Urinary Retention unexplained by Md.

[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.

[nyteshade, BSN]

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.

i would probably start with what's highlighted...it may explain why he is retaining.

i am assuming that the crd is chronic renal disease, as i have never seen this before. i've seen ckd (chronic kidney disease). i am also assuming ms is morphine sulfate, if i do abbreviate it would be mso4. please consider that ms could be misread as mag sulfate.

i would also be careful using doa, because where i come from doa is dead on arrival...

now i see why abbreviations are bad...

[Pquig]

Thank you for the reply. I had the tentatively put the morphine (MSo4) as the culprit in my care plan but I've never seen it act this way. I thought it would just create a little hesitancy. Yes DOA does seem like a bad choice of abbreviation for a brain sheet but it's one our instructor gave us.

[Nursey103, ADN, RN]

I've worked urology & I think most older men have some degree of an enlarged prostate.....put that with morphine & you have urinary retention.

[BluegrassRN]

It's the morphine.