Urinary Retention.pptx

Urinary Retention Dr. Sibi Peter, PhD,RN,CCRN Urinary Retention Inability to empty the bladder – Despite urination – Accumulation of urine in the bladder Acute urinary retention – total inability to pass urine (medical emergency) Chronic urinary retention – Incomplete bladder em...

Urinary Retention Dr. Sibi Peter, PhD,RN,CCRN Urinary Retention Inability to empty the bladder – Despite urination – Accumulation of urine in the bladder Acute urinary retention – total inability to pass urine (medical emergency) Chronic urinary retention – Incomplete bladder emptying despite urination – Normal postvoid (PVR) 50-75mL Etiology & Pathophysiology Caused by – Bladder outlet obstruction Leads to urinary retention - blockage is sufficiently severe, bladder cant no longer evacuate its contents despite a detrusor contraction – Deficient detrusor (bladder muscle) contraction strength Leads to urinary retention – muscle is no longer able to contract with enough force or for a sufficient period of time to complete the empty of the bladder  Clinical Manifestations What to look for Absence of voided urine Restlessness & diaphoresis Lower abdominal pain Distended bladder above level of the symphysis pubis on palpation Anxiety Hypertension Collaborative Care Behavioral therapies Double voiding Catheterization (may be required)  Diagnostic History& Physical Assessment Bladder Log Urinalysis Urodynamic Ultrasound  Drug Therapy Drug that may be administer to promote bladder evacuation α-Adrenergic Antagonists – Reduce urethral sphincter resistance to urinary outflow doxazosin (Cardura) terazosin (Hytrin) tamsulosin (Flomax) alfuzosin (Uroxatral)  Contraindicated Drugs Drug Effect α-Adrenergic receptor urinary retention (males) agonists: Anticholinergics Urinary retention, overflow Tricyclic antidepressants incontinence, fecal impaction β-Adrenergic receptor Urinary retention antagonists Calcium channel blockers Urinary retention & fecal impaction Opioids Urinary retention & fecal impaction  Surgical Therapy Transurethral or open surgical techniques – Benign or malignant prostatic enlargement – Bladder neck contracture – Urethral strictures – Dyssynergia of the bladder Abdominal or transvaginal approach – Pelvic reconstruction  Surgical Therapy Bladder stimulator – Device use to stimulate micturition – https://www.youtube.com/watch?v=WMIUrHFr_jA Acute Intervention Medical emergency -prompt recognition and bladder drainage Insert a catheter (as ordered) unless otherwise directed Teach patient to avoid intake of large volumes of fluid over a brief period. Instruct the patient (if chilled) to warm up before attempting to urinate Avoid excessive alcohol intake. Advise the patient who is unable to urinate to drink a cup of coffee or brewed caffeinated tea to create or maximize urinary urgency. Tell patients that sitting in a tub of warm water or taking a warm shower may also help them urinate. If these measures do not lead to successful urination, advise the patient to seek immediate care. Chronic Intervention Managed by Behavioral methods – Correct position for voiding – Pelvic floor exercises Indwelling or intermittent catheterization Surgery Drugs Scheduled toileting – Voiding every 3 to 4 hours – Micturition stimulation Double voiding – Voiding twice before leaving the bathroom  NCLEX Questions The physician documented that the patient has urinary retention. How should the nurse explain this when the patient asks what is it? A. Inability to void B. No urine formation of urination C. Large amount of urine output D. Increased incidence  NCLEX Questions Nursing care for a "PT" with an indwelling catheter includes which of the following A. Irrigation of the catheter with a 30mL of normal saline solution every 4hours B. Disconnecting and reconnecting the drainage system quickly to obtain a urine sample C. Encourage a generous fluid intake if not contraindicate by the "PT" conduction. D. Telling the "PT" that burning and irritation are normal, subsiding within a few days  NCLEX Questions After surgery, Ms. Young is having difficultly voiding. Which nursing action would most likely lead to an increased difficulty with voiding? A. Pouring warm water over Ms. Young's fingers B. Having Ms. Young ignore the urge to void until her bladder is full C. Using a warm bedpan when MS. Young feels the urge to void D. Stroking Ms. Young's leg or thigh