Question

Clyde of a Hunter, a 72- Long-term year-old African-American male, is a resident care facility. He has been unable to control the since experiencing a cerebrovascular accident (CVA) The nurse recognizes differing urinary bladder training program for Mr. Hunter patterns and initiates a program is unsuccessful. The nurse includes the diagnosis "Risk for impaired skin integrity" in the plan of care Skin care measures are implemented and a condom cat applied heter is Mr. Hunter is admitted to an acute care unit for surgery nurse indwelling too soon, causi documented. . The supervises a student, who selects equipment to insert an urinary catheter. The student inflates the balloon ng pain. The insertion and urine return are Hunter is confused and pulls on his Following catheter, causing hematuri the nurse obtains a prescription for supervi urinary output surgery, Mr. a. Blood clots obstruct urine flow, So irrigation. The nurse ses a student who irrigates the catheter and measures remains confused. The nurse identifies the need for Mr. Hunter wrist restraints restraints are applied. and monitors the client every 30 minutes while Three days later, the client's urine is cloudy. The nurse performs further assessment, notes the urinalysis results monitors additional lab work, and offers fluids. An antibiotic is prescribed and the nurse monitors the client's creatinine level.

Answer 1

1. Here the actual diagnosis of the patient has CVA results from the blood are not getting to the area of the brain and as well as he cannot be able to control his voiding and as well as after surgery in the confusion stage he tried to pull out the indwelling catheter results in the injury to the bladder neck that leads to the presence of blood in urine (hematuria) and blood clots results in obstruction of normal urine outflow leads to the irrigation of bladder(maybe in a unsterile way) results in the infection in the urinary tract leads to cloudiness of urine.

2. Confusion

Hematuria

Low urine output

cloudiness of the urine

Involved systems are cerebrovascular system and genitourinary system