Question

A patient returns from surgery with an indwelling urinary catheter in place and empty. Six hours later, the volume is 120 mL. The drainage system has no obstructions. Which intervention has priority?

A. Give a 500 mL bolus of isotonic saline
B. Evaluate the patient's circulation and VS
C. Flush the urinary catheter with sterile water or saline
D. Place the patient in the shock position, and notify the surgeon

Answer 1

The priority intervention when a patient has a low urine output post-surgery is to evaluate circulation and vital signs to rule out hypovolemia or shock, before considering other interventions.

Step-by-step explanation:

The correct intervention in this scenario where a patient returns from surgery with an indwelling urinary catheter in place and a low urine output of only 120 mL after six hours is B. Evaluate the patient's circulation and vital signs. This is a priority because the low output may indicate inadequate renal perfusion, which can be a sign of hypovolemia or shock. Given the amount of output and the time elapsed, it is essential to assess the patient's overall stability before proceeding with other interventions. Administering a 500 mL bolus of isotonic saline might be considered if the patient is hypovolemic, but only after a thorough evaluation. Flushing the urinary catheter is not the first choice unless there is evidence of an obstruction, which the question explicitly states is not present. Finally, placing the patient in the shock position and notifying the surgeon would be warranted if signs of shock were present, after the initial assessment. It's important to remember that both regular intravenous solutions used in medicine, which are normal saline and lactated Ringer's solution, are isotonic with body fluids for a reason. This is to avoid issues like cell lysis or fluid overload that would occur with hypotonic or hypertonic solutions, respectively.