Mrs. Brady is a 58 year old woman who is admitted to your unit post op from an ORIF (open reduction internal fixation) of the left hip. She is now three days post-op and has started physiotherapy. Her pain has been manageable since her surgery and she is keen to go home. Her Foley catheter was removed yesterday evening.
You arrive for your day shift and find Mrs. Brady in the bathroom. She tells you that she feels as though she needs to void, but that she has tried multiple times overnight and nothing has happened. She reports 6/10 pain to the pelvic region and appears to be in discomfort as she is unable to stay still and is diaphoretic.
You assist Mrs. Brady back to her bed and perform your head to toe assessment. Her vital signs are as follows: T- 36.8 C, P- 110 bpm and regular, BP 145/80, Sp02- 95% on room air and RR- 16 per minute, easy and regular. Her cardiovascular and neurological assessments show no abnormalities. She denies any gastrointestinal symptoms. On inspection you see a mass in the pelvic area, which is palpable. Mrs. Brady states it is painful on palpation and it makes her feel as though she needs to void again. You decide to ask the clinical instructor to assist you in bladder scanning the patient. The bladder scan shows 450 ml of urine in the bladder. Mrs. Brady tries once again to void and is unable to.
1. What would your priority action be?
2. Please discuss the risks of urinary catheterization in the hospital setting, specifically related to urinary tract infections. Please use current evidence-based research.
3. Which type of urinary catheter insertion would you anticipate for this situation and why?
4. Identify three potential causes for urinary retention in the post-op population and discuss whether these apply to Mrs. Brady.
5. Describe how you would provide patient education to Mrs. Brady. Include at least three teaching points with rationale.
Mrs. Brady has now had her urinary retention relieved and is reporting 5/10 pain to her surgical incision area of the hip after all of the moving back and forth to the bathroom. She has the following medications ordered on her MAR.
Acetaminophen 1000mg PO q6h PRN
Metoclopramide 10mg PO q8h PRN
Ketorolac 10 mg PO q8h PRN
Hydromorphone 1mg PO q4h PRN
6. Identify which of the above medications you would administer to Mrs. Brady for her pain.
7. Discuss why you chose the medication you did, the medication class and any side effects of the medication
8. Discuss if there are any follow up assessments that would be required based on your medication choice
9. Describe three alternate pain relieving interventions that the nurse could initiate without a physician’s order and rationale for their use
You remember that Mrs. Brady’s dressing is due to be changed today. The order in the chart reads:
Dressing change, q 3 days and PRN.
10. Please describe six points that you would assess and document about Mrs. Brady’s dressing change/incision
11. 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.
