The nurse is caring for a patient who had prostate surgery the previous day. The patient has had significantly decreased urine output over the last shift despite ample oral and IV fluid intake
The patient's urine from the indwelling catheter is cherry red with occasional small clots. What is the appropriate action of the nurse?
a.
Remove the urinary catheter and replace it with a new one
b.
Gently irrigate the catheter using warmed sterile normal saline
c.
Send a sample of the patient's urine to the laboratory for analysis
d.
Call the physician and obtain an order for kidney and bladder ultrasound
ANS: B
The patient most likely has decreased urine output caused by clot formation that is blocking urine from draining through the catheter. The catheter should be gently irrigated using sterile technique and warmed sterile saline to loosen clots and facilitate urinary drainage. The catheter should not be removed. Ultrasound and urinalysis are not necessary.
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