A postpartum patient has not urinated since birth. The bladder scanner indicates 1 000 mL in her bladder. What should the practical nurse do?

A postpartum patient has not urinated since birth. The bladder scanner indicates 1 000 mL in her bladder. What should the practical nurse do?

• A. Insert an intermittent catheter and drain the bladder.
• B. Have her sit in a warm bath to see if she can void in the bathtub.
• C. Insert an in-dwelling catheter for 24 hours so that her bladder will remain empty and her uterus will involute normally.
• D. Let her go home, as she feels she will be able to void in the privacy of her own home.

Answer: (A)

Postpartum urinary retention with a bladder volume of about 1000 mL is a medical issue that needs prompt relief of the distended bladder. When the bladder is overfilled, the detrusor muscle can become fatigued, increasing the risk of ongoing retention, bladder damage, infection, and interference with uterine involution. The best course is intermittent catheterization to drain the bladder now. This quickly relieves the distention with lower infection risk than leaving a catheter in place, and it allows assess­ment of the patient’s ability to void afterward. After drainage, reassess the patient’s voiding pattern and consider a voiding trial to determine if she can void spontaneously. Encourage fluids as appropriate, monitor urine output, and watch for signs of infection or recurrent retention. The other options don’t fit because they don’t reliably relieve the acute retention or they introduce unnecessary risks: a warm bath may not resolve substantial retention and delays needed treatment; an indwelling catheter for 24 hours unnecessarily increases infection risk and can impede spontaneous voiding; sending her home with unresolved retention is unsafe.

Postpartum urinary retention with a bladder volume of about 1000 mL is a medical issue that needs prompt relief of the distended bladder. When the bladder is overfilled, the detrusor muscle can become fatigued, increasing the risk of ongoing retention, bladder damage, infection, and interference with uterine involution. The best course is intermittent catheterization to drain the bladder now. This quickly relieves the distention with lower infection risk than leaving a catheter in place, and it allows assess­ment of the patient’s ability to void afterward.

After drainage, reassess the patient’s voiding pattern and consider a voiding trial to determine if she can void spontaneously. Encourage fluids as appropriate, monitor urine output, and watch for signs of infection or recurrent retention.

The other options don’t fit because they don’t reliably relieve the acute retention or they introduce unnecessary risks: a warm bath may not resolve substantial retention and delays needed treatment; an indwelling catheter for 24 hours unnecessarily increases infection risk and can impede spontaneous voiding; sending her home with unresolved retention is unsafe.