Indwelling Catheter Case Study MaryMount EHR Assignment

Indwelling Catheter Case Study MaryMount EHR Assignment #1 Directions: Please read the case study below and input the data into the MaryMount EHR template on Bb in Assignments >Week 4. Chart all the data that you can in the I+O, GU, Vital Signs, and Nursing Notes tabs. Data Entry will be worth 40% of the grade. The other 60% is for the written narrative note in the Nursing Notes tab. Please follow the rubric posted in Week 4 for what to include in the note. Your note will only be on the indwelling catheter procedure and the education given on the two types of drainage bags. There is an article posted in Week 4 on education for the drainage and leg bags. Consolidate the information as per the rubric to include both of the drainage bags. Having practiced inserting an indwelling catheter, you have an idea of the process. Please write the note as thorough as possible. Below is the case study and it is on Mr. Chen Young. Use today’s date and the time you are writing it. Mr. Chen Young is a 25-year-old graduate student who lives in the city. He was involved in a road rage incidentMr. Mr. Chen Young is a 25-year-old graduate student who lives in the city. He was involved in a road rage incident after leaving a local club and was shot twice in the abdomen when he got out of his car. He was transferred to the operating room after initial stabilization in the ED trauma room. No known allergies. He had a surgical repair of his stomach and transverse colon. He tolerated the procedure well. He went to the PACU and then transferred to the post-surgical unit. He developed a fever and has been on IV antibiotics for 3 days. He had his indwelling catheter removed yesterday and has been unable to void on his own. The nurses have been performing intermit catheterization but he has not yet voided on his own due to retention. His WBC is now 9.2 and he is being readied for discharge. His VS at 0800 are BP 110/70, P 72, Temp 99, RR 14, and O2sat 99% on room air. A bladder scan showed Mr. Young had 350 mls in his bladder and the urologist ordered an indwelling catheter for him to go home with and the nurse inserted. The indwelling catheter was a size 16French with a 10 ml balloon. Mr. Young stated the procedure was ‘a bit painful’ and rated it as a ‘5’. Urine was obtained and it was cloudy, yellow, and with some sediment. No odor. The urine was sent to the lab for a UA and a UC. The amount obtained was 375 mls. Education on draining the indwelling catheter bag and also using a leg bag was given along with s/s to report (mention what specifically these would be in your note). Also, if Mr. Young notes a decrease in urine output, to call the urologist right away. Mr. Young should follow-up with the urologist in 5 days. Mr. Young stated, “I got it’. Calculate the input and output.

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