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Senior dementia patient recently was in the hospital for UTI. He was treated with IV antibiotics and had a Foley catheter inserted because he was retaining urine. The Foley catheter was removed about two weeks after his hospital release. He now takes flomax. We are monitoring his urine output with a condom catheter bag. He drinks about 2/3 8oz cups of liquid a day (not much), but is well.


Anyone have experience monitoring for urinary retention? Without an ultra sound bladder exam at home, it is difficult to check. What does one look for; especially when urine output fluctuates?

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Ricky6: I did see your update 5 hours ago and that is good news.
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Reply to Llamalover47
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As an ICU nurse, adults should create at least 30 cc of urine every hour - day and night. If it goes down below that, he either has an obstruction or is dehydrated.
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Ricky6 Oct 25, 2020
I think a patient who is 90 does not meet that criteria, that would be 24oz in 24 hours!
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Update: Patient was released from the hospital with oral antibiotics and seems to be doing well. Two ultra sound exams of the bladder indicated that he was not retaining urine anymore, We continue to use a condom catheter to help heal his bedsore near the tailbone (keep it dry.)
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AlvaDeer Oct 25, 2020
Ricky, good news. And thanks for the update. So few think to give them to us.
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My dad could not be weaned off his foley and was not able to void after several attempts. He also was on flomax. We had to restrict his fluids to 40 oz a day due to cardiac disease. Many foods count as a fluid including applesauce, sherbet, smoothies, jello, soup and pudding. Try to work with them to get him hydrated better.
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Reply to InFamilyService
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HEllen be much more comfortable at home.
What goes in must come out so just monitor what he drinks and what his urine output is and he'll be fine.
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Reply to bevthegreat
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Condom catheters are not reliable because they come off too easily, so what you see in the bag is really not a good reflection.

A diaper would be better if he is unable to use a urinal. You can feel how heavy they get. Another reason could be due to poor fluid intake, and bad kidneys (which dehydration can cause--kidney damage).

Since your dad is NOT drinking much, you MUST ENCOURAGE him to drink. In other words, have a drinking schedule. Elder people lose their sense of thirst so dehydration is very common--along with it comes urinary tract infection.

If they are having problems swallowing, then the fluids must be thickened.
Failing that, and they refuse to drink your only other options are feeding tube verses hospice/DNR let them die (it can take 2 weeks to die of dehydration). Feeding tubes should only be a *LAST* resort and they require CONSIDERABLE amount of care. My mom had a feeding tube and she did great with it but it required a great deal of care.

DEHYDRATION causes kidney damage.

You must really have a terrible doctor to not explain these things to you. It sounds like your dad needs a new doctor who cares about their patients.
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Reply to cetude
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I’m sorry you and your dad are facing this extra struggle. We faced a similar problem but were able to beat it. Here’s what worked for us.

My mom left hospital after a uti with a catheter bc she twice failed the urine void tests. Once cath was removed, home health was supposed to scan her bladder. That didn’t happen and we faced a weekend of worry as to whether she was retaining urine. During this time, after she felt she was done urinating, I had her (per Dr. Google!) bend forward while sitting on the toilet. Always more urine came out! When she later got her void test with her urologist, she passed! She has had no problem since—6 months now. Wishing you the best!! And hoping you can beat the catheter, too. (On a side note, we did this by rehabbing mom at home. I don’t think we’d have had the same results if she’d gone to a residential rehab. The doc seemed resigned to her being on a catheter. I wasn’t.)
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My dad had issues with un diagnosed UTI, then hospitalized for other issues-got a catheter as he was fall risk-usually had to wait sometimes a while before help would arrive to get him in the bathroom. Eventually goes home with the catheter. Urology follow up testing shows dad no longer has the urge to go-it will never come back. Dad is 95. Super pubic-thru the abdomen is the final solution. The unit needs similar maintenance to Foley-30 day swap of the entire setup up at the dr office-unless you are qualified to do this at home- with 24/7 care can do most of what is needed to manage catheter but not the monthly swap. Was a nightmare CG were making a mess of the setup breaking the tube, messing with the incision and not keeping clean. For now seems to be going better than before with home care.
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Reply to medicaidmaze20
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Even though there is a lot going on, No hospice. IMHO he is producing urine almost close to his liquid intake. A wound care nurse comes tomorrow I will ask her to show me your procedure.

A PA-C would do an ultra sound in the doctor’s office. However, I just realized that the patient would need to be transferred from the wheelchair to the examination bed. The patient is hemiplegic. Unless they get a lift or have some strong people they do not do the transfer, nor do they want to.
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AlvaDeer Oct 21, 2020
Good luck, Ricky, and hope you will update us. I agree that you cannot run for an Ultrasound every time you need one. And it is great that your intake and output are matching. GREAT idea on getting the wound nurse to show you how to examine the bladder.
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Lay patient flat and feel the bladder. The area should be soft over the pubis. If you notice distention happening it will form a little bulge and it will become more hard. You have to start with the NORMAL feel to realize change. All exams done flat. Easier in a thinner person. Look this up online and you may find a surprising amount of info. If this happened once it is VERY likely to happen again. Do I recall that you have hospice??? If so they can help you in this. Any nurse in your neighborhood can help you toward doing this exam. You may ask a doctor if someone can be sent to your home to help you with this exam.
Also know that as the bladder fills there is often and increase in agitation as you can imagine. No output of urine is a clue you are headed to trouble. For some elders they have already lost enough sensors that they cannot tell, or cannot express where the agitation is coming from. Lightly pressing a full bladder will often get an instant reaction, legs pulled up, grimace, groan, and etc.
Without being there, don't know how else to help you ID what is happening. Just wish you good luck.
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