Which finding after a cesarean birth involving PCA morphine use would require clinical attention?

• A. Urine output 20 mL/hr
• B. Oxygen saturation 98% on room air
• C. Blood pressure 118/76 mmHg
• D. Respiratory rate 20 breaths/min

Answer: (A)

Opioid analgesics given through a PCA after cesarean birth can slow bladder emptying, leading to urinary retention. The key signal of this issue is reduced urine output, especially when other vital signs are stable. A urine output of 20 mL per hour is below the expected minimum (normal is roughly 30 mL/hour or more, and about 0.5 mL/kg/hour for adults). This suggests the bladder may not be emptying properly, which can be caused by opioid effects on the detrusor muscle and external sphincter, and it warrants further assessment.

What to do next is to evaluate for urinary retention: perform a bladder scan or palpate for a distended bladder, ask the patient about sensations to void, and measure ongoing urine output. If retention is present, nursing actions include facilitating voiding if possible, ensuring adequate hydration, and following protocol for intermittent catheterization or adjusting pain management to reduce opioid load (using non-opioid analgesics as appropriate). The other findings—normal oxygen saturation, blood pressure, and respiratory rate—do not indicate acute distress and thus are less concerning in this context.