Question

Case Study 3 Name Class Group Group Members INSTRUCTIONS: Al questions apply to this study Your responses should be brief and to the point. Adequate space has been provided for answers. When asked to provide several answers, they should be listed in order of priority or significance. Do not asume information that is not provided. Please print or write clearly. If your response is not legible, will be marked as ? and you will need to rewrite it. Scenario You are working in the ED when MB, a 72-year-old man, enters with a CIC (che complaint of inability to void. His til VS are 100/92, 70, 20, 982' F. 1. Are M.B.'S VS appropriate for a man his age? If not, what are the abnormalities Offer possibilities for the anomat While taking M.B.'s Hx, you discover he believes he is generally in good health and leads an active life. His current medications include finasteride (Proscan) mg daily and vitamin supplements. He reports that he has been unable to void for 12 hours and is very uncomfortable. He asks you to help 2. During your initiale C/C? ment, what physical emotional findings would you expect in regard to 3. What are your priorities for this patient? 4. Alior examining MB., the ED physician asks you to insert an Indwelling Foley catheter. What should you include in M.B.'s teaching before placing the Foley? 5. After 2 unsuccessful attempts to advance the catheter into the bladder, you stop. What is your next Intervention? Why? 6. The ED physician completes the catheterization and writes orders to discharge M.B. with Instructions to see his PCP the following day. It is your responsibility to give discharge instructions Outline your plan of care.

Answer 1

1. M.B is having Stage 2 hypertension as per the vital sign reading. As per his age the normal Blood pressure should be below 140/90.Whereas his reading was above 160/90.All other vital signs are under normal range. The main Causes for his increased blood pressure can be

a. As age increases the elasticity of the blood vessels decreases which causes the hardening of blood vessels which can be one cause of increased blood pressure in older age.

b. Since he has urine retention which can be related to any kind of kidney disease and Kidney disease is considered a major cause of high blood pressure.

c. He may have higher cholesterol level which is connected to higher blood pressure.

2. M.B will be having severe abdominal pain, Bladder distension and will be very much uncomfortable and may have aggression in behavior because of the discomfort caused by the urine retention.

3. The Main priority considering the patient’s condition is to empty the bladder which will relieve the M.B discomfort. Providing sitz bath or warm application to pelvic area can relax the pelvic muscles which can stimulate urination. If these measures are not inducing Mr. M.B to urinate then Catheterization is the recommended option.

4.

a. M.B should be explained about the procedure of Foleys insertion which may cause slight pain and irritation.

b. He should be informed about the necessity of catheterization and the complication of catheterization.

c. A Written consent should be taken from the M.B after explaining the procedure.

d. Explain about the catheter care.

5. If Unsuccessful for two times the procedure has to be immediately stopped and this should be informed to the doctor. More attempts may lead to internal injury of the urinary system as well as there is a high risk of infection due to removal and insertion of catheter again and again.

6. M.B should be advised on both catheter care as well as drainage system care. Some of the main instructions are as follows.

a. Advice the patient to clean his hand before touching the catheter insertion site to prevent infection.

b. Ask the patient to do self-catheter care (Clean the insertion area with soap and water)

c. Advise the patient to empty the urine bag every 3- 4 hours and request him to measure the urine output during emptying.

d. Advise him to take more fluids to promote urine output.

e. Explain about the discharge medicines.

f. Provide the emergency contact number of the hospital in case of any bleeding or fever, Hematuria, Nausea.

g. Inform the next follow up date and time.