A2

Acute urinary retention

Skilled assessment of a patient with suprapubic distension, the inability to void for several hours, and lower-abdominal discomfort — new and concerning for acute urinary retention. A bladder scan showed 700 mL; an indwelling catheter was placed per order and drained 700 mL of clear urine with relief of distension and discomfort. The provider was notified at 11:15 with the residual and drained volume; orders for continued catheterization and follow-up were received. Output will be monitored and the cause evaluated; the patient was educated on the warning signs of recurrent retention.

A3

Catheter obstruction

Skilled assessment of an indwelling catheter with no urine output for several hours and a distended, tender bladder — new and concerning for catheter obstruction. The tubing was checked and a kink and a dependent loop corrected, and the catheter was irrigated per order, after which clear urine drained freely and the distension resolved. The provider was notified at 14:30 of the obstruction and resolution; the catheter and output will be monitored, and the caregiver was taught to keep the tubing free of kinks and the bag below bladder level and to report absent drainage immediately.

A4

Gross hematuria on an anticoagulant

Skilled assessment of new gross hematuria with small clots in a patient on warfarin — new and significant given the anticoagulant and the risk of clot retention. The catheter, where present, was monitored for patency and clot obstruction; the provider was notified at 13:05 and orders for evaluation and coagulation studies were received. The patient was educated on increased fluid intake per order and the signs of clot retention or worsening bleeding, with instruction to seek emergency care for inability to void or heavy bleeding; the urine and hemoglobin trend will be monitored and the Anticoagulation overlay applied.

A5

Oliguria with fluid overload

Skilled assessment showing decreased urine output with a four-pound weight gain over two days, new 2+ pitting edema to the mid-shin, and mild exertional dyspnea — new and concerning for acute kidney injury or fluid overload. Vital signs and lung sounds were assessed and the provider notified at 10:25; orders for laboratory studies and a diuretic adjustment were received. The patient was educated on daily weights, the fluid plan, and the warning signs of worsening congestion, with instruction to activate EMS for severe shortness of breath; weight, edema, and output will be reassessed next visit (cross-reference Heart Failure overlay).

A6

Catheter-associated infection

Skilled assessment of an indwelling catheter site with new purulent drainage and erythema and a temperature of 101.6°F, with rigors reported after the catheter was last manipulated — new findings concerning for a catheter-associated urinary tract infection. Vital signs were obtained and the provider notified at 15:30; orders for a culture, evaluation, and a catheter exchange were received. The catheter was managed per order and the patient educated on the signs of worsening infection, with instruction to seek emergency care for high fever, rigors, or confusion; the site, temperature, and urine will be reassessed next visit.