Monday, September 20, 2010

Great Nurse Maryuni???(GNM)

Okey...hari ini hari kedua masuk ward after raya~

Semalam (in kelantan:maring), aku masih dalam mood raya, namun hari ini Alhamdulillah..aku mulai pulih dari demam raya dan ingin buat yang terbaik untuk pesakit kesayanganku.

Bunyi "message handphone" kedengaran. Oh, Alang a.k.a teman clinical ku.

Alang: Yun, hg dah siap?
Aku: belum..hg p dlu
Alang: Okey, aku p dlu sbb nk buat C.F (Okey..alang, c.f tu apa?? aku lupa nk tanya, nanti lah aku tnya dia?

Passing report over, aku ambik 1 patient je untuk buat management sebab abang staff nurse merungut dia tiada patient untuk buat report. Dapat kat student semua. ( Bagi aku, yes, report penting petanda aras dan bukti kita "do something" untuk patient, tapi jika hanya semata-mata report yang ditulis dan kita "done nothing" untuk patient, what for???)

Pesakit kubikal A2 ada seramai 6 orang (well, sampai hari ini aku berada di medikal ward rasa amat bersyukur kerana pesakit diarrangekan ikut kubikal, sewaktu di surgikal ward berkejaran aku ingin pantau pesakit aku...bukan seorang dua, kadang2 hingga 9 orang!..phewww~)

Okey, jangan ganggu aku lepas pass report, aku nk scan patient aku dlu.(memang habit aku sebelum mulakan tugas untuk mengscaning patient, lagi bagus sebenarnya kalau datang awal dan tengok patient sebelum pass report,sila jangan ikut habit ini..hehe)

patient aku..maaf,nama tidak disiarkan (hehe..ethic!)
1.
diagnose: Viral fever TRO dengue fever
6 pine n/s
Bd FBC
4H V/S
Strict I/O
Incourage oral intake

2.
left Loin hematoma secondary to overwarfarinazation, ccf, underlying dm, ckd
buse,creat dly
KIV abdo
tds cbs
restrict fluid- 500cc/day
modified condom
trace old note

3.
ckd,hpt,dm2
dly buse,creat
premeal cbs
800cc/day
strict i/o chart
echo today

4.
rt pleural effusion
ct guided biopsy
nbm-5 am
gsh ada
old note ada
2pm appoinment

5.
fever secondary to cap, infected ijc, dm2, hpt
u/s droppler 10/10
condom chateter
4h pulse rate
gcs chart
800 cc/day
strict i/o chart
echo today

6.
decompensated ccf, ihd, dm
transferred to 1s (if have bed)
premeal cbs
prone up
i/o chart
packed cell withold
u/s abdo
tca uro clinic 2/7

seorang pesakit aku mengalami urinary retention. dari pukul 7 hingga aku habis shift dia selalu rasa ingin pass urine tapi tidak dapat-dapat. kesian aku tengok. dia sampai tidak lalu nak makan nasi sebab keadaan dia. cuba fikir, kita rasa nak kencing tapi tidak keluar? susah hati kan?

emm..bila fkir balik, kenapa dia jadi macam tu? adakah ada kaitan dengan diagnosis dia iaitu Chronic Kidney Disease? aku kena balik cari ni..

Mula-mula, apa itu urinary retention??

Urinary retention is incomplete emptying of the bladder or cessation of urination; it may be acute or chronic. Causes include impaired bladder contractility, bladder outlet obstruction, detrusor-sphincter dyssynergia (lack of coordination between bladder contraction and sphincter relaxation), or a combination. Retention is most common among men, in whom prostate abnormalities or urethral strictures cause outlet obstruction. In either sex, retention may be due to drugs (particularly those with anticholinergic effects, including many OTC drugs), severe fecal impaction (which increases pressure on the bladder trigone), or neurogenic bladder in patients with diabetes, multiple sclerosis, Parkinson's disease, or prior pelvic surgery resulting in bladder denervation.

Urinary retention can cause urinary frequency and urge or overflow incontinence. It may cause abdominal distention and pain. When retention develops slowly, pain may be absent. Long-standing retention predisposes to UTI and can increase bladder pressure, causing obstructive uropathy (see Obstructive Uropathy).

Diagnosis

Diagnosis is obvious in patients who cannot void. In those who can void, diagnosis is by postvoid catheterization showing a residual urine volume > 100 mL. Other tests (eg, urinalysis, blood tests, ultrasonography, urodynamic testing, cystoscopy, cystography) are done based on clinical findings.

Treatment

  • Urethral catheterization and treatment of cause

Relief of acute urinary retention requires urethral catheterization. Subsequent treatment depends on cause. In men with benign prostatic hypertrophy, drugs (usually α-adrenergic blockers or 5α-reductase inhibitors) or surgery may help decrease bladder outlet resistance. No treatment is effective for impaired bladder contractility or a neurogenic bladder; intermittent self-catheterization or indwelling catheterization is usually required. Urinary diversion is a last resort.



wahhh...makin aku baca makin banyak aku nak tahu..dan yang aku lupa.


how many ml normal urination for patient per hour?
is ckd related to urinary retention?
what nursing intervention for urinary retention?
what complication may develop if i ignore the condition of patient have?


hemm....aku nk sambung baca...jumpa lagi!hehe

2 comments:

irma-ain ibrahim said...

siti maryuni mansor ,
acu gak tepek sekali gambar mu paka uniform. :D

Ct SoLeHa said...

rase nurse lagik byk belajar dr medical student