A 72-year old male client is brought to the emergency room by his son. The client is extremely uncomfortable and has been unable to void for the past 12 hours. He has known for some time that he has an enlarged prostate but has wanted to avoid surgery. The best method for the nurse to use when assessing for bladder distention in a male client is to check for:
A. A rounded swelling above the pubis.
B. Dullness in the lower left quadrant.
C. Rebound tenderness below the symphysis.
D. Urine discharge from the urethral meatus.
Correct Answer: A. A rounded swelling above the pubis.
The best way to assess for a distended bladder in either a male or female client is to check for a rounded swelling above the pubis. The swelling represents the distended bladder rising above the pubis into the abdominal cavity. Determine the condition of the skin in the perianal area. In patients with chronic neurogenic bladder, the skin typically shows areas of chronic irritation manifested by areas of excoriation and redness, usually superseded by fungal infection.
Option B: Dullness does not indicate a distended bladder. Physical examination of a patient for incontinence includes cognitive, neural, musculoskeletal, and pelvic assessment. This is because both voluntary and involuntary control of voiding involve the central and peripheral nervous systems as well as the renal and genitourinary systems.
Option C: The client might experience tenderness or pressure above the symphysis. Determine the motor level of the lesion, including the completeness of the lesion in SCI patients. Ascertain the extent of the patient’s hand function and ability to perform transfers and activities of daily living. Hand function is especially important in SCI patients who are to perform self-catheterization.
Option D: No urine discharge is expected; the urine flow is blocked by the enlarged prostate. Perform pelvic, genitourinary examinations on both male and female patients. For male patients, evaluate the status of the prostate, especially in men aged 60 years or older, as this can cause secondary urologic symptoms such as urinary retention. Perform pelvic, genitourinary examinations on both male and female patients. For male patients, evaluate the status of the prostate, especially in men aged 60 years or older, as this can cause secondary urologic symptoms such as urinary retention.
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