A patient presents with signs of urinary retention, including suprapubic tenderness, increased post-void residual volume, and mild confusion. What is the nurse's priority intervention to address the patient's condition?

B) Insert an indwelling urinary catheter to relieve bladder distension.

A) Administer an anticholinergic medication to reduce bladder spasms.

B) Insert an indwelling urinary catheter to relieve bladder distension.

C) Encourage the patient to increase oral fluid intake to promote diuresis.

D) Reassess vital signs to monitor for changes in the patient's condition.

A nurse is caring for a patient with significant urinary retention and mild confusion. The patient's post-void residual volume is 450 mL, and there is a potential need for catheterization. The healthcare team is also considering adjusting the patient's medication regimen due to the anticholinergic effects of olanzapine. Which intervention should the nurse prioritize to address the immediate needs of the patient?

A) Advocate for immediate catheterization to relieve bladder overdistension.

B) Request a urine culture to assess for a possible urinary tract infection.

C) Consult with the prescribing psychiatrist about adjusting the olanzapine dosage.

D) Encourage increased fluid intake to promote natural diuresis.

A patient diagnosed with a urinary tract infection (UTI) secondary to urinary retention is experiencing mild confusion and suprapubic discomfort. Considering the lab results and current clinical presentation, which nursing intervention is the priority to address both the infection and the associated urinary retention?

C) Administer prescribed antibiotics and assess the need for catheterization to relieve bladder distension.

A) Encourage the patient to increase fluid intake to 3 liters per day.

B) Monitor the patient’s renal function and report any further elevation in creatinine levels.

C) Administer prescribed antibiotics and assess the need for catheterization to relieve bladder distension.

D) Educate the patient about the signs and symptoms of worsening confusion and encourage immediate reporting.

A patient with mild confusion and suprapubic discomfort has been diagnosed with a urinary tract infection due to Escherichia coli. The patient is receiving antibiotic therapy and is being monitored for urinary retention. Which nursing intervention is most appropriate to prioritize at this stage to prevent complications related to urinary retention and renal function?

D) Assess for signs of urinary output and bladder distension every 4 hours.

A) Encourage patient to increase fluid intake to at least 2 liters per day.

B) Monitor vital signs and provide antipyretics as needed for fever.

C) Educate the patient on the importance of completing the full course of antibiotics.

D) Assess for signs of urinary output and bladder distension every 4 hours.

A patient who has been receiving treatment for a urinary tract infection is now experiencing intermittent urinary urgency and hesitancy. A bladder scan reveals a post-void residual volume of 250 mL. The healthcare team has decided to implement intermittent catheterization. What is the primary nursing consideration when performing intermittent catheterization for this patient?

B) Maintain strict aseptic technique to reduce the risk of introducing infection.

A) Ensure the catheter is inserted to the bifurcation to prevent injury.

B) Maintain strict aseptic technique to reduce the risk of introducing infection.

C) Use a larger catheter size to ensure complete bladder drainage.

D) Encourage the patient to limit fluid intake to reduce urine volume.

A patient recovering from a urinary tract infection exhibits intermittent episodes of urinary urgency and hesitancy despite initial improvement. The healthcare team identifies a post-void residual volume of 250 mL and initiates intermittent catheterization. What is the most appropriate nursing intervention to address the patient's ongoing urinary retention?

C) Schedule regular voiding times to train the bladder.

A) Increase fluid intake to promote diuresis and bladder emptying.

B) Educate the patient on Kegel exercises to strengthen pelvic floor muscles.

C) Schedule regular voiding times to train the bladder.

D) Encourage the patient to limit caffeine intake to reduce bladder irritation.

A patient with a history of antipsychotic use presents with increasing fatigue, mild headache, elevated blood pressure, decreased urine output, and rising creatinine levels. Which intervention should the nurse prioritize to address the suspected prerenal acute kidney injury?

B) Increase the patient's fluid intake.

A) Administer antihypertensive medication.

B) Increase the patient's fluid intake.

C) Adjust the patient's antipsychotic medication dosage.

D) Prepare the patient for dialysis.

A patient with suspected acute kidney injury presents with increased fatigue, mild headache, elevated blood pressure, and decreased urine output. Which of the following nursing interventions should be prioritized to address the prerenal cause of the patient's condition?

B) Increase oral fluid intake to address potential volume depletion

A) Administer antihypertensive medication to lower blood pressure

B) Increase oral fluid intake to address potential volume depletion

C) Restrict fluid intake to prevent further fluid overload

D) Initiate dialysis to manage elevated creatinine and BUN levels

A patient recovering from acute kidney injury shows gradual improvement but now presents with mild confusion and a persistent headache. Which intervention should the nurse prioritize to address the patient's new symptoms?

C) Adjust fluid intake to correct mild hyponatremia.

A) Increase oral fluid intake to improve hydration.

B) Administer prescribed antihypertensive medication to lower blood pressure.

C) Adjust fluid intake to correct mild hyponatremia.

D) Evaluate the need for continuing antipsychotic medication.

A patient with a history of psychiatric disorder is showing signs of mild confusion and a persistent headache, along with a recent lab result indicating hyponatremia (serum sodium level of 132 mEq/L). Which of the following nursing interventions would be most appropriate to address the patient's current condition?

B) Restrict the patient's fluid intake to help increase serum sodium levels.

A) Increase the patient's oral fluid intake to promote sodium excretion.

B) Restrict the patient's fluid intake to help increase serum sodium levels.

C) Administer a hypertonic saline solution to rapidly correct the sodium level.

D) Encourage the patient to eat high-sodium snacks to quickly raise sodium levels.

urinary retention related to antipsychotics - Nursing Case Study

Pathophysiology

• Primary mechanism: Antipsychotics often possess anticholinergic properties, which inhibit the action of acetylcholine on muscarinic receptors in the bladder, leading to detrusor muscle relaxation and impaired bladder contraction, resulting in urinary retention.

• Secondary mechanism: Some antipsychotics may also antagonize alpha-adrenergic receptors, particularly in the bladder neck and urethra, causing increased smooth muscle tone and further obstruction of urine flow.

• Key complication: Persistent urinary retention can lead to bladder overdistension, increasing the risk of urinary tract infections, kidney damage, and potentially requiring catheterization for relief.

Patient Profile

Demographics:

45-year-old male, software engineer

History:

• Key past medical history: Schizophrenia, hypertension

• Current medications: Olanzapine, Lisinopril

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Difficulty urinating and lower abdominal discomfort

• Key symptoms: Incomplete bladder emptying, increased urinary frequency, mild confusion

• Vital signs: Blood pressure 150/95 mmHg, heart rate 95 bpm, temperature 98.6°F, respiratory rate 18 breaths per minute

Section 1

Initial Assessment Findings:

Upon further assessment, the nurse notes that the patient exhibits signs of mild suprapubic tenderness upon palpation, indicating possible bladder overdistension. The patient reports feeling the urge to urinate frequently but is unable to produce more than a small amount of urine each time, suggesting incomplete bladder emptying. A bladder scan is performed, revealing a post-void residual volume of 450 mL, confirming significant urinary retention. The patient's mild confusion persists, which may be attributed to discomfort or early signs of a urinary tract infection.

Vital signs are reassessed: the patient's blood pressure remains elevated at 155/98 mmHg, heart rate has increased to 100 bpm, and respiratory rate is steady at 18 breaths per minute, with no change in temperature. Given these findings, the healthcare team considers the potential need for catheterization to relieve the bladder and prevent further complications. The patient's mental status and potential risk for a urinary tract infection are also monitored closely, emphasizing the need for a urine culture to rule out infection as a contributing factor to his confusion.

These assessment findings create a clinical scenario where the nurse must prioritize interventions that address the urinary retention while considering the patient's ongoing risk for infection and renal complications. The team plans to discuss medication adjustments with the prescribing psychiatrist to mitigate the anticholinergic effects of olanzapine, balancing the management of his psychiatric condition with the need to resolve urinary complications. This approach will guide the next steps in the patient's care, focusing on alleviating symptoms and preventing further deterioration.

Section 2

New Diagnostic Results:

As the team proceeds with the care plan, a urine culture is obtained to identify any potential pathogens contributing to the patient's confusion and urinary symptoms. The results come back positive for Escherichia coli, suggesting a urinary tract infection (UTI) secondary to the urinary retention. This finding aligns with the mild confusion and suprapubic discomfort previously observed, reinforcing the need for prompt intervention to address both the infection and underlying urinary retention. The lab results show elevated white blood cell count at 13,000/µL, supporting the diagnosis of an infection. Additionally, the patient’s creatinine level is slightly elevated at 1.4 mg/dL, indicating the need for careful monitoring of renal function.

In response to these new diagnostic findings, the healthcare team initiates a targeted antibiotic therapy to combat the UTI, while continuing to evaluate the need for catheterization to relieve the bladder distension. The prescribing psychiatrist is consulted to discuss possible adjustments to the patient’s antipsychotic regimen, with consideration given to switching to a medication with a lower anticholinergic burden or modifying the dosing schedule. The patient is educated about the importance of maintaining adequate hydration and promptly reporting any changes in symptoms, such as increased confusion or discomfort, which could signal further complications. With these interventions, the team aims to manage the infection effectively while mitigating the risks associated with prolonged urinary retention, setting the stage for possible improvement in the patient’s clinical status.

Section 3

Response to Interventions:

Following the initiation of targeted antibiotic therapy, the patient shows initial signs of improvement. Within 48 hours, the patient's temperature stabilizes at 98.6°F, and their white blood cell count decreases to 10,500/µL, indicating a positive response to the treatment of the urinary tract infection. The suprapubic discomfort begins to subside, and the patient is more alert, with a noticeable reduction in confusion. Despite these improvements, the patient continues to experience intermittent episodes of urinary urgency and hesitancy, suggesting that the underlying urinary retention remains a significant issue.

The healthcare team decides to implement a bladder scan to assess post-void residual volume, revealing 250 mL of urine remaining after voiding, indicating incomplete bladder emptying. Given the ongoing urinary retention, the decision is made to proceed with intermittent catheterization to relieve the bladder and prevent further complications. This intervention is carefully monitored, and the team educates the patient about recognizing symptoms of urinary retention and the importance of maintaining regular voiding schedules.

Simultaneously, the patient's psychiatric medication regimen is adjusted under the guidance of the psychiatrist. The antipsychotic is switched to a medication with a lower anticholinergic profile, aiming to reduce the adverse effects contributing to urinary retention. With these targeted interventions, the team is cautiously optimistic about the patient's trajectory towards recovery, while remaining vigilant for any signs of new complications, such as acute kidney injury, given the elevated creatinine levels. The patient is scheduled for follow-up renal function tests to ensure that kidney health is maintained as the treatment plan progresses.

Section 4

New Complications:

Despite the initial positive response to interventions, the patient starts experiencing new symptoms indicative of emerging complications. Over the next 24 hours, the patient reports increasing fatigue and a mild headache. On examination, the patient's blood pressure is noted to be 146/92 mmHg, which is elevated compared to previous readings. Additionally, there's a noticeable decrease in urine output, with amounts dropping to less than 400 mL in 24 hours, raising concerns about potential acute kidney injury. Laboratory tests are promptly ordered, revealing a creatinine level that has increased to 1.8 mg/dL from the previous 1.4 mg/dL, as well as elevated blood urea nitrogen (BUN) levels at 28 mg/dL.

These findings suggest a possible prerenal cause due to volume depletion, secondary to decreased fluid intake and urinary retention. The healthcare team acts quickly to address these issues, increasing the patient's fluid intake through careful oral hydration and continuing intermittent catheterization to ensure complete bladder emptying. A nephrology consult is requested to further evaluate and manage the potential renal complications. The team also re-evaluates the patient's antipsychotic medication plan, considering the necessity of further adjustments to minimize additional strain on renal function.

As the team monitors the patient's progress, they remain vigilant for any further decline in renal function or worsening of symptoms. Education is provided to the patient and family regarding the importance of adequate hydration and the recognition of symptoms that could indicate worsening kidney function. This phase of the patient's journey underscores the importance of comprehensive care and the need for continual reassessment to prevent and manage complications effectively.

Section 5

Over the next 48 hours, the patient's condition shows signs of gradual improvement, indicating a positive response to the adjustments in care. The increased oral hydration and continued intermittent catheterization have started to yield results, with urine output incrementally rising to 600 mL in 24 hours, suggesting partial resolution of the urinary retention and prerenal causes. The patient's creatinine level stabilizes, slightly decreasing to 1.6 mg/dL, and blood urea nitrogen (BUN) decreases to 24 mg/dL, indicating an improvement in kidney function. However, the patient's blood pressure remains slightly elevated at 142/90 mmHg, necessitating ongoing monitoring and possibly further intervention.

Despite these improvements, the patient begins to exhibit new symptoms, including mild confusion and a persistent headache, which raise concerns about additional complications. These neurological symptoms prompt the healthcare team to consider the possibility of antipsychotic-related side effects or other underlying causes such as electrolyte imbalances. A comprehensive metabolic panel is ordered, revealing a mild hyponatremia with a serum sodium level of 132 mEq/L, which could potentially explain the neurological manifestations. The team decides to cautiously adjust the patient's fluid intake to correct the electrolyte imbalance while continuing to monitor mental status closely.

In response to these developments, the interdisciplinary team, including nephrology and psychiatry, collaborates to reassess the patient's medication regimen. This includes evaluating the necessity and dosage of the current antipsychotic medication, balancing mental health stabilization with the minimization of adverse effects. Patient and family education is reinforced, emphasizing the signs of electrolyte imbalance and the importance of adherence to the revised care plan. This phase highlights the dynamic nature of patient care, where continuous evaluation and adaptation of treatment strategies are essential to address new complications effectively and promote overall recovery.