Q. Drag the appropriate treatment options for Annie from the list opposite to the box below.
Q. Drag the appropriate treatment options for Annie from the list opposite to the box below.
3 days of Trimethoprim to treat urinary tract infection (NICE Guidelines). Further specimen to lab after completion. – Not unless there is evidence of UTI on ward testing and a positive lab test returned.
Review the type of fluids Annie is drinking. Encourage less caffeine intake and more water. – Reducing caffeine in those with urinary problems, can help reduce bladder irritation. This is true in those drinking excessive amounts of coffee, carbonated drinks etc. ✓
Review bladder, bladder scan, ward urinalysis, and TPR chart. – The first thing is to review the evidence you have collected in order to diagnose the type of bladder dysfunction, then choose appropriate treatment. ✓
Teach Annie to use intermittent catheters. – Intermittent catheterisation is the best way to manage urinary retention while allowing recovery of normal bladder function. This method can reduce instances of patients needing to urinate as the bladder is being helped to fully drain. In stroke patients the amount of residual urine usually reduces over time so intermittent catheterisation is usually short term (2-3 days). It can be difficult for the patient to perform independently, but assistance can be given. Use in conjunction with scheduled voiding as number of catheterisations reduces. ✓
Consult with medical staff to offer anticholinergic drug therapy to stabilize bladder e.g. tolteradine/oxybutanin/solifenacin. – No these type of drugs are usually used in patients with the opposite type of problem of urgency and overactive bladder, where the bladder contracts and expels urine without warning. They wouldn’t be used in this case.
Encourage scheduled voiding. Contract a toileting regime with patient. Beginning with 2 hourly toileting increasing to 4 hourly. – This would not be used in isolation in this case, but as part of an overall rehabilitation plan it should be encouraged. ✓
Insert urinary catheter for free drainage. – This is inappropriate for initial management of retention following stroke. As always careful consideration should be given to any decision to catheterise because indwelling catheterisation will reduce bladder tone further and result in CAUTIs (catheter associated urinary tract infection).
Page last reviewed: 31 Jan 2022
