Urinary Elimination Nurse Assignment Help: How to Answer This Question

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Urinary Elimination The nurse is caring for an 82-year-old male who has been hospitalized after a fall. Medical/Surgical history: History of Parkinson’s disease x 10 years, hypertension x 20 years, coronary artery disease, heart failure, benign prostatic hypertrophy. Fell 1 day ago sustaining a right femoral fracture. Social history: Smoked 2-3 packs of cigarettes per week, quit 10 years ago. Denies use of alcohol or illicit drugs. Lives alone. Family history: Mother died of a heart attack at age 83 years. Father died from complications of Parkinson’s disease at age 86 years. No living siblings. Widowed, 2 adult children, both healthy. Physical Assessment: Underweight male with BMI 18. Frail in appearance. Alert and oriented x 2, confused to time. Moves upper extremities and left leg, grips and pushes weak. Fine tremors of the hands. Right leg immobilized in 5 pounds of skin traction, strong dorsalis pedis and posterior tibialis pulses bilaterally, capillary refill less than 3 seconds. S1S2 heart sounds, fine crackles in the bilateral bases, moist cough. Abdomen flat, hypoactive bowel sounds. Last bowel movement yesterday. Bladder moderately distended to palpation. Voids “urgently” 30 mL every hour via the urinal, urine amber in color, and cloudy with foul smell. Some dribbling. Medications: lisinopril 10 mg daily by mouth, atorvastatin 40 mg daily by mouth, baby aspirin daily by mouth, carbidopa-levodopa 25-250 mg every 4 hours by mouth, amantadine 100 mg twice a day by mouth, acetaminophen and codeine 1 tablet every 6 hours PRN for pain. Nurses’ Notes Vital Signs Laboratory Results NURSES NOTES 12/3/XX 0830 Morning assessment obtained. Client states, “I feel like my bladder is full, yet I don’t make much urine each time I use the urinal.” 0845 Bladder scan performed with 600 mL of residual urine in the bladder. Review of the client’s history, assessment, and lab reports cause concern. Provider notified of changes. 0905 Received an order for an indwelling catheter to be placed and urine analysis and C & S to be sent to the lab. Procedure explained to the client with stated understanding. 0920 Indwelling catheter placed by sterile technique; 550 mL cloudy urine drained. Catheter secured to the client’s leg. Urine sample sent to the lab. 12/4/XX 0915 Urine draining via indwelling catheter. No discomfort noted. Catheter care provided. VITAL SIGNS 12/3/XX 0830 Temp. 99.6°F (37.5°C) HR 98 bpm RR 20 breaths/min SpO2 95% on room air BP 147/92 mm Hg Pain 3 on 0-10 scale LAB RESULTS 12/3/XX 0630 Sodium: 145 mEq/L (135-145 mEq/L) Potassium: 3.3 mEq/L (3.5-5.0 mEq/L) Calcium: 8.5 mg/dL (8.4-10.2 mg/dL) Phosphorus: 3.0 mg/dL (2.5-4.5 mg/dL) Magnesium: 2.0 mg/dL (1.6-2.2 mg/dL) BUN: 25 mg/dL (8-21 mg/dL) Creatinine: 1.8 mg/dL (0.5-1.2 mg/dL) 1030 Urinalysis Color: Dark amber (pale yellow to deep amber) pH: 7.5 (5.0-9.0) Specific Gravity: 1.025 (1.002-1.030) Clarity: Cloudy (Translucent) Protein: 12 mg/dL (<20 mg/dL) Glucose: Negative (Negative) Ketones: Positive (Negative) Hemoglobin: Positive (Negative) Nitrite: Positive (Negative) Leukocyte esterase: Present (Negative) Question 1 of 6 What could be causing this client to have difficulty with emptying his bladder? Select all that apply. Enlarged prostate gland Parkinson's disease medications Pain medication Loss of privacy when urinating Excess fluid intake Bed rest Elevated creatinine level Elevated BUN Question 2 of 6 For each client finding, specify if the finding is consistent with a urinary tract infection (UTI), urinary retention, or urinary incontinence. Select all that apply in each row. Infection Retention Incontinence Distended bladder Urgency Frequency Cloudy urine Foul-smelling urine Low-grade fever Enlarged prostate Question 3 of 6 The nurse is explaining the indwelling catheter to the client. Complete the sentences. "The provider has requested that you have an indwelling catheter placed into your bladder to drain your urine. This catheter will - Be removed when your bladder is fully drained - remain in you bladder, continually draining your urine - be inserted through an incision above your symphysis pubis "This catheter has a higher rate of - catheter-associated urinary tract infection - Pain and discomfort - bleeding so it will remain in place no longer than absolutely necessary." Question 4 of 6 Drag the six steps of insertion of an indwelling catheter to the box on the right. Arrange in order of priority. Position the client, apply procedure gloves and cleanse the perineal area and penis. Organize the work area and open the kit. Place the sterile underpad and drape using the edges, don sterile gloves. Organize the sterile kit supplies, opening packages. Cleanse the urinary meatus with cleaning solution. Instill lubricant into the urethra and insert the catheter into the penis. Inflate the balloon, gently tug on the catheter, and place the drainage bag below the level of the bladder. Secure the catheter tubing to the side rail. Ask the client what size catheter he would prefer. Question 5 of 6 The nurse is reviewing the urinalysis report. Select to highlight the findings consistent with a urinary tract infection. 12/3/XX 1030 Color: Dark amber pH: 7.5 Specific Gravity: 1.025 Clarity: Cloudy Protein: 12 mg/dL Glucose: Negative Ketones: Positive Hemoglobin: Positive Nitrite: Positive Leukocyte esterase: Present Question 6 of 6 Drag the anticipated outcomes for the client with an indwelling catheter to the box on the right. Be sure to drag all that apply. Tubing secured to the client's thigh. Urine draining freely with the collection bag below the level of the bladder. Minimal skin irritation around the meatus. Urine output <50 mL/hr. Collection bag gently touching the floor. Afebrile

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