1. Based on your assessment, what do you think is happening? Explain your rationale. (4)
Mrs. Brady is experiencing urinary retention post Foley catheter removal. On catheter removal some patients experience difficulty in voiding and can develop acute urinary retention due to anastomotic edema or urethra edema. Urinary retention results in the inability to voluntary void as experienced by Mrs. Brady. Urinary retention can be obstructive, infectious and inflammatory, pharmacologic, or neurologic (Cialic et al.,2017). In this case, the patient urinary retention is due to postoperative complications which can be associated with her surgical operation of the left hip which involved her pelvic organs. Contributing factors to the current state of the patient include pain, the traumatic instrumentation process, bladder over distention as well as the use of pharmacological agents (Potter et al.,2018). The urinary retention condition is also indicated by the pelvic pain and abdominal discomfort experienced by the patient. On physical examination, the palpable bladder above the symphysis pubic on pelvic region the discomfort and the feeling of voiding and inability to do so voluntarily further indicate urinary retention after the removal of the Foley catheter.
2. Please discuss the risks of urinary catheterization in the hospital setting, specifically related to urinary tract infections. Please use current evidence-based research. (6)
Delegate your assignment to our experts and they will do the rest.
Urinary tract infections (UTIs) affects the urinary system namely the urethra bladder, ureters and kidney. In the hospital setting, UTIs are the most common health related infections associated with the use of catheters. Research indicates that 75% of UTIs are linked o the use of urinary catheters. Urinary catheters are inserted to the bladder through the urethra to drain urine with 25% of hospitalized patients requiring the use of urinary catheters during their hospitalization period (Potter et al.,2018). Urinary catherization presents significant risks in the development of catheter associated UTIS. The risks arise due to prolonged use of catheters (Kowalik, & Plante, 2016).
Catheter related urinary tract infections are caused by organisms developed on the urethral catheters into the bladder causing bacterial infections and irritations. A commonly used catheter is the indwelling urethral catheter which is essential for patient care in voiding management, selective surgical procedures and providing patient comfort in urinary incontinence. Research shows that the use of an indwelling catheter presents a predictable and unavoidable risk o UTI for an average of 5% of all patients using catheters (Cialic et al.,2017). Prolonged use of catheters prompts biofilm formation n the external and internal surfaces of the catheter and continued growth leads to UTIs.
3. Which type of urinary catheter insertion would you anticipate for this situation and why? (2)
I would recommend the use of clean intermittent catheterization CISC to facilitate bladder emptying. The CISC is a better choice in addressing urine retention in post-surgery situation. CISC is affordable as the catheters can be cleaned and reused and the process is easy for the patient to learn. The catheterization also prevents the threat of urinary infection that would cause the patient to sit the emergency room in excruciating pain. For proper monitoring, Mrs. Brady should be placed on a regimen of CISC for every four hours after voiding. The catheterization would then be systematically reduced as voluntary voids volumes increase (Potter et al.,2018). My preference for this type of urinary catheter is because it allows the patient to safely evacuate the bladder without taking concomitant antibiotics associated with an indwelling catheter (Kowalik, & Plante, 2016). CISC also prevents the formation of biofilm exposing the bladder to the presence of a foreign body leading to urinary tract infections. intermittent catheterization is also favorable with early return of normal voiding compared to the use of an indwelling catheter.
4. What is the most likely cause of post-operative urinary retention in Mrs. Brady? Provide rationale. (4)
The post-operative urinary retention in Mrs. Brady was most likely cause by the surgical procedures combined with age advancement. Multiple factors related to surgery such as the type of anesthesia used, type and duration of surgeries and the patient underlying comorbidities are a likely cause of the urinary retention (Potter et al.,2018). Research shows that the duration of urinary retention is prolonged in older patients (Mrs. Brady is 56 years) and is also common to patient who undergo intraoperative Foley catheterization as was the case with Mrs. Brady. Urinary retention is also considered as a common complication of neurosurgical surgical procedure thus the straining to void and sensations and urges to empty the bladder are symptoms of urinary retention (Cialic et al.,2017).
One week later, you are caring for Mrs. Brady again. Her orders read: Dressing change today and remove alternate staples.
5. Please describe six points that you would assess and document about Mrs. Brady’s dressing change/incision (6)
Uniform closure of the edges-I would visually assess the wound for uniform closure of the edges determine if the wound is sufficiently healed to have to allow staples removal. I would address any concerns that are present and seek advice from the appropriate department to eliminate any room for complication.
Absence of Drainage- drainage indicate incomplete healing and infections from microorganisms on the wound site or surrounding skin.
Redness and Inflammation - there is need to assess the area for redness indetermination of healing of the incision. The step includes cleaning of the incision site to loosen and remove any dried blood and evaluate the wound effectively.
Staple removal -I would examine the staples and determine their appropriateness of their removal starting with every second staple. The main goal of the assessment is to ensure that no staple is removed prematurely to avoid putting pressure on the wound or scratching of the skin. Alternate removal of staples offers strength to incision line while removing staples and prevents accidental separation of incision line .
6. After removing alternate staples, gaping of the incision is evident. What are your next steps? (list a minimum of 4 steps) (6)
After the removal of staples and the gaping of the incision is evident, I will cut steri-Strips allowing them to extend 1.5 to 2 cm on each side of incision. I would then remove sterile backing to apply Steri-Strips. Steri-Strips ae important as they support wound tension across wound and eradicate scarring. This allows wound to heal by primary intention. The application is also significance to eliminate the risk of infection (Potter et al.,2018). The final procedure will be the application of a dry, sterile dressing on incision site. On physician orders, I would alternatively the incision exposed to air if wound is not irritated by clothing. After the procedure I would position the patient by lowering the bed to a safe height to ensure that she is comfortable and free form pain. I would them offer a complete training on the steri strips regarding aspects pf bathing, wound inspection and different ways to enhance the healing of the wound.
7. Mrs. Brady asks you if there is anything, she could be doing to help her incision heal faster. Using current evidence-based literature, please provide at least three suggestions for Mrs. Brady. (6
For faster healing of the wound, it is important that the patient understands how to care for the wound and the necessary steps that would facilitate faster healing. To help the incision heal faster I would instruct Mrs. Brady to take showers instead of bathing for give enough time for the wound to heal. I would also instruct her to avoid pulling the steri-strips and instead allow them to heal and fall off naturally and gradually (Potter et al.,2018). I would also emphasize on the importance of avoiding straining especially during defecation. I would provide guidance on rest encouraging her to have adequate rest, have plenty of fluids, observe proper nutrition habits (Cialic et al.,2017). Another significant suggestion I would offer Mrs. Brady is ambulation in
order to stimulate circulation and prevention of blood clots which can result in strokes (Kowalik, & Plante, 2016). I would offer insights on the importance of walking such a promotion of blood flow and circulation through the body which aids in healing of wounds.
References
Cialic, R., Shvedov, V., & Lerman, Y. (2017). Risk factors for urinary retention following surgical repair of hip fracture in female patients. Geriatric orthopaedic surgery & rehabilitation , 8 (1), 39-43.
Kowalik, U., & Plante, M. K. (2016). Urinary retention in surgical patients. Surgical Clinics , 96 (3), 453-467.
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.
