An adult female patient has been prescribed a 10-day course of nitrofurantoin (Macrodantin) for a urinary tract infection (UTI). On the sixth day, she contacts the healthcare provider’s office and informs the nurse that her symptoms have subsided. She inquires if she should continue with the treatment.
What would be the most suitable response from the registered nurse?

Urinary retention is the inability to completely empty the bladder. It is a common symptom of BPH, as the enlarged prostate can press on the urethra and obstruct the flow of urine. This can lead to several characteristic symptoms, including:

Feeling of incomplete bladder emptying: Patients often feel as though they haven't fully emptied their bladder, even after urinating.

Straining to urinate: It may take extra effort to initiate and maintain a urine stream.

Weak urine stream: The force of the urine stream may be noticeably reduced.

Intermittent urine stream: The flow of urine may start and stop repeatedly.

Post-void dribbling: Urine may continue to drip after urination has seemingly ended.

Urinary frequency: The need to urinate frequently, often at night (nocturia).

Urgency: A sudden, compelling need to urinate that may be difficult to postpone.

Bladder pain or discomfort: Pressure or pain in the lower abdomen, often associated with a full bladder. Pathophysiology:

Bladder outlet obstruction: The enlarged prostate physically compresses the urethra, the tube that carries urine from the bladder to the outside of the body. This obstruction makes it difficult for urine to flow freely, leading to incomplete bladder emptying.

Detrusor muscle dysfunction: The detrusor muscle, which forms the bladder wall, may become weakened or overactive due to the constant strain of trying to empty against resistance. This can further impair bladder emptying.

Neurological factors: In some cases, nerve damage or dysfunction may contribute to urinary retention, particularly in men with diabetes or neurological conditions.

Additional insights:

Chronic urinary retention can result in serious complications, such as bladder stones, urinary tract infections, and kidney damage.

Acute urinary retention is a medical emergency that requires immediate catheterization to relieve the bladder and prevent further complications.

Treatment for urinary retention typically involves medications to relax the prostate and bladder muscles, as well as lifestyle modifications such as limiting fluid intake before bedtime. In some cases, surgical intervention may be necessary to reduce the size of the prostate or widen the urethra.

Choice A rationale:
Straight catheters are single-use catheters that are inserted into the bladder to drain urine and then immediately removed. They are not suitable for long-term use in clients with obstructed urethras because they would need to be inserted repeatedly, causing discomfort and potential trauma to the urethral tissues. Additionally, the obstruction itself would make it difficult or impossible to insert a straight catheter.
Choice B rationale:
Indwelling urethral catheters, also known as Foley catheters, are inserted into the bladder and remain in place for a period of time. They are typically used for clients who cannot void on their own or who require continuous bladder drainage. However, they are not the best option for clients with obstructed urethras for the following reasons:
The presence of the catheter within the urethra can further irritate or damage the already obstructed tissues. The balloon that holds the catheter in place could potentially worsen the obstruction.
The risk of urinary tract infections (UTIs) is increased with indwelling catheters.
Choice C rationale:
Intermittent urethral catheters are inserted into the bladder to drain urine and then removed. They are typically used by clients who can self-catheterize several times a day. However, they are not suitable for clients with complete prostatic obstruction, as the obstruction would make it difficult or impossible to insert the catheter.
Choice D rationale:
Suprapubic catheters are inserted directly into the bladder through a small incision in the abdomen, bypassing the urethra entirely. This makes them the most suitable option for clients with obstructed urethras, as it eliminates the need to pass a catheter through the obstructed area. Suprapubic catheters offer several advantages in this situation:
They avoid further irritation or damage to the urethral tissues.
They provide a more comfortable and convenient option for long-term bladder drainage.
They may reduce the risk of UTIs compared to indwelling urethral catheters.