Question

Case Scenarios 1 &2.

A.You are a nurse working with John, an 18-year-old boy who has been recovering for 1 week after a motor vehicle accident on the night of his senior prom. John has had an indwelling (Foley) catheter in place for 3 days, draining large amounts of urine. Yesterday, you noted that John’s urine was cloudy and he had a temperature of 37.8 °C. When you reported these fi ndings to the physician, he discontinued John’s catheter and ordered a urine sample for culture and sensitivity.

1. Identify risk factors that could alter John’s urinary function.

2. Analyzing the information provided, determine what alteration in urinary function the data suggest.

3. Construct appropriate patient teaching for when an indwelling catheter is removed. Plan how you will individualize this teaching for John.

B.You are working in a nursing home, caring for a 76-year-old woman with metastatic cancer. For the last few weeks, she has been receiving increasing doses of morphine to control her back pain. Her appetite is poor, and she spends most of the day in bed. At change of shift report, you learn that she has not had a bowel movement for 7 days and she has an order for an enema. When you go in to assess her and explain that she needs an enema, she replies, “Please leave me alone. Can’t you see how tired I am and how much I hurt?”

1. Examine factors that could contribute to the patient’s constipation.

2. Reflect on how you feel when you must ask patients questions about elimination or perform procedures such as enemas.

3. Appraise possible factors that may have influenced the woman’s refusal to have an enema.

4. Consider ethical and legal factors in determining how to respond to the patient.

5. Critique the use of therapeutic communication in responding to this patient.

Answer 1

A .

1 . Insertion of the Foley's catheter was the risk factor that altered John's urinary function. Unsterile insertion could have resulted in entry of microorganisms and lessened immunity after motor vehicle accident has resulted in urinary infection.

2 . Cloudy urine and the urine draining heavy amounts of urine determine alteration in the urinary system.

3 . When the catheter is removed, the patient is educated to drink water and void as soon as possible. In John's case , he has to be advised to drink lots of water so that the cloudy appearance of urine gets normalised and educate him to keep the area clean and dry.

B .

1. Use of morphine can lead to constipation in this scenario as it controls the involuntary action of digestion too.

2. I feel normal and not embarrassed as a nurse to ask questions regarding elimination or enema.

3 . Possible factors could be -- she must be feeling embarrassed or fear regarding the unknown procedure, fear of pain , or too tired with alot of procedures done on her.

4 . Respond to the patient as this procedure is needed and there is no need to be embarrassed as we as the nurses are not embarrassed and record if the patient still refuses enema.

5. This patient can be explained the importance of enema in her case and she will feel much better after the procedure. Tell her the medical assistant donor feel embarrassed as it is their work and to relax.

Thank you.