| Course | NU140 Nursing Fundamentals |
|---|---|
| Unit | Unit 3 |
| Paper type | Care plan |
| Length | About 860 words, 6 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | BSN (prelicensure) |
| Updated | October 2026 |
Free sample paper for NU140 Unit 3
Eight Hours and No Void: A Single-Problem Care Plan for Impaired Urinary Elimination in a Composite 44-Year-Old Woman After Hemorrhoidectomy Under Spinal Anesthesia, From Cues to Evaluation
[Student Name]
Purdue University Global
NU140: Nursing Fundamentals
Unit 3 Care Plan
[Instructor Name]
[Date]
The patient is composite; values and times are bracketed where illustrative, and the plan follows a typical five-column format given here as sections.
The Patient
[Ms. R.], a composite 44-year-old office manager, had a hemorrhoidectomy this morning under spinal anesthesia. She received [1,600] mL of IV fluid during and after surgery and has had sips of water since. It is now [6 p.m.], about eight hours after the spinal was placed, and she has not urinated. She says she feels "full and crampy" above the pubic bone and is afraid that bearing down will hurt the surgical site. She rates the incision pain at [6] on a ten-point scale. She has no history of urinary problems.
Assessment Cues
Subjective cues: no urge to void until the last hour, now a sense of fullness and cramping; fear of pain with straining.
Objective cues: no void in eight hours despite IV fluids; a firm, rounded swelling palpable above the pubic bone; bladder scan showing [720] mL of urine; heart rate [96], slightly above her preoperative [78]; incision pain rated [6].
Contributing factors: spinal anesthesia, which temporarily blocks the nerves that signal bladder fullness and allow emptying; anorectal surgery, which is associated with a higher risk of urinary retention, likely through pain and reflex tightening of the pelvic floor; IV fluid volume; and anxiety (Baldini et al., 2009).
Nursing Diagnosis
Urinary retention related to residual effects of spinal anesthesia and pain-related pelvic floor guarding after anorectal surgery, as evidenced by no void in eight hours, bladder distention on palpation, a bladder scan volume of 720 mL and the patient's report of fullness (Herdman et al., 2024).
The diagnosis names two causes, the anesthetic and the pain, because each points to different interventions.
Expected Outcome
Ms. R. will empty her bladder, with a post-void residual under [150] mL, within two hours, and will void at least every four to six hours for the next 24 hours without needing a catheter again.
Interventions and Rationales
1. Control incision pain before attempting to void: give the prescribed analgesic and wait for it to take effect. Rationale: pain causes reflex tightening of the pelvic floor muscles and urethral sphincter, which makes voiding harder after anorectal surgery.
2. Help her to the bathroom or onto a commode rather than a bedpan, with privacy and time. Rationale: a normal upright position and privacy make voiding easier than a bedpan in bed.
3. Use sensory cues: run water at the sink, place her feet flat on the floor, and offer a warm sitz bath if her surgeon permits. Rationale: running water and warmth can relax the pelvic floor and trigger the voiding reflex; a sitz bath also eases incision pain.
4. Reassure her that relaxing, not straining, is what helps, and that voiding will not tear the incision. Rationale: fear increases muscle tension; accurate information reduces it.
5. Rescan the bladder after any void. Rationale: a void does not prove emptying; residual volume shows whether retention persists.
6. If she cannot void and the scan shows more than about [600] mL, contact the provider about a single in-and-out catheterization according to protocol. Rationale: overfilling the bladder can stretch the muscle and prolong retention, and intermittent catheterization relieves it with less infection risk than an indwelling catheter (Baldini et al., 2009).
7. Record intake and output for 24 hours. Rationale: a pattern of small voids with large residuals would show retention returning.
Implementation Note
After her analgesic took effect, Ms. R. walked to the bathroom, sat with the water running and voided [480] mL after several minutes. A bladder scan afterward showed [260] mL remaining. Because the residual was above the target, she was helped into a warm sitz bath and tried again an hour later, voiding [210] mL with a residual of [70] mL.
Teaching Before Discharge
Because retention can return at home, Ms. R. is taught three things: to urinate at least every four to six hours even without a strong urge, to take her pain medicine before trying if the incision is sore, and to call the surgeon's office if eight hours pass without passing urine or if she feels fullness that does not ease after voiding. She repeats the three points back in her own order, and her partner writes down the office number.
Evaluation
The outcome was partly met at two hours and fully met at three: her bladder emptied with a residual under 150 mL without catheterization. Over the next 24 hours she voided every four to five hours with residuals under [100] mL. The plan is continued with pain control before voiding and is revised to add a scan after the first void each shift until discharge, since the first void left a large residual. Explaining the reason for each step helped her relax, which she identified as the most useful part of the plan (Potter et al., 2023).
References
Baldini, G., Bagry, H., Aprikian, A., Carli, F., Warner, D. S., & Warner, M. A. (2009). Postoperative urinary retention: Anesthetic and perioperative considerations. Anesthesiology, 110(5), 1139-1157. https://doi.org/10.1097/ALN.0b013e31819f7aea
Herdman, T. H., Kamitsuru, S., & Takáo Lopes, C. (Eds.). (2024). NANDA International nursing diagnoses: Definitions and classification, 2024-2026 (13th ed.). Thieme.
Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2023). Fundamentals of nursing (11th ed.). Elsevier.
The Purdue Global NU140 Unit 3 instructions
Unit 3 usually asks for a care plan built around one nursing problem, so that each part can be judged closely. Prompts typically want assessment cues separated into subjective and objective data, a nursing diagnosis with its related factors and defining characteristics, a measurable and dated outcome, interventions with rationales, and an evaluation of whether the outcome was met. A five-column table or equivalent sections is the common format. Faculty look for internal consistency: the cues should support the diagnosis, the related factors should drive the interventions, and the outcome should be something the evaluation can actually measure. Rationales should explain why an action works for this patient, supported by the course text or evidence.
How the NU 140 Unit 3 example is put together
The plan opens with the patient, her surgery, her IV fluid volume and her fear of pain. Assessment cues are divided into subjective, objective and contributing factors, citing a review of postoperative urinary retention. The diagnosis names urinary retention with two causes, and the highlighted line explains why both are named. The outcome sets a residual under 150 mL within two hours and regular voiding for a day. Seven numbered interventions follow, each with its rationale. An implementation note describes the first void and its residual, and a teaching section lists three points for home. The evaluation reports the outcome met at three hours and revises the plan to add a scan after each shift's first void.
Where the points sit in the NU140 Unit 3 rubric
Care plans in NU 140 tend to earn points for accurate assessment, a correctly written diagnosis, measurable outcomes, rationales, and evaluation. Assessment credit goes to cues that are specific and clearly sorted. The diagnosis is judged on correct format, with related factors and defining characteristics that match the cues. Outcome points require a measurable, time-limited statement centered on the patient. Rationales earn the most when they explain why each action addresses the stated cause. Evaluation is graded on whether it compares results with the outcome and revises the plan when needed. Consistency from column to column matters throughout, and a single well-built problem is valued over several thin ones.
NU140 Unit 3 help from the desk
Care plans often lose points when the diagnosis lists symptoms instead of causes, which leaves interventions without a target. Another frequent issue is an outcome that cannot be measured, such as "patient will be comfortable." Some plans list routine actions that apply to any surgical patient rather than to this problem. Many end with "goal met" and no data. Write cues that point clearly to the diagnosis, name the cause in the related-to statement, make the outcome measurable and dated, link each intervention to the cause, and in evaluation report the actual numbers, then revise the plan if the result falls short.
Get an NU140 Unit 3 example written to your instructions
Three things let the plan match your section: the Unit 3 scenario, the column template and the rubric. Mention any approved diagnosis list as well, since the wording follows it. A first custom sample costs nothing and is typically ready in 24-48h, built on that scenario's data rather than on the airway case above. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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NU140 Unit 3 questions, answered
Where can I find a free NU140 Unit 3 sample paper?
This page presents the full NU140 Unit 3 care plan for urinary retention after anorectal surgery, from cues and diagnosis through outcome, seven interventions with rationales, teaching and evaluation with revision, with three references. A single-problem plan for your assigned patient can be prepared for you.
Why does the NU140 Unit 3 diagnosis name two causes?
Spinal anesthesia and pain-related pelvic floor guarding each contribute, and each calls for different interventions: time and positioning for the anesthetic effect, pain control before voiding for the guarding.
What is a post-void residual?
The volume of urine left in the bladder after urinating, often measured with a bladder scanner. A void alone does not prove the bladder emptied, so the plan sets a residual target.
When is catheterization used for urinary retention?
When the patient cannot void and the bladder scan shows a large volume, according to protocol. A single in-and-out catheterization relieves retention with less infection risk than leaving a catheter in place.
How is the care plan revised in this sample?
Her first void left a residual above target, so a warm sitz bath and a second attempt followed, and the plan was revised to add a bladder scan after the first void each shift until discharge.