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Urinary Retention

Urinary Retention. Definition Inability to empty the bladder completely during attempts to void Chronic retention leads to overflow incontinence Residual urine is the amount that remains in the bladder after voiding. Less than 60yrs of age bladder must be completely empty after voiding

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Urinary Retention

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  1. Urinary Retention

  2. Definition Inability to empty the bladder completely during attempts to void • Chronic retention leads to overflow incontinence • Residual urine is the amount that remains in the bladder after voiding. • Less than 60yrs of age bladder must be completely empty after voiding • Above 60 yrs of age 50 to 100 ml remains

  3. Aetiology • Urinary retention can occur postoperatively in any patient, particularly if the surgery affected the perineal or anal region and resulted in reflex spasm of the sphincters • General anaesthesia suppresses the urge to void • BHP • Diabetes mellitus • Urethral pathology : infection, tumour, calculus • Trauma : pelvic injuries, • Pregnancy • Neurologic disorders such as cerebrovascular accident, spinal cord injury • Drugs : atropine, dicyclomine, imipramine; ephedrine, pseudoephedrine, propranolol oestrogens.

  4. Clinical Features • Bladder fullness and sensation of incomplete emptying • Haematuria • Dysuria • Ultrasound assessment – reveals residual urine

  5. Complications • Infection • Calculi • Pyelonephritis • Sepsis • Backward pressure in the kidneys

  6. Nursing Management • Promoting normal urinary elimination • privacy • proper environment • position • bathroom • commode rather than bedpan • male patient made to stand beside bed

  7. sitz bath, warm compresses to perineum,showers, hot tea, turning on the water faucet stroking the abdomen or inner thighs, tapping above the pubic area and dipping the patient’s hand in warm water • After surgery the prescribed analgesic • Promoting urinary eliminationcatheterization • Urethral catheter or suprapubic catheter

  8. Nursing Management During Catheterization • Monitor color, odour and volume • Pressure at penoscrotal junction in male patients is avoided by proper anchoring • Traction on the bladder is avoided • Observe signs and symptoms of urinary tract infection • The area around the urethra is observed for drainage and excoriation • Do C&S

  9. Assessing for age related complications • Typical signs and symptoms of UTI may not be seen in the elderly • Any subtle change in physical condition or mental status  possible infection

  10. Preventing infection • Vigorous cleaning of the meatus discouraged since to and fro movts of the catheter ↑ infection • Catheter anchored to prevent to and fro movement • Liberal intake of fluids • Hand hygiene

  11. Minimizing Trauma • Catheter - Use appropriate size • Lubricate adequately – water soluble • Insert far enough to prevent injury to the urethral tissue when the balloon is inflated • Prevent movements of the catheter – in male patients the drainage tube not the catheter is taped laterally to the thigh to prevent pressure on the urethra at the penoscrotal junction • In female patients drainage tube is taped to the thigh to prevent tension and traction on the bladder

  12. Retraining the Bladder • To retrain the detrusor muscle • Timed voiding taught • Completion of drainage by straight catheterization

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