SCRIPT
URINARY RETENTION IN PATIENT WITH S1-
S2 LESION
SCENARIO #181
NAME
PIERCE DANO
MEDICAL CATEGORY
UROLOGY
SCENARIO DIFFICULTY
BASIC
SIMULATION ENVIRONMENT
EMERGENCY ROOM
These patients are not real patients and their clinical cases, whilst clinically plausible, are fictional.
Scenario
General description of the scenario info. Corresponds to the initial information presented to the trainee when
selecting this scenario.
Title
Urinary retention in patient with S1-S2 lesion
Context
Patient hospitalized four weeks after a car accident.
Briefing
A 20-year-old male victim of a motor vehicle accident four weeks ago resulted in: mild ECD
and spinal cord injury in S1-S2 with loss of sensitive and motor function. The patient is
currently conscious. Urinary catheter removal was performed 6 hours ago and the patient has
not yet urinated.
General learning goal
Adequate approach to a case of urinary retention
Specific learning goals
Identify signs of urinary retention
Identify diagnostic activities that lead to acquiring data with referencial integrity to diagnose
urinary retention
Implement interventions with referential integrity to urinary retention diagnosis
Evaluate effectiveness of implemented interventions
Environment
Emergency room
Category
Urology
Difficulty
Basic
Patient Characteristics
Characterization of the patient's demographic, habits, behaviour and specific status effects.
Avatar
First name Last name
Pierce Dano
Age Gender
20 Male
Date: 17/04/2018
Race/Ethnicity
Caucasian
Model
Smoker Conscious
No Yes
Sedated Confused
No No
Agitated Last meal over 2h
No Yes
Acetylsalicylic acid intolerance Facial palsy
No 0
Speech impairment Eyeblink reflex impairment
No 0
Patient Parameters
These parameter values are used by the simulator to initialize this scenario.
Systolic arterial blood pressure (mmHg) Diastolic arterial blood pressure (mmHg)
105 65
Heart rate (bpm) O2 saturation (%)
80 95
Respiratory rate (/min) Blood glucose (mg/dL)
14 90
Temperature (ºC) Hemoglobin (g/dL)
36.7 12.9
Urinary output (mL/kg/h) Height (cm)
0 160
Weight (kg) End-tidal CO2 (mmHg)
70 -
Potassium (mEq/L) Sodium (mEq/L)
4.1 139
Date: 17/04/2018
Chloride (mEq/L) Calcium (mg/dL)
- -
Speech rate (speed multiplier)
-
ABCDE assessment
The items below characterize the patient's physical examination findings on admission.
Airway
Airway observation 2nd Priority Clear airway.
Breathing
Respiratory rate 2nd Priority 14 /min
(breath/min)
O2 Sat (%) 2nd Priority 95 %
Chest percussion Not a priority Right: 1R - resonance; 2R - resonance; 3R -
resonance; 4R - resonance; 5R - resonance
Left: 1L - resonance; 2L - resonance; 3L -
superficial cardiac dullness; 4L - superficial
cardiac dullness; 5L - resonance
Chest palpation Not a priority 2L - normal; 2R - normal
Pulmonary auscultation Not a priority Clear to auscultation, with normal vesicular
murmurs in all sites.
Circulation
Heart rate (bpm) 2nd Priority 80 bpm
Pulse palpation 2nd Priority Carotid - Amplitude: strong; Rhythmic;
Radial - Amplitude: strong; Rhythmic, both
sides equal;
Femoral - Amplitude: strong; Rhythmic, both
sides equal;
Dorsalis pedis &Posterior tibial - Amplitude:
strong; Rhythmic, both sides equal;
Popliteal - Amplitude: strong; Rhythmic, both
sides equal.
Blood pressure (mmHg) 2nd Priority 105/65 mmHg
Capillary refill time 2nd Priority 2.5 s
(seconds)
Heart auscultation Not a priority n.a.
Disability
Pupil light reflex 2nd Priority Right: Size - 4 mm; Right eye light: 2 mm;
Left eye light: 2 mmLeft: Size - 4 mm; Right
eye light: 2 mm; Left eye light: 2 mm
Glasgow Coma Scale 2nd Priority 15 (E-4; V-5; M-6)
Date: 17/04/2018
Blood Glucose (mg/dL) 2nd Priority 90 mg/dL
Exposure
Abdominal auscultation Not a priority n.a.
Abdominal percussion Not a priority Dullness to percussion in lower abdomen
Abdominal palpation 1st Priority Hypogastric distension
Temperature (°C) Not a priority n.a.
Dialogues
This is a complete list of all the possible dialogue lines both by the health practitioner (on the left) and respective
responses by the patient (on the right).
Medical condition
1. Currently, how do you 1st Priority I feel good, as far as possible.
feel?
2. Are you feeling any 1st Priority No.
discomfort?
3. Are you feeling any pain? 2nd Priority I don't feel any pain now.
4. Do you feel like 1st Priority No.
urinating?
Medication
1. Are you taking any 2nd Priority Yes.
medication?
Nutrition
1. What do you usually eat? Not a priority I eat about everything. I'm not picky.
State of consciousness
1. Please tell us your full 1st Priority Pierce Dano
name.
2. Could you please tell us 1st Priority I am 20 years old.
your age?
3. Can you tell me where 1st Priority In the hospital.
you are?
4. Do you know what month 1st Priority Yes, I do.
it is?
Date: 17/04/2018
Diagnostic strategies
The items below characterize the test results that are possible during this scenario, including rules that may condition
test results.
Bacteriological
examinations
Blood cultures Not a priority No significant alterations.
Electrophysiology
12-Lead ECG Not a priority No significant alterations.
Imaging
Chest CT scan Not a priority No significant alterations.
Chest X-ray Not a priority No significant alterations.
Transesophageal echo Not a priority No significant alterations.
Transthoracic echo Not a priority No significant alterations.
Lab tests
Arterial blood gas Not a priority No significant alterations.
Biochemistry Not a priority No significant alterations.
Cardiac markers Not a priority No significant alterations.
Complete blood count Not a priority No significant alterations.
Lipid profile Not a priority No significant alterations.
Date: 17/04/2018
Baseline
This graph is automatically generated and predicts scenario behaviour assuming no actions by the trainee, which
usually represents the worst case scenario.
Date: 17/04/2018
Optimal Clinical Approach
This graph previews how the optimal approach resolves the scenario successfully. Comparison with Baseline may be
useful to understand the scenario behaviour.
Date: 17/04/2018
Health Conditions
This section characterizes the illnesses, or Health conditions, the patient may be afflicted with in this scenario. These
serve important foundational purposes in the Scenario, as they can be used to: affect what the patient says in
Dialogues; influence how the patient deteriorates over time; condition Examination, Medical test and Call results; and
determine the adequate Clinical approach required to solve the case successfully.
Critical Health Conditions
Anuria
Description: Absent urinary output. Does not directly lead to other conditions.
Solution: Diuretics. If SAP < 90, Fluids also help.
Urinary retention
Description: Inability to empty the bladder. Does not directly lead to other conditions.
Solution: Urinary catheterization.
Treatments Priorities
Treatment items that are considered necessary or adequate to solve this scenario are listed below. Notes: 1st Priority
- mandatory items to solve the case successfully. 2nd Priority - optional items that are considered adequate, but are
not essential. Not a Priority - unnecessary items that are considered inadequate or a waste of time.
Interventions
Inner thigh stimulation
Inner thigh 1st Priority
Suprapubic stimulation
Suprapubic region 1st Priority
Urinary catheter
Urinary catheterization 1st Priority
Differential Diagnosis
Multiple choice question presented to the trainee in order to confirm whether they got the diagnosis right.
Correct answer Urinary retention
3 Incorrect answers Overflow urinary incontinence
Impaired urinary elimination
Reflex urinary incontinence
Ending Messages
Feedback messages presented to trainees for particular successful or failed approaches and the respective
conditional rules that trigger these messages.
Message Conditional
Date: 17/04/2018
Success Congratulations, Suprapubic and inner thigh stimulation
your practice meets massages followed by residual volume
the guidelines' monitoring through urinary catheterization.
requirements. Total
drained urine
volume of 750 mL
through urinary
catheterization.
Failure Compliance with Perform urinary catheterization as first
the guidelines' intervention.
requirements was
not achieved. Try
again!
References
1. DOENGES, Marilynn E.; MOORHOUSE, Mary Frances. Aplicação do processo de
enfermagem e do diagnóstico de enfermagem: um texto interativo para o raciocínio
diagnóstico. Loures. Lusociência, 2010. ISBN 978-972-8930-57-8.
2. INTERNATIONAL COUNCIL OF NURSES – International Classification for Nursing
Practice [em linha]. Versão 2015. Switzerland: International Council of Nurses, 2015, [consult.
23/05/2017]. Disponível em linha http://www.icn.ch/ICNP-Browser-NEW.html
3. NATIONAL CLINICAL GUIDELINE CENTRE (2010). The management of lower urinary
tract symptoms in men: methods, evidence & guidance. Reviewed 2015. National Clinical
Guideline Centre. Https://www.nice.org.uk/guidance/cg97
4. NATIONAL CLINICAL GUIDELINE CENTRE (2012). Urinary incontinence in neurological
disease: assessment and management. Clinical guideline Published: 8 August 2012. [consult.
23/05/2017]. Disponível em linha nice.org.uk/guidance/cg148
5. NIËL-WEISE BS, VAN DEN BROEK PJ, DA SILVA EMK, SILVA LA. Urinary catheter
policies for long-term bladder drainage. Cochrane Database of Systematic Reviews 2012,
Issue 8. Art. No.: CD004201. DOI: 10.1002/14651858.CD004201.pub
6. NORTH AMERICAN NURSING DIAGNOSIS ASSOCIATION . Diagnósticos de
Enfermagem da NANDA: definições e classificação 2015-17. Porto Alegre: Artmed, 2015.
7. ORDEM DOS ENFERMEIROS - Guia de Boa Pratica de Cuidados de Enfermagem a
Pessoa com Traumatismo VertebroMedular. Edição: Ordem dos Enfermeiros – Março de
2009. ISBN: 978-989-96021-2-0.
8. PANNEK, J. et al. Guidelines on Neurogenic Lower Urinary Tract Dysfunction. European
Association of Urology 2013. SCHUB Tanja. Neurogenic Bladder.
9. CINAHL Nursing Guide, EBSCO Publishing June 17. 2016
Date: 17/04/2018
