MS PRN q 4 hrs for his pain which has pretty much been administered as if it was scheduled. On top of all this he has been retaining urine acutely. There were orders to bladder scan q 6 hrs and then to straight cath him if the scan revealed over 300 ml. His history of out put has been at or above the ol 30ml per hour. When I inserted the catheter I didn't feel any resistance as I rounded the bend of the prostate and there is no history of BPH. All nerve function as far as I could tell was unhindered. What the heck could be the cause of the urinary retention. He had 475ml the last time I drained it and he could barely feel that he was getting full prior to it.

[9livesRN, BSN, RN]

Hi there, i just can think of some pointers here:

1- you said PT has history of CRD right? and he is receiving 125ml/hour that seems like alot (then again, depending of which stage of CRD he is at)

you did not feel as if the prostate was blocking the urethra, so then the channel should be open right? You also did not feel bundles.

you said no BPH, what about DM, or pelvic trauma, or nerve,brain,spinal injury, or even a stroke?

another thing I could think of is bladder infection/inflammation!

now i had patients with 600 ml tghat could not even feel it either! one Urologist explained to me that some bladders will get flacid, with age, dm, infections, and the patient will not feel it!

was he wanting to go? did he feel any pressure?