Medical Surgical Urinary retention vs Incontinence #5

Question

A new mother on the maternity floor is having trouble voiding due to urinary retention after just giving birth to a large-for-gestational age (LGA) newborn. Which intervention is most appropriate for this client?

Answers

  1. Pouring warm water over the perineum.
    • Rationale:

      This answer is correct because it is the least invasive method to encourage voiding. Pouring warm water over the perineum will promote urination. Warm water creates vasodilation, which in turn, assists the muscarinic receptors to stimulate the bladder and relax the sphincter in order to promote micturition. Warm water also creates the sensation to urinate through sensory stimulation.

  2. Obtain an order to catheterize the client.
    • Rationale:

      This answer is not correct because it is the most invasive method. Catheterization should not be carried out until all noninvasive techniques have been attempted.

  3. Administer oxybutynin to the client.
    • Rationale:

      This answer is not correct because medication is used for chronic or long-term urinary retention. The client is having an acute episode due to the stress to her pelvic floor muscles and their nerves and perhaps some swelling around the birth canal which makes it more difficult to pass urine.

  4. Limit the client's fluid intake.
    • Rationale:

      This answer is not correct because restricting fluid intake will irritate the bladder and cause urge incontinence. Encouragement of fluid intake will increase voiding symptoms.

Overview

Urinary retention in a postpartum client occurs due to an increase in progesterone level, which represses the bladder muscle and leads to the retention of urine. Pouring warm water over the perineum will promote urination.

Explanation

Learning Outcomes

Urinary retention in a postpartum client occurs due to an increase in progesterone level, which represses the bladder muscle and leads to the retention of urine. A vaginal delivery that is distressing for the pelvic floor muscles and their nerves can also result in diminished bladder sensitivity. Trying the least invasive method to encourage bladder emptying is preferred. The risks that come with urinary catheterization can be avoided if the client is able to urinate on their own. Pouring warm water over the perineum will promote urination. Warm water increases blood flow to the muscles, creating vasodilation. This assists the muscarinic receptors to stimulate the bladder and relax the sphincter in order to promote micturition. Warm water also creates the sensation to urinate through sensory stimulation.

Test Taking Tip

Least invasive methods are preferred first.

Video Rationale