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

1. Risk factors that alter urinary function

• the catheter may become cintamiconta upon insertion
• The drainage bag may not be emptied often enough
• Bacteria from a bowel movement may get on the catheter
• Urine in the catheter bag may flow backward into the bladder
• The catheter may not be regularly cleaned

2. The altered urinary function mentioned here is CATHETER ASSOCIATED UTI (CAUTI). CAUTI is one of the most common infections a person can contract in the hospital, according to American Association of Critical Care Nurses.

3. Teaching instructions for John after catheter removal

• increase or maintain fluid intake
• Void when able and within 6-8hrs after removal of the catheter
• Inform the healthcare provider when he has voided, and measure the amount, colour, and any Abnormal findings, ensure first void is measured
• Report any burning, pain, discomfort or small ount of urine volume
• Report any inability to void, bladder tenderness and distension
• Report any signs and symptoms of CAUTI.
• Encourage Vitamin C rich diet

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