A nurse is discussing the plan of care of a client who is 4 hr postoperative and has a urostomy with assistive personnel.
Which of the following statements should the nurse include in the discussion?
A.
We will keep the client’s fluid intake restricted until he is free of pain.
B.
Expect the stoma to appear pale until healing is complete.
C.
We need to check the client’s urine output every hour.
D.
Expect the diet’s urine to contain clots for the first 24 hours.
The Correct Answer and Explanation is:
The correct answer is C. We need to check the client’s urine output every hour.
Explanation:
When caring for a client who is 4 hours postoperative and has a urostomy, monitoring the client’s urine output is crucial for several reasons:
- Assessing Renal Function and Urostomy Performance: Regular assessment of urine output is essential to ensure that the urostomy is functioning correctly and that the kidneys are effectively eliminating waste. The output should be monitored hourly to quickly identify any issues such as obstruction or leakage that could compromise the client’s health. Adequate urine output also helps in assessing the hydration status and the effectiveness of postoperative fluid management.
- Early Detection of Complications: Postoperative patients with a urostomy are at risk for complications like dehydration, infection, or stoma complications. Monitoring urine output closely allows for early detection of any potential issues, such as decreased urine output, which might indicate dehydration, renal impairment, or a blockage in the urostomy.
- Guiding Fluid Management: Accurate and timely measurement of urine output helps guide fluid management decisions. If the urine output is lower than expected, it may prompt the need for increased fluid intake or further investigation to address possible causes. Conversely, if urine output is normal, it reassures that the current fluid intake is adequate.
Let’s briefly review why the other options are less appropriate:
- A. We will keep the client’s fluid intake restricted until he is free of pain.: This statement is incorrect as it is crucial to maintain adequate fluid intake to ensure proper kidney function and hydration, especially postoperatively. Restricting fluids could lead to dehydration and affect urine output.
- B. Expect the stoma to appear pale until healing is complete.: The stoma should be pink to red in color, indicating good blood flow. Pale appearance might suggest poor circulation or other issues, so it is important to monitor and report any abnormalities.
- D. Expect the diet’s urine to contain clots for the first 24 hours.: Postoperative urine may contain some blood initially, but clots should not be a common expectation. Continuous monitoring and reporting of significant clots are necessary, as they could indicate a bleeding complication or other issues.
In summary, hourly urine output monitoring is critical to ensure the proper functioning of the urostomy and to detect any early complications or issues that might arise in the postoperative period.