Chronic Urinary Retention Management Case Report

Answer

Chronic Urinary Retention Management Case Report

Introduction

            Nurses remains the most crucial link between patients and their wellbeing. This paper presents a case study of an elderly man, Mr. Bentley, suspected to have a chronic urinary retention illness. It explains the risk factors and physiological effects associated with ageing that contribute to the process of chronic urinary retention and the most appropriate nursing assessment methods used to assess Mr. Bentley. It further describes the relevant nursing management strategies to be used on Mr. Bentley and the role of the members of the interdisciplinary team that needs to be involved in his care.

Aetiology of the Chronic urinary Retention Process

            Chronic urinary retention, an inability to completely empty the bladder of urine, has several causes and effects. The causes are categorized into obstructive, neurologic, inflammatory and other causes. Obstructive causes, such as benign prostatic hyperplasia (BPH) in men, organ prolapse in women and urethral strictures in both sexes, are conditions that clog the urinary tract. Neurologic causes, such as spinal cord injury, stroke, multiple sclerosis, and diabetes mellitus, involve the nervous system. Inflammatory causes, such as Guillain-Barre syndrome and herpes simplex virus, involve inflammation of concerned organs while other causes include Fowler’s syndrome (in women), trauma, postoperative complications, and psychogenic conditions (Mevcha, & Drake, 2010). The effects of the illness are urinary tract infections and acute urinary retention (complete inability to pass out urine despite the urge or effort to do so). Thus, Chronic urinary retention has several causes and effects. 

Benign Prostatic Hyperplasia (BPH) and longstanding Diabetes are risk factors and physiological effects associated with ageing that contribute to the chronic urinary retention process. Chronic urinary retention (CUR) develops gradually over years. All men experience BPH, a non-cancerous increase in size of the prostrate. However, for elderly men, BPH is characterized by excessive urethral stricture, which results in a weak urine stream and thus contributes to chronic urinary retention (Sung et al., 2015). Old age has a negative effect on urinary tract functions. Chronic diseases such as longstanding diabetes tend to exacerbate this effect (Hunter & Moore, 2020). Thus, Longstanding diabetes results in diabetic cystopathy which ultimately results in urinary retention (Serlin, Heidelbaugh and Stoffel, 2015). Hence, BPH and Diabetes are risk factors and physiological effects associated with ageing that contribute to the chronic urinary retention process.

Mr. Bentley possesses several conditions that can be linked to Chronic Urinary Retention (CRU). He reported having previous cases where he had a weak urine stream, an indication of the gradual development of chronic urinary retention. He also reported that recently, he had a weaker urine stream than usual, a symptom of BPH further confirming the possibility of chronic urine retention. Finally, he has a history of longstanding Type 1 Diabetes which is a known cause of urinary retention. Thus, Mr. Bentley likely has a chronic urinary retention illness.

Nursing assessment methods

            Problem-focused assessment is one nursing assessment method I would use to assess Mr. Bentley. Mr. Bentley already presents symptoms of a potential urine retention illness. He indicates that he has had a previous inability to open his bowels and urinate but recently it has advanced. Furthermore, he is affected by urinary retention risk factors which are longstanding diabetes and BPH in elderly men. Thus, a problem-focused assessment is necessary to ascertain that Mr. Bentley has chronic urinary retention and to manage any problems that may arise during treatment. During the assessment, I would review Mr. Bentley’s previous pattern of voiding to establish his normal frequency. I would also perform a physical assessment of the hypogastric region through palpation and percussion. Bladder distension and perception of bladder fullness point to urinary retention (Wayne, 2017). Through a laboratory test, I would monitor Mr. Bentley’s blood urea Nitrogen and creatinine to differentiate between renal failure and urinary retention. Finally, assuming incomplete emptying of the bladder, I would conduct a bladder scan to determine the post-void residual urine. Urine retention exposes a patient to urinary tract infection (Mody & Juthani-Mehta, 2014). Thus, this would help determine if a catheterization program would be necessary for Mr. Bentley. Hence, problem-focused assessment would be a useful assessment method to use on Mr. Bentley.

            A time-elapsed assessment would also be necessary for use on Mr. Bentley. This would help to determine whether he is recovering once treatment is initialized. This assessment would include a comparison between current patterns and pre-treatment patterns of voiding through the use of a bladder chart. Thus, a time-elapsed assessment would be useful in Mr. Bentley’s recovery.

Nursing management strategies

            Dietary and fluid management is a necessary management strategy for Mr. Bentley. Constipation results in urinary tract obstruction which contributes to chronic urinary retention (Iwata, Kunishi, & Yoshie, 2015). Mr. Bentley reports having difficulty in emptying his bowels which likely puts pressure on his bladder thus his inability to empty his bladder. Furthermore, Mr. Bentley reports not drinking much water which is another likely cause of constipation and consequent urinary retention. Thus, a fiber rich diet is useful in relieving Mr. Bentley of constipation and consequent urinary retention (Cirillo, & Capasso, 2015). Also, adequate fluid intake is a necessary management strategy. Therefore, a dietary and fluid management strategy is necessary for Mr. Bentley.

            Patient and family education is another relevant management strategy for Mr. Bentley. Like Mr. Bentley, most patients are unaware that they suffer from chronic urinary retention (Tidy, & Knott, 2018). Thus, educating him and his family on the causes, signs, symptoms, the disease process and treatment procedures promotes a more effective management. It will enable him and his family to seek medical attention early enough and thus improve his outcome. Moreover, it reduces the physical, psychological and social limitations associated with an unaware patient thus improving his safety. Therefore, patient and family education is a relevant management strategy for Mr. Bentley.

Interdisciplinary Management

            The urologist is the most important member of the interdisciplinary team that needs to be involved in the care of a chronic urinary retention patient. Several healthcare professionals are involved with such a patient. Different laboratory technicians perform urinalysis to check for infection in urine, a bladder scan to determine post-void residual urine and a CT scan to check for blockages to urine flow. Nurses, in cooperation with the doctor, play a key role in sustaining the functions of the patients including the excretion, preventing further urinary retention development, early realization and managing the urinary retention by using appropriate nursing attempts (Simsek, & Sureyya, 2016). Nurses also educate patients on how to conduct themselves including the use of a catheter for those requiring home catherization. However, the urologist plays the most important role as he determines the extent of the disease and the appropriate treatment strategy for the quick recovery of the patient. The urologist suggests the relevant medication, devices to be used, procedures to be followed and conducts surgery if necessary. Hence, the urologist is the most important member of the interdisciplinary team. 

Conclusion

In conclusion, chronic urinary retention has several causes and effects. Benign Prostatic Hyperplasia (BPH) and longstanding Diabetes serve as ageing risk factors and physiological effects that contribute to the disease process. The case in question possesses several similarities to the clinical symptoms and thus Mr. Bentley likely has chronic urinary retention. Problem-focused and timely elapsed assessment methods are appropriate for Mr. Bentley as he already shows some symptoms of chronic urinary retention. Dietary and fluid management and the education of Mr. Bentley and his family are relevant nursing management strategies as they promote a more effective management. Lab technicians and nurses play an important role in the care of a patient like Mr. Bentley but the urologist plays the key role as he initiates treatment.