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Nursing plays an important role in healthcare for improving the health conditions of patients by educating and supporting them. Nurses can be considered advocates for promoting health, participating in rehabilitation, educating the patients as well as the public regarding various illnesses, and providing care to support the patients. This report would shed light on discussing the health condition of a patient suffering from blocked IDC (indwelling catheter) and haematuria.
The patient, Mr. Brown is 89 years old and experiencing blood discharge whiles the twoc process. It has been observed that the prevalence of haematuria is 4-5% in the UK and can generally be caused due to malignancy in the kidney and urogenital tract. The prevalence of haematuria is 0.19 to 21 percent and it can be observed in 4 per 1000 persons every year. In this report, the discussion would be made on the journey of the patient and the associated pathophysiology of the patient. A care plan would be devised illustrating the activities to be performed and ensuring that the need of the patient has been made. An insight into the discharging plan would also be devised in this report to minimize associated harm and promote the health of the patient.
The case study deals with the explanation of an 89-year-old patient, Mr. Brown suffering from blocked IDC and haematuria. The patient had been shifted from Lewisham hospital under emergency with the help of an ambulance on 05/06/2022. The patient lives alone and is independent and has been suffering from 2 ways IDC. Insertion of IDC is an invasive process and is carried out with the help of an aseptic technique (NHS, 2020). In this condition, the catheters are left in the place for the collection of urine, and sometimes it is also fitted with the valve. Haematuria can be referred to as the presence of blood in the urine (Bolenz et al., 2018). This condition can lead to discomfort and pain during urine discharge. There are various factors that can give rise to the condition of haematuria including the age of the patients. This condition can be observed in people with old age, having an enlarged prostate, or because of a family history of kidney problems. According to the medical history of Mr. Brown, he has been found to be suffering from hyperkalemia. Hyperkalemia can be referred to as the diseased condition which explains the inability of the kidneys to excrete potassium (Viteri, and Reid-Adam, 2018). This results in increasing the potassium level in the blood which is higher than normal. Potassium is an important component that helps a vital role in the functioning of nerve and muscle cells.
Potassium elevation and the condition of hyperkalemia has considered life-threatening and require long-term treatment. Mr. Brown here has been found to be suffering from the condition of IV hyperkalemia with k+6. The patient has been given +ECG 13 treatment for the conditions. Blood tests have also been performed for the patient after providing the K+ treatment (Hanna et al. 2021). The presence of dysmorphic RBC having irregular contours and shape in the urine indicates the presence of haematuria and it indicated RBCs egression from the glomerular cavity into the urinary space.
The problem in the functioning of the kidney or inflammation in the urethra or prostate can also result in this condition. Considering the symptoms of the patient it had been observed that the patient has been given MDM for next Tuesday. Moreover, slow irrigation has also been observed in the patient. The assessment of this condition is done with the help of lower abdominal pain and urinary urgency. Mr. Brown had been administered through emergency admission and had been under the emergency department for proper care. Nurses and doctors have been involved in this process and keeping the patient under observation in the emergency department has been the correct clinical area for the patient. Urinalysis has been performed for the patient in order to have a better understanding of the Mr. Brown’s condition. It is considered as the most useful test and give better results to establish diagnosis. The reason behind this is considering the medical history of the patient it can be seen that the patient had experienced hernia repair, high cholesterol, glaucoma as well as CLL. Bladder washout is carried out for the patient and the process has been successful each time.
However, it has been observed that whenever the patient encounters this process and gets twoc that is “trail without catheter” the condition of haematuria returns. Twoc or “trail without catheter” can be described as the removal of a urinary catheter from Mr. Brown. It has been performed for Mr. Brown in order to ensure that the patient can easily pass urine on its own without the help of a catheter (NHS, 2021). However, when this process is performed on the patient it has been observed that haematuria returns with more blood in the urine. The irrigation process has been done as the condition of the patient has improved the doctors have decided to discharge the patient without twoc and the patient has been permitted to go home with a catheter to mitigate any discomfort. The patient has completed his course of co-amox.
TTO has been done in the bedside locker. It has been decided that the patient had be discharged on 16/06/2022 and the decision related to the discharge of the patient has been taken on 14/02/2022. On this date with other treatment procedures, it has been found that IDC has changed to 3-way, and considering the condition of the patient it has been observed that day and night referral is required by the patient for catheter care. It has been advised considering the age of Mr. Brown that a distinct nurse referral can visit the patient in order to take care of his catheter.
On the basis of the condition shown by Mr. Brown, urinalysis has been performed on the patient. This has been useful in determining positive and negative results and evaluating the condition of the patient. Assessment plays an important role in deriving and understanding the exact condition of the patient. In this case, the assessment process is vital and it is important to check the urination of the patient for better assessment (Yu et al., 2020). In this case, the medication process related to haematuria and dip urination for the presence of blood can be considered as the element of the plan of care.
It is evident that Mr. Brown requires assistance and assistance has been given based on the guidelines. Considering the age of Mr. Brown it is required to set a primary care plan to manage the condition of the patient. The patient has been accessed in terms of any accessed pain it helps the nurse in deciding the activities to be performed in terms of relieving the condition of the patient. In this case, dipsticks have been given consideration and the reason behind that is urine dipsticks have the capability to reveal abnormalities. Moreover, with the use of this dipstick, it has been possible for the nurses to determine the presence of blood in the patient’s urine. Mr Brown needs some solution for washing his bladder and the most effective nursing intervention for this is the use of saline water with irrigated urine. The unwanted particles of the bladder are cleared through the catheter by the use of saline. Mr Brown suffered from this issue for a long period of time therefore selected a simple clear process to help him get over the issue. “Catheter-Associated Urinary Tract Infection (CAUTI)” is an expected infection issue which may develop if the cleaning process is not completed properly. The introduction of povidone-iodine has also been done. Mr. Brown was administered with antibiotics and intake of fluid is encouraged in order to overcome the condition. The patient was provided with a “point-of-service” plan to provide better care to patients. In this care plan managed health care has been provided to the patient.
A “problem-focused diagnosis” has been performed for the patient in whom the problem of the patient has been focused entirely during the nursing assessment. The diagnosis procedure was performed with the help of urinalysis and with the help of dipsticks to check for blood. The goal is to soothe the condition of the patient and restrict the occurrence of blood in the urine of the patient. Mr. Brown had been provided with twoc which showed the occurrence of hematuria every time it is done. The patient is further provided with IV hyperkalemia treatment with +ECG 13 and blood tests have been performed after K+ treatment. Slow irrigation has been observed in the patient. The collection and the analysis processes have been done under the NHS guidelines for the same. It has been evaluated that Mr. Brown is experiencing blood on twoc and it was discharged with a catheter and a referral nurse has been provided to take better care of the patient and catheter considering his age.
During the assessment process, the privacy and confidentiality of Mr. Brown has been kept intact (Mayoclinic, 2020). The patient has been encouraged to void at least every four hours and this allowed emptying of the bladder and reduce the risk of urinary retention. Privacy aids helps in the relaxation of urinary sphincters. Since blood in the urination is the major element to be managed in the patient, he has been administered co-amox and other antibiotics to clear urinary tract infections and also to shrink an enlarged prostate. On being evaluated after the treatmebht5 process the patient is called for prostrate MDM to identify any further complications. The care to the patient has been given considering the 6Cs of practice that is “care, compassion, communication, courage, competence, and commitment”. While delivering care it is needed to ensure that the patient gets the best quality of service and in this regard, it is important to maintain communication with the patient. The patient should be advocated for the consequences of the treatment process and should be encouraged to be independent (NHS, 2019). The patient was treated with respect, and empathy, and the dignity of the patient was kept intact. Moreover, NICE guidelines have been followed while discharging the patient. As Mr. Brown lives independently and alone, no family was included during the discharge process however, care has been given in terms of maintaining the safety of the patients.
Moreover, the privacy and dignity of the patient was kept into consideration while inserting and removing the catheter from the patient (Kagan, 2022). The treatment process complied considering the NMC code which is surrounded by four themes that is “priortise people, practices effectively, preserve the safety and promote professionalism”. In this case, the removal of the catheter was done with utmost care in order to ensure the safety of Mr. Brown and adult nurses was being delegated for the care of the patient for better professionalism. The maintenance of safety, privacy, and dignity of the patient also help in strengthens the trust of the patient and this, in turn, can be beneficial in improving the quality of care being provided to the patient. It is to be noted that since the condition of the patient is critical a multidisciplinary team was useful in upgrading the care services. It might be required to involve a nephrologists or urologist in the care service and enhanced communication with the team is important to mitigate any delay in the diagnosis process. The discharging process was accomplished with the help of guidelines accompanied by NHS and follow-up appointments have been scheduled for the patient. The patient is provided with a referral nurse to take care of the catheter and this prostate MDM is scheduled for the next week.
In this report discussion has been made on the care planning procedure of Mr. Brown. The illustration of the case study and the consideration of the patient are illustrated in this report. The report discussed the patho-physiology of IDC and the hematuria experience by the patient. The entire journey of Mr. Brown has been explained and the patient is kept in emergency wards for better treatment process. The evaluation of the condition of the patient has been performed and a discussion has been, made on the health history of the patient as well. The report also sheds light on the care plan such as “point-of-care” and “problem-focused diagnosis” to be performed for the patient. The discussion of the guidelines released by NHS and NMC has been explained here. Moreover the processes of discharge and providing the patient with a referral nurse to take care of the patient as well as the catheter of the patient.
Journals
Bolenz, C., Schröppel, B., Eisenhardt, A., Schmitz-Dräger, B.J. and Grimm, M.O., 2018. The investigation of hematuria. Deutsches Ärzteblatt International, 115(48), p.801.
Hanna, C., Hernandez, L.P.H., Bu, L., Kizilbash, S., Najera, L., Rheault, M.N., Czyzyk, J. and Kouri, A.M., 2021. IgA nephropathy presenting as macroscopic hematuria in 2 pediatric patients after receiving the Pfizer COVID-19 vaccine. Kidney international, 100(3), p.705.
Viteri, B. and Reid-Adam, J., 2018. Hematuria and proteinuria in children. Pediatrics in review, 39(12), p.573.
Yu, G.Z., Guo, L., Dong, J.F., Shi, S.F., Liu, L.J., Wang, J.W., Sui, G.L., Zhou, X.J., Xing, Y., Li, H.X. and Lv, J.C., 2020. Persistent hematuria and kidney disease progression in IgA nephropathy: a cohort study. American Journal of Kidney Diseases, 76(1), pp.90-99.
Websites
Kagan, J. (2022). Point-of-Service (POS) Plan. Available at: https://www.investopedia.com/terms/p/pointofservice-plan-pos.asp [Accessed on: 19.07.2022]
Mayoclinic, (2020). Blood in urine (hematuria). Available at: https://www.mayoclinic.org/diseases-conditions/blood-in-urine/diagnosis-treatment/drc-20353436#:~:text=Depending%20on%20the%20condition%20causing,cases%2C%20no%20treatment%20is%20necessary. [Accessed on: 19.07.2022]
NHS, (2019). Being discharged from hospital. Available at: https://www.nhs.uk/nhs-services/hospitals/going-into-hospital/being-discharged-from-hospital/#:~:text=You%20have%20the%20right%20to,PALS%20member%20at%20the%20hospital. [Accessed on: 19.07.2022]
NHS, (2020). Types-Urinary catheter. Available at: https://www.nhs.uk/conditions/urinary-catheters/types/#:~:text=Indwelling%20urinary%20catheters,often%20known%20as%20Foley%20catheters. [Accessed on: 19.07.2022]
NHS, (2021). Trial Without Catheter (TWOC). Available at: https://www.pat.nhs.uk/downloads/New%20NCA%20Leaflets/Urology/672%20-%20Trial%20Without%20Catheter%20-%20TWOC.pdf. [Accessed on: 19.07.2022]
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