Next, let's talk about urinary retention. So we're moving to the bladder.
So by definition, urinary retention is failure to void or completely empty the bladder
within six hours of delivery.
You can in our graphic that this patient looks pretty uncomfortable
and urinary retention definitely meets that criteria.
Clinical features include a palpable bladder.
An empty bladder, you can't feel.
A bladder however that is full or almost full,
you can feel it and it feels like a bubble that sits right up on top of the symphysis pubis.
Now, remember, when we were talking about the uterus,
that a full bladder causes the uterus to lean?
So a deviated uterus may also be an indicative of urinary retention.
Hesitancy. So, when you go to the bathroom and you try to empty your bladder
and nothing is coming out, maybe because something is blocking it
or maybe because your uterus and your bladder won't let anything through, that would be hesitancy.
Urgency, that feeling of, "Gotta go, gotta go, right now,"
because the bladder feels permanently full.
And finally, if we check for a residual void.
So a residual void occurs when you go to the restroom to empty your bladder,
and, you, maybe get some urine out but there's still quite a bit left.
If what's left is greater than a 150 milliliters, then that's considered urinary retention.
Risk factors for urinary retention include prolonged second stage.
So imagine, if you're pushing for three or four hours in all different kinds of position
and the kind of trauma that may happen not only in the vaginal tract,
but to the bladder as it sort of being pounced on during those few hours.
Epidural anesthesia can cause lots of numbness
and make it very difficult to actually feel when your bladder is full.
The weight of a large fetus, so, an 8, 9, 10, 11 pound baby on top of your bladder overtime
certainly going to cause some changes there.
An instrument delivery.
So if you remember back in our lecture of talking about intrapartum procedures?
We talked about a forceps that looked like tongs?
So using those can actually cause some damage inside the vaginal track
and near the urethra that may also lead to urinary retention.
And, finally, not emptying the bladder.
So think about the bladder like a balloon and if we blow up the balloon,
then it never quite goes back down to its normal shape
and the more we blow it up, the less elastic it is.
So if we let the bladder get super full and we don't empty it,
when we finally do empty it, the contractility is going to be decreased.
How do we diagnose urinary retention?
When we discuss the residual void,
so the way that we can get that residual void is to have the client go to the restroom
and then do a straight cath after.
Now, I don't know about you, but straight caths are never something that I considered to be fun,
so most of the time, we try to use what's called a post-void residual test using an ultrasound.
So this is a bladder scanner, and we can use the bladder scanner to also measure, sort of estimate,
the amount of urine that's left in the bladder.
Much easier, if it's available to detect a residual void.
We can also palpate.
Remember, a full bladder feels like a bubble, that sits up on top of the symphysis pubis,
so that may be an indicator, if it's significant enough,
to let us know that urinary retention is at play.
So what can the nurse do?
First of all, it's really important that we perform frequent assessments of bladder fullness,
so we can avoid an over-distended bladder.
We can encourage the client to get up and move around, gravity is our friend.
We can insert an indwelling or straight catheter as ordered
to help alleviate some of the work on the bladder.
Monitoring for pain, because a full bladder is very uncomfortable.
We can also assess for signs infection because a urinary tract infection
can also lead to urinary retention.
Speaking of urinary tract infection, that's our next complication.
So a UTI results when there's presence of bacteria within the urinary tract.
It's supposed to be sterile in there. There's not supposed to be bacteria.
Clinical features include frequency, having to empty the bladder often.
Dysuria, pain when we urinate, or just generalized pain in the pelvic region in general.
There can also be fever, that goes along with infection or chills or malaise,
that general feeling of, you know, I just don't feel great and I don't really know why.
When we think about risk factors having a hypotonic bladder,
meaning the contractility is decreased, so remember it has a relationship with urinary retention.
Having an epidural, and the reason is not just having an epidural.
When you have an epidural, you usually have an indwelling catheter
and that catheter is what increases your risk, bingo.
Also, repeated in and out cath, so if we do a straight cath several times during labor,
the client is going to be at increased risk of developing a UTI.
Frequent pelvic exams because when we use our fingers to access the cervix,
it rubs right underneath the urethral meatus.
A history if urinary tract infections or other genital tract injuries,
can also increase a client's risk of developing a UTI.
Diagnosing a urinary tract infection can happen in many ways.
The first one is the one you see represented here in the graphic.
This is a urine dipstick, so we take one of these stick
and actually dip it into the urine and we match it up to a graphic that indicates
whether white blood cells are present or blood, both of which might indicate a UTI.
Another method occurs in the lab.
So the lab will actually take a small sample of the urine, look at it under the microscope
and identify perhaps some wee beasties that shouldn't be there.
If there's something noted under the microscope,
then next step is a urine culture where we actually place some of the urine on an Agar plate,
and see what bacteria grows.
And the good thing about that,
is we know exactly what type of antibiotic would be the most effective.
And, finally, we always want to listen to the client.
If they tell us they're having frequency, and burning, and hesitancy,
then we definitely want to investigate and see what's going on.
So what does the nurse do?
We administer antibiotics as ordered.
We encourage fluids to help push that bacteria out and then we want to educate,
washing hands and hygiene, especially wiping, front to back.
We talk about that often, but I often find that client still haven't heard front to back.