FIND YOUR PERFECT RN DEGREE
 

RNCentral Facebook

Sign up for our newsletter & get tips, news and features in your inbox! We respect your privacy.



Alteration in Patterns of Urinary Elimination: Retention

Alteration in Patterns of Urinary Elimination: Retention

(_)Actual (_) Potential

Related To:
[Check those that apply]
(_) Anxiety
(_) Fecal impaction
(_) Flaccid bladder
(_) Medications
(_) Packing
(_) Stones
(_) Weak or absent sensory and/or motor impulses
(_) Other:_____________________________
____________________________________
____________________________________

 

As evidenced by:
[Check those that apply]
Major:
(
Must be present)
(_) Bladder distention (not related to acute, reversible etiology).
(_) Distention with small frequent voids or dribbling (overflow incontinence).
(_) 100 ml or more residual of urine.
Minor:
(
May be present)
(_) The individual states that it feels as though the bladder is not empty after voiding.

 

Date &
Sign.
Plan and Outcome
[Check those that apply]
Target
Date:
Nursing Interventions
[Check those that apply]
Date
Achieved:
  The patient will:

(_) Void in the amount of:
__________

(_) Have urine resicual less than 30cc.

(_) Verbalize knowledge of signs and symptoms of infection.

(_) Other:

  (_) Palpate bladder for distention q___ hours or after each void.

(_) Monitor I & O.

(_) Attempt to stimulate relaxation of urethral sphincter by:

  • running water
  • providing warm water for patient to place hand/fingers in
  • other:

(_) Provide privacy.

(_) Intermittent straight cath q___ hours per physician order.

(_) Other:________________
________________________
________________________
________________________

 

 

__________________________
Patient/Significant other signature

 

__________________________
RN signature