Acute Pyelonephritis

ACUTE PYELONEPHRITIS

I. INTRODUCTION

Pyelonephritis is a kidney infection usually caused by bacteria that have traveled to the kidney from an infection in the bladder. It is most often occurs as a result of urinary tract infection, particularly in the presence of occasional or persistent backflow of urine from the bladder into the ureters or kidney pelvis (vesicoureteric reflux).

There are two types of Pyelonephritis: Acute uncomplicated pyelonephritis and chronic pyelonephritis. They differ primarily in their clinical picture and long-term effects. Acute uncomplicated pyelonephritis is a sudden development of kidney inflammation while chronic pyelonephritis is a long-standing infection that does not clear.

Acute pyelonephritis is a potentially organ- and/or life-threatening infection that characteristically causes some scarring of the kidney with each infection and may lead to significant damage to the kidney (any given episode), kidney failure, abscess formation (eg, nephric, perinephric), sepsis, or sepsis syndrome/shock/multiorgan system failure. Wide variation exists in the clinical presentation, severity, options, and disposition of acute pyelonephritis.

Diagnosing and managing acute pyelonephritis is not always straightforward. In the age range of 5-65 years, it typically presents in the context of a symptomatic (eg, dysuria, frequency, urgency, gross hematuria, suprapubic pain) urinary tract infection (UTI) with classic upper urinary tract symptoms (eg, flank pain, back pain) with or without systemic symptoms (eg, fever, chills, abdominal pain, nausea, vomiting) and signs (eg, fever, costovertebral angle tenderness) with or without leukocytosis. However, it can present with nonspecific symptoms.

In contrast to the plethora of data available for the treatment of lower UTI, less substantial data are available regarding the appropriate antibiotic choice or duration of therapy for acute pyelonephritis, but useful recommendations can be made. An additional cause for concern is the growing antimicrobial resistance to accepted standards of treatment. The current emphasis on cost effectiveness and the advent of newer antibiotics have led clinicians to reevaluate the benefit of hospitalization to treat patients with acute pyelonephritis; however, if the patient is managed as an outpatient, he or she should have close follow-up care. The first follow-up visit should occur in 1-2 days, depending on the clinician's estimation of the severity of the infection. Any deterioration or unsatisfactory improvement warrants admission for intravenous antibiotics and evaluation for any complications. Most cases of uncomplicated pyelonephritis in young women can be managed successfully on an outpatient basis.

The estimated annual incidence of pyelonephritis was 27.6 cases per 10,000 persons. Only 7% of cases required hospitalization. Escherichia coli caused 85% of cases, including 6 of 7 cases among inpatients for whom data were available. Of E. coli isolates, 85% were sensitive to trimethoprim-sulfamethoxazole, while 99% were susceptible to ciprofloxacin.

Local and Foreign trends

Our local trend is a health program/service made by the Department of Health which is about “Renal Disease Control Program (REDCOP)”

The REDCOP consists of the following components: RDR (Renal Disease Registry); Study on GN and Kidney Stones; Follow-up of PNP cases; and Organ Donation.

This is a relatively new program with the objective of reducing the mortality and morbidity rates caused by renal diseases. (http://www.doh.gov.ph/CHD-12-new/degenerative.htm)

We have researched a foreign trend about “Kidney-damaging Protein Offers Clue to New Treatment to Kidney Diseases”.

Scientists led by a University of Cincinnati (UC) kidney expert have found that a naturally occurring protein that normally fights cancer cells can also cause severe kidney failure when normal blood flow is disrupted. This finding, seen in mice in which the gene controlling the protein is actually expressed or "turned on," could provide a target for drugs that will reduce the risk of kidney damage in humans, the researchers believe.

Acute kidney failure is a life-threatening illness caused by sudden, severe loss of blood flow to the kidneys (ischemia). Despite advances in supportive care, such as dialysis, severe kidney injury is a major cause of death.

The scientists, headed by Manoocher Soleimani, MD, director of nephrology and hypertension at UC and the Cincinnati Veterans Affairs Medical Center, report their findings, the issue of the Journal of Clinical Investigation.

The protein, thrombospondin (TSP-1), is known for its role in fighting cancer. It does this by killing off cancer cells and preventing the tumor from building a greater blood supply.

Although TSP-1 causes irreversible, severe kidney damage when blood flow to mouse kidneys is disrupted, the researchers say, this only occurs in animals whose TSP-1 gene is turned on.

The study showed that the protein damages kidney cells when blood flow is reduced for 30 minutes or more. When blood flow is restored to the kidneys, if TSP-1 protein is present, normal kidney function doesn't return.

"This raises the important possibility that TSP-1 may serve as a target in preventing or successfully treating acute kidney failure," said Dr. Soleimani. "Understanding the mechanisms of kidney cell injury moves us that much closer to preventing this life-altering damage from happening.

"If we can develop a drug that will inhibit or turn off the TSP-1 gene function, then severe kidney damage could be prevented--even during a 30-minute disruption in blood flow," he said.

"Since the incidence of death remains high in patients with damaged kidneys, prevention or early treatment of acute kidney failure will increase survival."

The study showed that the damaging protein is released rapidly, in response to diminished blood flow, in mice that have the active TSP-1 gene. TSP-1 also killed kidney cells when exposed to them in a Petri dish.

"Most importantly," Dr. Soleimani said, "we found that genetically engineered mice, which lack TSP-1 protein, were significantly protected from kidney damage. Mice without TSP-1 preserved their kidney function relatively well, even after being subjected to a 30-minute disruption of blood flow to the kidneys.

"Consequently, this study raises an important possibility that TSP-1 may serve as a target for preventing or successfully treating acute kidney failure," Dr. Soleimani said. (Source: http//:www.sciencedaily.com)

A. Importance of the study

This study was a part of the partial requirement in NCM 104 (R.L.E.) of the Fourth year college students of the Dee Hwa Liong College Foundation. This study regarding Acute Pyelonephritis may serve as a reference for each student that will encounter this case soon in their future career as professional nurses. It may also help in developing and widening the knowledge of each health care provider to be more skillful and competent in rendering care among their client with same cases.

B. Objectives

Nurse – Centered Objectives

After the completion of the study, the nurse – researcher will be able to;

Gather the personal information of the client, from his / her past medical history and from the family’s health history Perform a complete physical assessment (cephalocaudal) of the client Make a comprehensive understanding and analysis regarding the laboratory and diagnostic findings, as a part of the nursing responsibilities of every nurse Identify the predisposing and precipitating factors of the client’s condition Determine the dependent and independent function as a nurse in rendering health care services.

Patient – Centered Objectives

Upon completion of the study, the patient will be able to;

Acquire and enhance knowledge about the disease, the factors that contribute to the development of the client’s condition Build trust and gain respect among the nurses and able to deepen information about his / her condition Meet the needs of the client in the best way possible, either physically, mentally, socially, spiritually and emotionally Perform self – care before the discharge of the client

II. NURSING ASSESSMENT

A. Personal Data

Ms. Pye, 18 years old, a Filipino was born at year 1992 and the eldest among the three children of Mr. and Mrs. Kidney. A roman catholic and an out-of-school youth

.B. History of past illness

Ms. Pye only experienced common cough and colds, fever and never been hospitalized. Her family believes on herbal medicines. Instead of going straight to the hospital for check-ups, they try to cure it using herbal medicines and if not successful, that’s the time they will seek medical advice. In the case of Ms. Pye, her godmother gave her powdered charcoal mixed in water to cure the disease.

Ms. Pye and her family also believed in superstitions, “pagtatawas” and “albularyo”

C. History of present illness

According to Ms. Pye she likes to eat junk foods while watching television and do not drink enough water. She just stays inside the house the whole day doing the household choirs.

Prior to admission, Ms. Pye experienced fever, vomiting and generalized body weakness for one week. Ms. Pye self medicated and took Biogesic and Alaxan. She also took powdered charcoal mixed in a glass of water as advised by her godmother.

She was rushed by her mother to Ospital Ning Angeles on June 16, 2010 at 9:10pm with chief complaint of fever and vomiting.

D. Physical examination

Upon Admission (June 16, 2010)Physical Examinations upon admission lifted from the chart are as follows:

Vital signs:Temp: 38.1 ºCPR: 89 bpmRR: 22 bpmBP: 120/90 mmHgAppearance: weak and paleEyes: slightly pale conjunctivaLungs: clear breath sounds, (-) rales, (-) wheezeHeart: (-) murmursAbdomen: soft tender abdomen, (-) bowel soundsExtremities: strong pulses, (-) cyanosis

1ST NPI (June 17, 2010)

Student Nurse-Patient interactionVital signs are the followingTemp: 37 ºCPR: 70 bpmRR: 18 bpmBP: 120/80 mmHg

Head and FaceSkull : symmetrical in shape, (-) nodules and massEyes : symmetrical, PEARRL, pink conjuncivaEars : symmetrical appearance of pinna, (-) dischargesNose : symmetrical nares, (-) bleeding and dischargesMouth : absence of swelling of lips and gums, no lesions and ulcerationsNeck : no swelling of lymph nodesIntegumentary: pale and dry skin, no clubbing of fingers

Chest : clear breath sounds, symmetrical chest expansionCardiovascular: NRRR, normal capillary refillGastrointestinal: normal bowel movement and soundsMusculoskeletalUpper extremities: normal muscle strength and ROMLower extremities: normal muscle strength and ROM

III. ANATOMY AND PHYSIOLOGY

Anatomy & Physiology of the Urinary System

Urinary System produces and excretes urine from the body. Urine is a transparent yellow

fluid containing unwanted wastes, mostly excess water, salts, and nitrogen compounds. The

major organs of the urinary system are the kidneys, a pair of bean-shaped organs that

continuously filter substances from the blood and produce urine. Urine flows from the

kidneys through two long, thin tubes called ureters. With the aid of gravity and wavelike

contractions, the ureters transport the urine to the bladder, a muscular vessel. The normal

adult bladder can store up to about 0.5 liter (1 pt) of urine, which it excretes through the

tubelike urethra.

An average adult produces about 1.5 liters (3 pt) of urine each day, and the body needs, at

a minimum, to excrete about 0.5 liter (1 pint) of urine daily to get rid of its waste products.

Excessive or inadequate production of urine may indicate illness and doctors often use

urinalysis (examination of a patient’s urine) as part of diagnosing disease. For instance, the

presence of glucose, or blood sugar, in the urine is a sign of diabetes mellitus; bacteria in the

urine signal an infection of the urinary system; and red blood cells in the urine may indicate

cancer of the urinary tract.

The kidneys lie embedded in fat tissue on either side of the backbone at about waist

level. Each fist-sized kidney is reddish-brown, weighs 140 to 160 g (5 to 6 oz), and is

similar in shape to the kidney beans sold at the supermarket.

On the inner border of each kidney is a depression called the hilum, where the renal

artery, the renal vein, and the ureter connect with the kidney (the adjective renal is from

the Latin term renalis, meaning of or near the kidneys). The renal artery delivers over

1700 liters (450 gal) of blood to the kidneys each day, which these organs filter and

return to the heart via the renal vein. Each kidney contains about 1 million microscopic

coiled channels, called nephrons, which perform this critical blood-filtering function and

produce urine in the process.

The bulblike upper portion of the kidney’s nephrons filters water; urea, the nitrogen-

containing breakdown product of protein; salts; glucose; amino acids, the building blocks

of proteins; yellow bile compounds from the liver; and other trace substances from the

blood. As this material moves through a long, looped tubule, many of these filtered

materials are reabsorbed into the blood to be reused by the body to maintain normal body

functions. Less than 1 percent of the water and other materials remain behind to be

excreted as waste products in the urine.

These waste materials then pass from the nephrons into a funnel-shaped area called

the renal pelvis. From the renal pelvis, waste trickles out of the kidney into the ureter,

which is about 25 to 30 cm (10 to 12 in) long and about 0.5 cm (0.2 in) in diameter. The

ureter empties into a hollow, muscular sac called the urinary bladder. A valvelike flap of

tissue at the point of entry into the bladder prevents urine from flowing backward into the

ureter. The urinary bladder is able to expand and contract according to how much urine it

contains. As it fills with urine, the walls of the bladder stretch and become thinner, with

the bladder itself lengthening to 12.5 cm (5 in) or more and holding up to about 0.5 liter

(1 pt) of urine. A ringlike sphincter muscle surrounds the bladder’s outlet and prevents

spontaneous emptying.

As the bladder becomes full, stretch-sensitive receptors in its walls are stimulated,

and the person becomes aware of the fullness. When the person is ready to urinate, or

expel urine, the sphincter relaxes and urine flows from the bladder to the outside through

the urethra. In females, the urethra is about 3.8 cm (1.5 in) long and is strictly a urinary

passage. In males, the urethra is about 20 cm (8 in) long; it passes through the penis and

also serves to convey semen during sexual intercourse.

In addition to their vital role in ridding the body of wastes through the production of

urine, kidneys play important regulatory roles. They maintain water balance, ensuring

that the amount of water in body tissues remains at a constant level. So, for example, if a

person drinks a lot of water one day, but little water the next, the kidneys are able to

adapt by regulating the water balance in the tissues. The kidneys also control calcium

levels in the blood to maintain healthy bones. They aid in regulating the acid-base

balance of the blood and body fluids so that all body processes can proceed smoothly. By

controlling salt levels, the kidneys help regulate blood pressure. Finally, they stimulate

the body to make red blood cells, the primary component of healthy blood. Properly

functioning kidneys are so vital to health that if they cease to function, death follows

within days.

IV. PATHOPHYSIOLOGY

PATHOPHYSIOLOGY THE DISEASE (BOOK BASED)

----PRECIPITATING FACTORS---- --PREDISPOSING FACTORS--

-Obstruction of urinary outflow -gender -Vesicoureteral reflux -older age -Neurogenic bladder -lifestyle -Renal disease -environment -Metabolic disturbances -pregnancy

-instrumentation -chronic analgesic abuse

Bacteria gain access to blood intestinal exogenous genitor-urinary m.o m.o m.o

Systematic arteriesurethra

Systemic circulation Ureters and bladder

Kidney

Infection Inflammation of renal tissue fever pain

Increase WBC and platelet small abscess in the calyx surface pain, bladder

irritation fever

Suppuration (Pus Formation) change of abscess to lesions pain, pyuria

bleeding in the mucousIncrease polymorphonuclea membrane of the adjacentleukocytes in the tubules and collecting systemin the interstitium surrounding the tubules

Necrosis of renal tissue dysuriaDestruction of segments of tubules

leukocyte casts may lead to renal failure (Accumulation of WBC)

PATHOPHYSIOLOGY THE DISEASE (PATIENT CENTERED)

----PRECIPITATING FACTORS---- --PREDISPOSING FACTORS-- -gender

-lifestyle

Bacterial invasion

intestinal exogenous genito-urinary m.o m.o m.o

urethra

Ureters and bladder

Kidney

Infection

Increase WBC & Inflammation of renal tissue

Pain, fever, chills, bladder irritation

V. DIAGNOSTIC AND LABORATORY PROCEDURES

Diagnostic/Laboratory Procedures

Indication or Purpose

Result/s Normal Values Analysis and interpretation of

results

Hematology

Hemoglobin

Hematocrit

A hemoglobin determination is used to evaluate the hemoglobin content (and thus the iron status and oxygen-carrying capacity) of erythrocytes by measuring the number of grams of hemoglobin per deciliter of blood.

Often used in replacement of the RBC count, the hematocrit is a measure of the volume of the RBCs in the whole blood expressed as a percentage.

116 g/dL

0.34%

M 140-180 g/dLF 120-160 g/dL

M 0.42 - 0.57 %F 0.37-0.47%

Result was below normal, means that low transport and exchange of oxygen to the tissues and carbon dioxide from the tissues.

The result was below the normal range which indicates low RBC/hemoglobin to the plasma level. It indicates anemia and oxygen insufficiency.

WBC

RBC

Lymphocytes

Helpful in the evaluation of the patient with infection, neoplasm, allergy or immunosuppression

RBC count is used to evaluate any type of decrease or increase in the number of red blood cells as measured per liter of blood.

Determine if there is enough cell that produces antibodies and other chemicals responsible for destroying microorganisms; contributes to allergic reactions, graft rejection, tumor control, and regulation of the immune system

16.9

4.01

.26 %

5-10 × 10 g/L

.

M 4.5-6.3×1012/LF 4.2-5.4×1012/L

0.10 - 0.48 %

The result was above normal range which indicates infection.

The result was below normal RBC count resulting also in the decrease of Hgb and Hct.

The result is within the normal range which indicates normal immune response.

Diagnostic and Laboratory

Indication(s) or Purpose(s)

Results FindingsAnalysis and

Interpretation

URINALYSIS Urinalysis is part of routine diagnostic and screening evaluations. It can reveal a significant amount of preliminary information about the kidneys and other metabolic processes. Urinalysis includes remarks as to the color, appearance and odor, pH, and presence of proteins, glucose, ketones, and blood and leukocyte esterase. In addition, the urine is examined microscopically for RBC’s WBC’s, casts, crystals and bacteria this procedure was done to our pt. to check test if there is any complication/ingestion on her kidney or if her kidney’s functioning well.

Color: Yellow

Transparency:

Cloudy

Albumin:

Trace

pH:

Acidic

Specific gravity:

1.0200

Pus cells:

2.3/HPF

Bacteria

Glucose

Yellow, Clear

Clear

Trace

Alkaline

1.001-1.035

None

Many

Negative

-Urine ranges from pale yellow to amber because of the pigment urochrome (production of bilirubin metabolism)

-Cloudy urine may contain RBC’s or WBC’s bacteria, fat, or chyle, if may reflect renal infection.

-Proteinuria may result from renal failure of disease

Acidic-increased formation of acids in the urine

Fixed specific gravity in which values remain 1.010 regardless of fluid intake occurs in chronic glumerolonephritis with several renal damage.

- Indicates presence of infection

-Abnormal transport and exchange of oxygen to the tissues and carbon dioxide from the tissues.

Indication of UTI

Glycosuria is usually an indicator of significant hyperglycemia and diabetes milletus.

procedure(s)

Ultrasound It is a non- invasive test performed which provides images of the renal and urinary bladder.

Sonically normal kidneys and urinary bladder.

Sonographic examination reveals bilaterally normal size kidneys with smooth cortical outlines. Echogencity is within normal. No evident renal or suprarenal mass lesion noted.No lithiasis or hydronephrosis seen.Perirenal area are unremarkable.

Sonically normal kidneys and urinary bladder.

VI. Medical Management

a. Doctor’s Order

6 – 16 – 10

Ceftriaxone gm IV q 12º (-) ANS Paracetamol 500 mg 1 tab. q 4º Feminine wash BID D5LRS 1L x 30-31 gtts./min. Refer

6 – 17 – 10

continue meds repeat UA FTF: D5LRS 1L x 8º schedule for KUB ultrasound

b. Treatments, Surgery, Procedures, Intravenous fluids

Treatment:

Ceftriaxone gm IV q 12º (-) ANST Paracetamol 500 mg 1 tab. q 4º Feminine wash BID

Intravenous fluidsMedical

management / Treatment

General Description Indication Client’s initial reaction to noted

Client’s response to the treatment

D5 LRS 1L It is a hypertonic solution that has an osmolarity higher than serum osmolarity when a patient relieves a hypertonic IV solution; serum osmolarity initially increases causing fluid to be pulled from the intestine and intracellular compartments into the blood vessels.

To replace fluid loss and electrolyte loss, maintain patient’s hydration, nutritional status and fluid balance. It is use to supply the necessary nutrient to the patient.

Patient has no complain regarding his IV infusion.

Patient tolerated IV infusion. He does not complain of any pain or irritation.

D. Diet DAT – the patient can take anything by mouth as long as she can tolerate it to nourish the

body with nutrients.

C. Drug study

GENERIC NAME ACTION INDICATION CONTRAINDICATION ADVERSE EFFECT NURSING INTERVENTION

Ceftriaxone

BRAND NAMERocephin

CLASSIFICATIONAntibioticCephalosporin (third generation)

AVAILABLE FORMSPowder for injection- 2 gInjection- 1, 2 g

Ceftriaxone binds to one or more of the penicillin-binding proteins (PBPs) which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death.

· Lower respiratory infections· UTI’s cause byE. coli· Gonnorhea· Intra abdominal infections· Skin and skin structures infection· Septicemia· Bone and joint infections· Meningitis· Perioperative prophylaxis

Hypersensitivity to cephalosporins; hyperbilirubinaemic neonates. Do not use calcium or calcium-containing solutions or products with or within 48 hr of ceftriaxone administration due to risk of calcium-ceftriaxone precipitate formation.

Superinfection; anaphylaxis; diarrhea; local reactions; blood dyscrasias; rash, fever, pruritus; elevated transaminases and alkaline phosphatase; leucopenia, neutropenia.Potentially Fatal: Pseudomembranous colitis; nephrotoxicity.

· Culture infection and arrange for sensitivity test.· Reconstitute with sterile water for IM injection.

GENERIC NAME ACTION INDICATION CONTRAINDICATION ADVERSE EFFECT NURSING INTERVENTIONParacetamol

BRAND NAME

Unknown. Thought to produce analgesia by blocking pain impulses

Mild pain. Fever. Contraindicated in: Previous htpersensitivity.

HEMAT: hemolytic anemia, neutropenia, leukopenia, pancytopenia.

· Alert: Many OTC and prescription products

Tempra

CLASSIFICATIONNon-opioid analgesics and antipyretics

AVAILABLE FORMSTablets: 160 mg, 500 mg.Oral susp.: 80 mg/ 0.8 ml, 120 mg/ 5 ml.

by inhibiting synthesis of prostaglandin in the CNS or of other substances that sensitize pain receptors to stimulation. The drug may relieve fever through central action in the hypothalamic heat-regulating center.

Therapeutics: Analgesia, Antipyresis.

Products containing alcohol, aspartame, saccharin, sugar, or tartrazine should be avoided in patients who have hypersensitivity or intolerance to these compounds.

HEPATIC: jaundice.META: hypoglycemia.DERM: rash, urticaria.GU: renal failure (high doses/chronic use).GI: hepatic failure, hepatotoxicity (overdose)

contain acetaminophen; be aware of this when calculating daily dose.· Use liquid form for children and patients who have difficulty swallowing.· In children, don’t exceed five doses in 24 hours.· Tell parents to consult prescribes before giving drug to children younger than age 2.· Advise patient that drug is only for short-term use.

Problem #1: Acute pain related to frequency of urination

Assessment Nursing diagnosis Scientific

explanation

Objective Interventions Rationale Expected outcome

S>Ø

O>patient

manifested:

>guarding behavior

Acute pain related

to frequency of

urination

Atrophied

parenchyma

brought about by

narrowing of the

calyx neck and

Short-term

goal: after 3 hours

of nursing

interventions,

patient will be able

>Assess pain characteristics: location, quality, severity, onset and duration.

>Observe and monitor signs and

>To identify extent of pain.

>Some people deny the experience of

Short-term goal:

after 3 hours of

nursing

interventions,

patient shall have

>facial grimaces

The pt. May

manifest:

>suprapubic

tenderness

>low back pain or

flank pain

>fever

>chills

>fatigue

>anorexia

scarring of

parenchyma causes

urine retention and

which further

causes unpleasant

sensation to the

patient thereby by

resulting to pain.

to verbalize ways to

decrease pain.

Long term goal:

after 3 days of

nursing

interventions the

patient will be able

to report less pain

or increase pain

tolerance.

symptoms of pain such as BP, heart rate, temperature, color and moisture of the skin.

>Anticipate need for pain relief

>Eliminate additional stressors or sources of discomfort whenever possible.

>Provide rest periods to facilitate comfort, sleep and relaxation.

>Use non-pharmacologic pain-relief methods: distraction techniques, relaxation techniques, music therapy.

>Notify physician if interventions are unsuccessful or if current complaint is significant change

pain when it is present.

>Early intervention may decrease the total amount of analgesia required.

>Pt. May experience exaggeration in pain or a decreased ability to tolerate painful stimuli if environmental, intrapersonal factors are further stressing them.

>The pt’s experiences of pain may become exaggerated as the result of fatigue.

>Decreases one’s awareness and experience of pain. Some methods are breathing modifications and nerve stimulation.

>To prescribe medication if possible.

verbalized ways to

decrease pain.

Long term goal:

after 3 days of

nursing

interventions the

patient shall have

reported less pain

or increase pain

tolerance.

from past experience.

Problem #2: Impaired urinary elimination related to disease conditions.

Assessment Nursing diagnosis Scientific

explanation

Objective Interventions Rationale Expected outcome

S>” Panay ang ihi

ko”

O> patient

manifested:

>Frequency of

urination

(5-6x/day)

>Body malaise

>A febrile

Patient may

manifest:

>dysuria

>Incontinence

Impaired urinary

elimination related

to disease

conditions.

The most common

mechanism by

which a UTI

develops is via

ascending and

invading bacteria.

The organism

triggers an

inflammatory

response in the

lining of the urinary

tract.

Short term:

After 1-3 hours of

nursing

interventions patient

will be able to

verbalize

understanding on

the health teachings

given

Long term:

After 2 days of

nursing intervention

the patient will be

able to demonstrate

behavior techniques

to prevent urinary

tract infection

>Note the age and

sex of the client

(UTI’s are prevalent

among women and

older men)

>Determine client

previous pattern of

elimination and

compare with

current situations

>Determine client

usual daily fluid

intake

>Encourage client

to verbalize fear and

concern

>Instruct client to

increase fluid intake

>Recommend

>To gather

baseline data

>Contribute to

immobility

>To obtain

baseline data

>To provide

comfort

>To adjust care as

indicated

>For continuity of

Short term: the

patient shall have

verbalized

understanding of the

condition

Long term:

The patient shall

have demonstrated

behavior and

techniques to

prevent urinary

infection

avoidance of gas

forming foods in

presence of

uterosigmoidostom

y as flatus can cause

urinary

incontinence

care

Problem #3: Impaired physical mobility r/t acute pain

Assessment Nursing

Diagnosis

Scientific

Explanation

Objectives Interventions Rationale Expected Outcome

S> Report of

pain and

O> irritability

>Gait changes

>pain ranges

from 6 out of 10

Impaired

physical

mobility r/t

acute pain

Pain is an

unpleasant

sensation that

can range from

mild, localized

discomfort to

agony. Pain has

Short Term:

After 3hrs of NPI, the

patient will be able to

verbalize willingness to and

demonstrate participation in

activities.

>Monitor V/S and

Record

>Observe

patient’s

movements

>to obtain baseline

data

>to note any

incongruence with

reports of abilities.

Short Term:

After 3 hrs of NPI, the

patient shall have

verbalized willingness to

and demonstrate

participation

both physical

and emotional

components.

The physical

part of pain

results from

nerve

stimulation. Pain

is mediated by

specific nerve

fibers that carry

the pain

impulses to the

brain where their

conscious

appreciation

may be modified

by many factors.

Long Term:

After 3 days of Nursing

Intervention, the patient

will be able to demonstrate

techniques/behaviors that

enable resumption of

activities.

>Schedule

activities with

adequate rest

periods during the

day

>Encourage

participation in

self-care,

occupational,

diversional,

recreational

activities

>to reduce fatigue

>enhances self-

concept and sense

of independence.

Long Term:

After 3 days of

Nursing Intervention, the

patient shall have

demonstrated

techniques/behaviors that

enable resumption of

activities.

VII. EVALUATION

M – edication

Patient was advise to continue home medication (noting on medication that should not be able to discontinue abruptly) to maintain a normal functioning of the body and maintain homeostasis. The treatment regimen ordered by the doctors must be followed strictly and should not be stopped to prevent the aggravation of the condition. The full course of antibiotics should be followed. (At least 7 days.)

E - xercise

Discuss to the client importance or help client develop a program of exercise and relaxation techniques as tolerated.

T – eachings

Moreover, a teaching plan that affect client’s holistic wellness should be done in order to maintain an environment that is conducive for health promotion.

H – ygiene

Encourage to have a good personal hygiene especially proper perineal care.

OPD schedule

Proper referral is best for the health care provider to evaluate condition of the client, whether it is improving or not. Also for early detection of other underlying conditions.

Patient was instructed to go back after 1 week at Ospital Ning Angeles OPD department.

D – iet

Instructed to have proper diet especially foods rich in vitamin C, and increase fluid intake.