A nurse is assessing a client who is postoperative following abdominal surgery and has an indwelling urinary catheter that is draining dark yellow urine at 25 mL/hr.
Which of the following interventions should the nurse anticipate?
A.
Administer a fluid bolus
B.
Initiate continuous bladder irrigation
C.
Obtain a urine specimen for culture and sensitivity
D.
Clamp the catheter tubing for 30 min
The Correct Answer and Explanation is:
The correct answer is A. Administer a fluid bolus.
Explanation
In the postoperative setting, particularly following abdominal surgery, a patient with an indwelling urinary catheter should ideally be producing a sufficient volume of urine, typically around 30 mL/hr or more, depending on their fluid intake, output, and overall condition. In this scenario, the patient is only producing 25 mL/hr of dark yellow urine, indicating possible dehydration, inadequate fluid intake, or a developing complication.
Rationale for Administering a Fluid Bolus:
- Hydration Status: Dark yellow urine suggests concentrated urine, which can be indicative of dehydration. The kidneys conserve water and concentrate urine when fluid intake is low. Administering a fluid bolus helps restore hydration, promoting adequate renal perfusion and urine output.
- Postoperative Considerations: After abdominal surgery, patients may have decreased oral intake due to nausea, pain, or dietary restrictions. This can lead to hypovolemia and decreased urine production. A fluid bolus can help re-establish appropriate fluid levels.
- Prevention of Complications: Maintaining adequate urine output is crucial in preventing complications such as acute kidney injury. By improving hydration status, the nurse can support renal function and prevent potential issues related to low urine output.
- Monitoring Urinary Output: After administering a fluid bolus, it’s essential to monitor the urinary output closely. An increase in urine output and a change in color from dark yellow to a lighter hue would suggest an improvement in hydration status.
Rationale Against Other Options:
- B. Initiate continuous bladder irrigation: This intervention is typically used to prevent blood clots and maintain catheter patency in certain postoperative situations, especially following prostate surgery, but it is not the first response to low urine output.
- C. Obtain a urine specimen for culture and sensitivity: While this may be necessary if there are signs of infection, the immediate concern here is urine output, not infection.
- D. Clamp the catheter tubing for 30 min: Clamping can lead to bladder distention and increased pressure, potentially causing harm or discomfort. This is not an appropriate response to low urine output.
In conclusion, the priority intervention is to administer a fluid bolus to address potential dehydration and improve urine output.