Inpatient Rounds - follow up

DAILY PROGRESS NOTE SYNOPSIS: A 68-year-old male with a history of prostate cancer, status post-radical prostatectomy, and recent urinary retention. He is admitted for management of a urinary tract infection and ongoing urinary retention. 24 HOUR EVENTS: Patient had a fever of 38.5°C. Blood cultures were drawn. Foley catheter was irrigated and yielded purulent material. Patient reported increased suprapubic discomfort. SUBJECTIVE: Patient reports, "I'm still having a lot of trouble passing urine, and the pain is getting worse." OBJECTIVE: "Vital signs last 24h:" Max temp 38.5°C, current temp 37.8°C, HR 88 bpm (range 60-100 bpm), BP 130/80 mmHg (range 120/80-140/90 mmHg), SpO₂ 98% (range 95-100%), RR 18. "Intake and Output:" Intake 1500 mL, Output 1200 mL in last 24 hours; Intake 500 mL, Output 400 mL in last 8 hours. "Drains:" Foley catheter. PHYSICAL EXAM: Abdomen soft, non-tender to palpation. Suprapubic tenderness present. Foley catheter patent with cloudy urine. LABS, IMAGING, AND OTHER STUDIES: "Radiology: Recent imaging studies have been reviewed and are notable for" No recent imaging. "Laboratory: All recent labs have been reviewed. Pertinent labs include" Creatinine 1.1 mg/dL (stable), Hematocrit 38% (stable). "Microbiology data: All recent micro results have been reviewed. Pertinent micro results include" Blood cultures pending. Urine culture pending. ASSESSMENT AND PLAN: 68-year-old male with prostate cancer, urinary retention, and UTI. 1. Urinary Tract Infection Assessment: Patient is showing signs of systemic infection, with fever and increased suprapubic pain. Blood and urine cultures are pending. Plan: * Continue IV antibiotics (Ceftriaxone) as prescribed. * Monitor vital signs, including temperature, every 4 hours. * Monitor urine output and characteristics. * Repeat urinalysis and urine culture in 24 hours. * Administer IV fluids as needed. * Consult infectious disease if blood cultures are positive. 2. Urinary Retention Assessment: Patient continues to experience urinary retention, despite Foley catheter placement. Plan: * Continue Foley catheter irrigation with sterile saline. * Assess for catheter blockage or kinking. * Consider bladder scan to assess for residual urine after catheter removal. * Educate patient on signs and symptoms of urinary retention. 3. Prostate Cancer Assessment: Patient is status post-radical prostatectomy and is being monitored for recurrence. Plan: * Review PSA results when available. * Schedule follow-up appointment with oncologist as needed.