Question

Describe urinary retention, factors causing retention, complications of urinary retention, signs, and symptoms of urinary retention.

B. Give a nursing assessment and interventions of urinary retention with goals and outcomes of urinary retention.

Answer 1

Ans)1) Urinary retention:

- Symptoms:
Sudden onset: Inability to urinate, low abdominal pain
Long term: Frequent urination, loss of bladder control, urinary tract infection
Types: Acute, chronic
Causes:
- Blockage of the urethra, nerve problems, certain medications, weak bladder muscles

Diagnostic method:
Amount of urine in the bladder post urination

Treatment:
- Catheter, urethral dilation, urethral stents,

Surgery
Medication:
- Alpha blockers such as terazosin, 5α-reductase inhibitors such as finasteride.

2) The following are the common goals and expected outcomes for Urinary Retention:

- Patient empties bladder completely.
- Patient voids in sufficient quantity with no palpable bladder distension.
- Patient has urine volume greater than or equal to 300 mL with each voiding and residual volume less than 100 mL.

Nursing Assessment:
- Assessment is required to determine potential problems that may have lead to Urinary Retention as well as manage any difficulty that may appear during nursing care.

-

Ascertain quantity, frequency, and character of urine, such as color, odor, and specific gravity. Urinary retention, vaginal discharge, and presence of catheter predispose patient to infection, especially if patient has perineal sutures.

Review previous patterns of voiding. There is a wide range of “normal” voiding frequency. Acute urinary retention requires immediate medical intervention. With chronic urinary retention, one is able to urinate but may have trouble starting the stream or emptying the bladder completely.

Allow patient to keep a record of the amount and time of each voiding. Take down decreased urinary output. Determine specific gravity as ordered. Retention of urine increases pressure in the kidneys and ureters which may lead to renal insufficiency. Insufficiency of blood circulation to the kidney alters its capability to filter and concentrate substances.

Assess vital signs. Check for changes in mentation, hypertension, and peripheral or dependent edema. Weigh daily. Maintain precise I&O record. Kidney failure results in reduced fluid excretion and builds up of toxic wastes. It may lead to complete renal shutdown.

- Monitor time intervals between voiding and document the quantity voided. Keeping an hourly record for 48 hours can help in establishing a toileting program and gives a clear picture of the patient’s voiding pattern.

- Ask patient concerning stress incontinence when moving, sneezing, coughing, laughing, and lifting objects. High urethral pressure can inhibit voiding until abdominal pressure increases enough for urine to be involuntarily lost. Also, hinders bladder emptying.

- Palpate and percuss suprapubic area. Examine verbalization of discomfort, pain, fullness, and difficulty of voiding. A distended bladder could be felt by the patient in the suprapubic area. Perception of bladder fullness, bladder distention above symphysis pubis implies urinary retention.

- Monitor urinalysis, urine culture, and sensitivity. Urinary tract infection can cause retention.