Medical History:

5 myocardial infarctions

Diagnosed with CHF

Clinical manifestations of heart failure: peripheral edema (2+/4+), orthopnea, paroxysmal nocturnal
dyspnea, respiratory crackling

2 vessel coronary artery bypass surgery

Infected wound from vessel graft site

6 weeks of antibacterial treatment; 2X daily dressing changes by his wife & home health nurse

Medications to manage heart problems:

Lanoxin (digoxin) 0.25 mg daily

Lasix (furosemide) 80 mg 2X daily

Zocor (simvastatin) 10 mg daily

Vasotec (enalapril) 5 mg daily

Patient habits:

Doesnt eat well

Fluid intake: <1,000 mL/day

Lost 10 lbs in the past 2 months

Wife states: doesnt sleep in bed anymore

History:

Urinary retention

Indwelling catheter

6 months ago: urologist performed surgery for benign prostatic hypertrophy

Home care nurse visits every 2 weeks

Home health visits:

Visits every 2 weeks

Orders include urinary catheter management with monthly changes, medication surveillance, cardiac
assessment

Nurse notices 150 mL urine in drainage bag in the morning

Wife states: He has not emptied bag since last night at 6 pm, blue pad in his chair was wet and smelled
strongly. Also noticed blood clots in his tubing last night when she emptied the bad

Nurse: notices small amount of purulent drainage from urethra

Nurse changes catheter and notices small amount of bloody urine and catheters insertion

Client reports: mild lower back pain which he attributes to lying in bed too long

Vitals:

BP 130/90 mmHg

HR: 98 BPM & regular

Respiratory rate: 20 breaths/min & regular

Oral temperature: 97.8 F

Nurse changes catheter and notices small amount of bloody urine and catheters insertion

Calls physician and draws blood for cell blood count with differential

WBC elevated at 18,000 mm3