| Course | NR 224 Fundamentals: Skills |
|---|---|
| Week | 3 |
| Paper type | Procedure rationale paper |
| Length | About 1,090 words, 3 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | BSN (pre-licensure) |
| Updated | October 2026 |
Free sample paper for NR 224 Week 3
Procedure Rationale: Inserting an Indwelling Urinary Catheter in a 72-Year-Old Woman With Retention, One Clause for Every Step
Student Name
College of Nursing, Chamberlain University
NR 224: Fundamentals: Skills
Instructor Name
Month Day, Year
Procedure Rationale: Inserting an Indwelling Urinary Catheter in a 72-Year-Old Woman With Retention, One Clause for Every Step
The Patient in the Bed
Mrs. D. is 72, on the first day after a hip replacement under spinal anesthesia. She has not passed urine in eight hours despite trying, her lower abdomen is full and tender, and a bladder scan shows about 750 mL. The provider has ordered an indwelling urinary catheter because a single in-and-out catheterization four hours ago was followed by retention again. Her history includes mild dementia; she is oriented to person and place but not to time. Details are composite.
The indication matters before any step is performed. The national guideline on preventing catheter-associated urinary tract infections lists acute urinary retention or obstruction among the appropriate reasons for an indwelling catheter, and recommends inserting catheters only for appropriate indications and leaving them in only as long as needed (Gould et al., 2010). Mrs. D. meets the indication. The plan, written on her chart, is to review the catheter daily and remove it as soon as she can void.
The Steps and Their Reasons
Table 1 gives each step as an action someone could watch me do, and beside it one clause saying what goes wrong without it.
Table 1
Steps for Indwelling Catheter Insertion With the Harm Each Prevents
| Step | Without it |
|---|---|
| Confirm the order, the indication and her identity with two identifiers | The wrong patient, or a catheter placed with no reason, which carries infection risk for no benefit |
| Explain in short sentences and ask her daughter to stay by her head | A confused patient startles, moves her legs and contaminates the field |
| Raise the bed to working height; position her supine with knees bent and apart, hip precautions kept, with a second nurse supporting the operated leg | A dislocated new hip, or a nurse bending so far the field is touched with a sleeve |
| Clean hands; wash the perineum with soap and water before opening the kit | Stool or skin bacteria carried into the urethra on the catheter tip |
| Open the kit on the over-bed table at waist height, first flap away from me | Reaching over the sterile field and contaminating it |
| Put on sterile gloves; place the drape without touching her skin | Gloves no longer sterile before the procedure starts |
| Lubricate the tip generously; do not pre-inflate the balloon to test it | Urethral trauma and pain from a dry tip; a pre-tested balloon can crease and injure, and many manufacturers advise against it |
| Separate the labia with the nondominant hand and keep it there until the catheter is in | The labia close over the cleaned meatus and recontaminate it |
| Clean front to back with each swab once, center last | Bacteria from the anal area moved toward the urethra |
| Insert with the dominant hand until urine flows, then 2 to 3 cm further | Inflating the balloon in the urethra, which causes serious injury |
| Inflate the balloon with the volume printed on the port; stop if she reports pain | A balloon in the wrong place, or a catheter that falls out |
| Secure the tubing to her thigh with slack; hang the bag below the bladder, off the floor | Urethral pulling with every movement; backflow of urine into the bladder |
| Record time, size, balloon volume, urine volume and appearance, and her tolerance | No baseline for the daily review and no record of what was placed |
Note. Steps follow the unit's procedure and the kit's instructions for a 14 French catheter.
Why This Step and Not the Next One
Some steps look interchangeable and are not. The perineal wash with soap and water comes before the kit is opened because once sterile gloves are on, my hands cannot touch anything unclean, and a wash done after gloving would require regloving. The balloon is inflated only after urine flows and the catheter has been advanced a little further, because urine flow confirms the tip is in the bladder, and the extra distance ensures the balloon, which sits a short way back from the tip, is also in the bladder rather than in the urethra. The catheter is secured before the patient moves, because an unsecured catheter pulls at the bladder neck with every turn.
The guideline supports the steps that matter most for infection: aseptic technique and sterile equipment for insertion, the smallest catheter that will drain the bladder, secure fixation, a closed drainage system, and keeping the bag below the bladder and off the floor (Gould et al., 2010). The table's reasons for those steps come from that guidance, not from habit.
Somebody Is in the Bed
Mrs. D. is not a manikin, and two parts of the procedure exist because of her. Her new hip means that her position is set by the hip precautions, not by the textbook picture, so a second nurse supports her leg and I work within a narrower space. Her dementia means she may not remember my explanation from one minute to the next; her daughter's presence at the head of the bed and my short, repeated sentences, "You'll feel me cleaning now; this will feel cold," are part of keeping the field sterile, because a startled patient moves.
Where the Procedure Would Stop
The procedure has three stopping points. If the catheter meets resistance that does not ease with gentle pressure and the patient taking a slow breath, I stop, because forcing it can create a false passage in the urethra, and I call the provider. If no urine appears after the catheter is inserted to the expected depth, I check whether it has entered the vagina instead; if so, it stays in place as a marker while a new sterile catheter is inserted into the urethra, since the first is now contaminated. And if Mrs. D. reports sharp pain as the balloon inflates, I stop inflating, deflate it, and advance the catheter slightly before trying again, because pain at that moment suggests the balloon is not in the bladder.
The procedure also stops, in a sense, when the reason for it ends. A catheter placed for retention after surgery should come out as soon as she can void. The daily review is written into the plan because the most common harm from a catheter is not from inserting it but from leaving it in.
References
Gould, C. V., Umscheid, C. A., Agarwal, R. K., Kuntz, G., & Pegues, D. A. (2010). Guideline for prevention of catheter-associated urinary tract infections 2009. Infection Control & Hospital Epidemiology, 31(4), 319-326. https://doi.org/10.1086/651091
NR 224 Week 3 instructions, in plain terms
The Week 3 assignment asks for a written rationale for a nursing procedure, often one taught in the skills lab such as urinary catheter insertion, a sterile dressing change or medication administration. Expect to list the steps and give an evidence-based reason for each. Many sections ask for a patient scenario and a few APA pages citing a guideline or textbook. The task rewards reasons tied to a harm, such as infection, injury or the wrong patient, rather than reasons like comfort or tidiness. The indication for the procedure belongs at the start. Hand hygiene and identity checks are steps with reasons too. A good rationale also says when the procedure should stop.
How the NR 224 Week 3 example is put together
The paper opens on Mrs. D., 72, eight hours without voiding after spinal anesthesia, with about 750 mL on the bladder scan. The indication is checked against the CAUTI guideline before any step. Table 1 lists every step, from confirming the order and two identifiers to securing the tubing, each beside one clause saying what goes wrong without it. A section explains why the perineal wash comes before the kit is opened. Gould et al. (2010) support the infection steps. Another section shows her hip precautions setting her position and her daughter's role. Three stopping points follow: resistance, no urine and her own refusal, plus daily review for removal.
NR 224 Week 3 rubric: what full points look like
Rationale papers are usually graded on correct sequence, the quality of each reason, use of evidence, application to the patient and APA mechanics. Reasons carry the most marks, so every step names the harm it prevents rather than a preference. Sequence matters when order changes the outcome, and the sample defends the order of the wash, gloving and balloon inflation. Evidence counts when it is a current guideline used for specific steps, such as catheter size and keeping the bag below the bladder. Application to the patient shows in the hip precautions and the daughter's presence. Naming stopping points demonstrates the safety judgment that many criteria for this course describe.
NR 224 Week 3 help: mistakes that cost points
The most expensive version is a recipe: steps copied neatly and not one reason given. Another loses points with reasons that are preferences, comfort offered where infection is the answer. A write-up with no patient in it cannot show judgment, because nothing can go wrong. Leaving out hand hygiene or identity checks as obvious costs points every time. Reasons with no source behind them are weak. Not naming a stopping point makes the procedure read as something that always finishes. If your section assigned a different skill, the same table works for it. Send the skill and your scenario, and a model rationale can be written with reasons for every step.
Get a NR 224 Week 3 example written to your instructions
Send the assignment instructions, the rubric and the skill checklist your lab uses, and a custom NR 224 rationale is written against that exact procedure and returned inside 24 to 48 hours, the first one free. Steps and equipment vary by term and by instructor, so an example built on your own checklist is worth considerably more than one built on a textbook version.
More NR 224 papers and pre-licensure samples
- NR 224 Week 1: One Small Safety Action Post
- NR 224 Week 2: C. diff Contact Precautions Write-Up
- NR 224 Week 4: Vital Signs Write-up
- NR 224 Week 5: Safety Scenario Response
- NR 224 Week 6: Wound Care Write-up
- NR 224 Week 7: Charting Exercise
- NR 224 Week 8: Skills Reflection
- NR 226 Week 3: Nursing Diagnosis Exercise
- NR 222 Week 3: Family Assessment Paper
- NR 228 Week 3: Nutrient Report
- NR 103 Week 3: RN Role and Delegation Paper
NR 224 Week 3 questions, answered
Which skill should the example use?
Whichever one your lab covered that week, since equipment and order differ and a grader marks the version taught in your own section. If the assignment leaves the choice open, a procedure with several steps that could be reordered gives you more to argue about than one that runs in only a single possible direction.
How long is a rationale supposed to be?
Shorter than most people expect, because the reasons are clauses rather than paragraphs. The length comes from the number of steps, not from elaboration on each. If a write-up is running long, it is usually because principles are being explained twice over, once at the top and again beside every individual step.
Do I have to include hand hygiene and identity checks?
Yes, every time, and leaving them out because they feel too obvious to write is among the most common deductions on this assignment. A marker cannot award what is not on the page. The steps everybody assumes are the ones a rubric checks first, precisely because they are the ones skipped in a hurry.
Where can I find a free NR 224 Week 3 sample paper?
The whole Week 3 catheter insertion rationale, with the step table, the stopping points and the CAUTI guideline, appears further down this page.
When does the NR 224 Week 3 procedure stop?
It stops for resistance that does not ease, for no urine returning after correct placement and if Mrs. D. withdraws consent, and the catheter is reviewed daily for removal.