Mr. Brady’s condition may most likely be as a result of the bag getting full leading to the bag’s valve being squeezed and shutting it or formation of a small clot that may be the cause of the obstruction. The bag gets full and to prevent this it is recommended that the drainage bag (s) is emptied before they get full to this level. The bag should be emptied especially before the patient departs from the surgical room or theatre (Potter et al., 2018). This should be followed by constant review of the patient as he/she recovers from the recovery room as this will ensure that the catheter bag is not left neglected to the extent that it overfills. Another cause of the condition may be a prostate’s chip may get stuck in the catheter’s eye.
In this case, involving Mr. Brandy, my priority action will be unblocking the catheter. This can be achieved by the use of a bladder syringe and applying it at the catheter’s end followed by a proper suck. This is more likely to initiate the flow. The flow may also be achieved by the use of various irrigants such as normal saline. About 20 ml of the irrigant is delivered or injected followed by a careful and smartly undertaken re-aspiration with the aim of clearing the catheter’s eye thus unblocking it (Potter et al., 2018). In the event that, none of these actions bring the intended results of unblocking the catheter, then the next resolve is to change the catheter or the tubing. There is no point of engaging in fruitless activity trying to have a blocked catheter syringed as this may even worsen the situation by causing bladder overdistension which increases the patient’s restlessness and distress.
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Why the Patient Has Continuous Bladder Irrigation, Specifically Related to His Surgery
Mr. Brandy, the patient in this case, has continuous bladder irrigation to ensure that retention of clot is prevented. It also aids in getting rid of bacteria, decomposed urine, excess mucus, pus, maintenance of urinary catheter’s potency, relieves pain and congestion due to inflammation, and promotion of the healing process. This is ensured by the use of a sterile fluid through the use of a three-way catheter (Potter et al., 2018). Generally, bladder irrigation is a major requirement for this particular patient as a result of the vascular nature of the prostate as well as the bladder itself. Bladder irrigation also helps in preventing the bladder and the prostate gland from bleeding during the postoperative time period. The bleeding may be as a result of the inability by the surgeon to attain haemostasis as it is difficult to visualize all the bleeding tiny blood vessels.
The steps I would take as an intervention for this patient related to your answer in question 1.
For Mr. Brandy’s case, various steps would be undertaken as an intervention. The first step is to try and unblock the catheter. This can be through syringing and applying an appropriate suck that will help in unblocking it. Where the process of unblocking the catheter is unsuccessful the catheter is changed. When the catheter has been unblocked or a new one has been introduced to replace the blocked one, urine which is less or more clear will come out at once. This may empty the bladder completely paving way for initiation of the irrigation once again. If the mass is a result of the formation of a full bladder clot, the patient will be rushed back to the theatre immediately (Guo et al., 2016). This would be much easier if the recovery room is located close enough to the operating theatre. The decision to have the patient returned to the theatre is arrived at after the nursing staff at the recovery room informs the surgical team who will check and assess the situation. At this point, medical staff finds it much better to make an error by being cautious than waste much time as the patient bleeds. In the operating room, the patient is re-anesthetized before the clot is evacuated. This involves the reposition, cleaning, and draping of the patient just like in transurethral resection. Once the catheter is removed, the resectoscope is passed once more. Here, the problem is resolved as the chip or clot emerges. Good nursing practice will require that the bladder is assessed and all clots that may be present are irrigated out. The activity of the prostate gland is checked to ensure that no anymore bleeding.
Three Potential Complications That Can Arise from Continuous Bladder Irrigation, Use Current Literature in Your Answers
There are several potential complications that can result from continuous bladder irrigation. Some of these complications are bladder injury, bladder rupture, and bacteriuria and urinary tract infection (Guo et al., 2016). Bladder injury may occur as a result of mechanical force when inserting the catheter tubing, the formation of the clot as well as the bacterial infection. When the catheter is blocked, the bladder may be overdistended and eventually rupture. The formation of clots increases the risk of bladder rupture too. The patients undergoing continuous bladder irrigation are more likely to suffer from urinary tract infection as well as bacteriuria which may become recurrent due to the continuous nature of the bladder irrigation.
How I would Provide Patient Education to Mr. Brady
Patient education is a crucial aspect of nursing as a practice. In this case Mr. Brandy will be told that it will be possible for him to pass urine following the removal of the catheter or even if he is discharged before the catheter is removed. He will be encouraged to exercise confidence as he manages the catheters at home because control of pain will be achieved by the use of oral analgesics (Guo et al., 2016). Other vital parameters such as blood pressure, pulse, and temperature should be within normal limits. He should be informed of activities that he should stay away from. This will include heavy lifting and strenuous activities such as sports, long walks, and sexual intercourse for up to 8 weeks or until he is healed. He will be recommended to avoid constipation through intake of fiber-rich diet, increased fluid intake, and avoiding codeine-based analgesic medication.
Concerns About In Assessment and What Action Will I Take
In my assessment am concerned about Mr. Brandy’s blood pressure which is lower than normal, his clammy and moist skin, the presence of the four clots in the drainage bag, and the red color of the drainage in the catheter. The low blood pressure may be an indication that the patient is dehydrated while the presence of the four clots in the drainage bag may be an indication that a clot has formed within the catheter hence blocking it. The red color of the drainage in the catheter is an indication that Mr. Brandy is bleeding internally. With this in mind, the appropriate action to undertake is to inform the surgeon in charge and return the patient to the theatre room so that the clot is removed or evacuated (Guo et al., 2016).
Which Lab Results Are Abnormal and Their Significance
In the provided laboratory results, the abnormality is observed in Red blood cell count, Hemoglobin level, and hematocrit. The red blood count is below the normal range. Normally, low red blow count is caused by anemia, hemolysis, and chronic kidney disease (erythropoietin deficiency) among other causes (Guo et al., 2016). However, in this case, this may have been caused by blood loss as a result of the procedure Mr. Brandy underwent. Just like red blood cell count, Mr. Brandy’s hemoglobin is lower than the reference range. This is an indication that the patient has lost a lot of blood. This also is the reason why the hematocrit is below the normal range.
Guo, R., Yu, W., Zhang, K., & Xu, B. (2016). Impact of changing trends in medical therapy on transurethral resection of the prostate: two decades of change in China. Urology, 92, 80-86.
Potter, P. A., Perry, A. G., Stockert, P., Hall, A., Astle, B. J., & Duggleby, W. (2018). Canadian Fundamentals of Nursing-E-Book. Elsevier Health Sciences.