PRN administration by the nurse From the nursing perspective PCA reduces the workload because it is preloaded with multiple doses and it can also help reduce medication errors and opioidrelated oversedation

You set up the monitor, PCA, make sure that the nasal prongs are delivering oxygen, and leave to attend to another patient. When you recheck on Kumar you find him restless, agitated, and attempting to pull out all his IV lines and nasal prongs.

Describe your management?

You have to execute the AIR cycle. You check his respirations and other vital signs and then undertake a review of all medications recently administered. A review of PCA pump shows that he has made several successful attempts at pressing the PCA button and has received 2 mg of hydromorphone within the last hour. However, Kumar is unable to comply with your assessment of pain score. He is hypertensive and tachycardic. He is attempting to touch his lower abdomen, and he is trying to tug on the urinary catheter. You notice that there is suprapubic swelling and the urine bag is empty. The urine output since he came to the ward has been minimal. On palpation you notice that he has a distended urinary bladder.

What would you do next?

The most likely cause of Kumar's distress appears to be a distended bladder. The first step is to evaluate the Foley catheter. You flush the catheter with 50 ml sterile water using a bladder syringe. You notice that when you do this the water is leaking from around the catheter. You then notice that the catheter tip is outside the bladder. You decide to insert a new, sterile catheter, which consequently drains about 600 ml of urine. Kumar settles down and appears to be very much relieved. You assess the pain score now and he states it is a "2."

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