Urinary Retention

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This assignment will focus on an account of patient care that I have provided to a patient who was unable to excrete urine during a long day shift in a secondary care setting. It will discuss regarding my contribution to a change in care while assessing the patient. The assessment will be evaluated to help analyse and synthesise information, make evidence- based decision and implement these decisions into clinical environment appropriately which is also known as clinical decision making according to Pritchard (2006). I will be using evidence based research and appropriate pathophysiology to understand why the patient had to be catheterized. Consent has been gained and a pseudonym is given to protect the patients’ identity as people have the right to confidentiality according to Nursing and Midwifery Council (NMC, 2008a). Therefore she will be addressed as Tania. Tania was a 68 years old lady who was admitted to Coronary Care Unit (CCU). During her stay a coronary angiography procedure was done on her. Coronary angiography is used to diagnose a number of heart conditions and to help guide treatment according to National Health Service (NHS) (2012). After this procedure, she had tried to pass urine several times using a bed pan. She was unable to do this even with a full bladder sensation. As her discomfort was rising, I and my mentor concluded that she was experiencing urinary retention. This is one of the most common complication post angiography according to Walters Huang et al. (2008) who did a group research on it. As Pellatt (2007a) describes that urinary retention is the sudden inability to excrete urine, the decision to catheterise her was made. One aspect of the urinary system is to get rid of waste products as a result of cellular metabolism. Hence it is referred as the excretory system according to Self (2006). The urinary elimination depends on effective functioning of kidneys, ureters, bladder and urethra (Kozier et al. 2008).Urine is produced by the two kidneys. The main component of urine are water, urea , uric acids, sodium, potassium , phosphates, sulphates and oxalates according to Lawson and Peate (2009).The two ureters transport urine from the kidneys to the urinary bladder. The urinary bladder is a temporary storage reservoir for urine. The bladder is able to distend and contract due to the detrusor muscle wall present in the bladder (Gosling, 2005). Stegall (2007) explains that as the bladder fills with urine at approximately 0.5 ml/kg/hour, the bladder wall stretches when a critical volume between approximately 200ml and 400ml in adults is reached. This triggers a nerve impulse to travel to the spinal cord and into the brain– pons and cerebrum – providing the signal that the bladder is getting full. In order to empty the bladder, the brain transmits a different nerve impulse which comes from the spinal cord to the bladder muscle (detrusor) and the internal and external urinary sphincters. At this point according to Stegall (2007), the detrusor contracts and the internal and external sphincters open. Marieb (2009) declares that this allows the urine to flow out of the bladder through the urethra. During this process Stegall (2007) argues that urinary retention can develop if there is obstruction to outflow or damage or interruption to neural pathways.

On Tania’s arrival to the ward from the cath laboratory, I offered her a cup of tea and a jug of water. She drank a glass of water and a cup of tea. I encouraged her to drink plenty of water as Shepherd (2011) suggests that she may have been dehydrated since prior to the procedure she was on Nil By Mouth (NBM).

During the procedure a long, flexible tube called a catheter was inserted into a blood vessel in her groin. Using X-ray images as a guide, the tip of the catheter was fed up to the heart and coronary arteries and a special dye called contrast medium was injected into the catheter (NHS 2012). According to the study done by Fikret et al....
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