The patient has not yet voided in the 3 hours following a total knee replacement surgery. Which action by the nurse is appropriate?

Palpate the patient’s bladder for fullness. Prior to performing an invasive procedure such as intermittent catheterization, the nurse palpates the patient’s bladder for fullness. The patient likely has urinary retention rather than decreased urine production, so increasing the patient’s fluid intake is unlikely to be helpful. The nurse can report the patient’s anuria and presence or absence of full bladder to the provider for further instruction after the nurse has palpated the bladder.

The patient has not yet voided in the 3 hours following a total k...

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Physiological Adaptation
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Category: Physiological Adaptation
Difficulty: 6

Topics: Communication & Documentation Assessment Cardiovascular Elimination Fluid and Electrolytes

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