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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 ºC
PR: 89 bpm
RR: 22 bpm
BP: 120/90 mmHg
Appearance: weak and pale
Eyes: slightly pale conjunctiva
Lungs: clear breath sounds, (-) rales, (-) wheeze
Heart: (-) murmurs
Abdomen: soft tender abdomen, (-) bowel sounds
Extremities: strong pulses, (-) cyanosis

1ST NPI (June 17, 2010)


Student Nurse-Patient interaction
Vital signs are the following
Temp: 37 ºC
PR: 70 bpm
RR: 18 bpm
BP: 120/80 mmHg

Head and Face


Skull : symmetrical in shape, (-) nodules and mass
Eyes : symmetrical, PEARRL, pink conjunciva
Ears : symmetrical appearance of pinna, (-) discharges
Nose : symmetrical nares, (-) bleeding and discharges
Mouth : absence of swelling of lips and gums, no lesions and ulcerations
Neck : no swelling of lymph nodes
Integumentary: pale and dry skin, no clubbing of fingers

Chest : clear breath sounds, symmetrical chest expansion


Cardiovascular: NRRR, normal capillary refill
Gastrointestinal: normal bowel movement and sounds
Musculoskeletal
Upper extremities: normal muscle strength and ROM
Lower 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 arteries
urethra

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 mucous


Increase polymorphonuclea membrane of the adjacent
leukocytes in the tubules and collecting system
in the interstitium
surrounding the tubules

Necrosis of renal tissue dysuria


Destruction 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/ Indication or Result/s Normal Values Analysis and


Laboratory Purpose interpretation of
Procedures results

Hematology

Hemoglobin
A hemoglobin 116 g/dL M 140-180 g/dL Result was below
determination is F 120-160 g/dL normal, means
used to evaluate the that low transport
hemoglobin content and exchange of
(and thus the iron oxygen to the
status and oxygen- tissues and
carrying capacity) carbon dioxide
of erythrocytes by from the tissues.
measuring the
number of grams of
hemoglobin per
deciliter of blood.

Hematocrit Often used in The result was


replacement of the 0.34% M 0.42 - 0.57 % below the normal
RBC count, the F 0.37-0.47% range which
hematocrit is a indicates low
measure of the RBC/hemoglobin
volume of the to the plasma
RBCs in the whole level. It indicates
blood expressed as anemia and
a percentage. oxygen
insufficiency.
The result was
Helpful in the
WBC 16.9 5-10 × 10 g/L above normal
evaluation of the
range which
patient with
indicates
infection,
infection.
neoplasm, allergy
or
.
immunosuppressio
n

RBC count is used


RBC to evaluate any type 4.01 M 4.5-6.3×1012/L The result was
of decrease or F 4.2-5.4×1012/L below normal
increase in the RBC count
number of red resulting also in
blood cells as the decrease of
measured per liter Hgb and Hct.
of blood.

Determine if there
Lymphocytes is enough cell that .26 % 0.10 - 0.48 % The result is
produces antibodies within the normal
and other chemicals range which
responsible for indicates normal
destroying immune
microorganisms; response.
contributes to
allergic reactions,
graft rejection,
tumor control, and
regulation of the
immune system
Urinalysis is part of Color:
URINALYSIS routine diagnostic Yellow Yellow, Clear -Urine ranges from pale yellow to
and screening amber because of the pigment
evaluations. It can urochrome (production of bilirubin
reveal a significant metabolism)
amount of
preliminary
information about
the kidneys and Transparency:
other metabolic
processes. Cloudy Clear
Urinalysis includes -Cloudy urine may contain RBC’s
remarks as to the or WBC’s bacteria, fat, or chyle, if
color, appearance may reflect renal infection.
and odor, pH, and Albumin:
presence of proteins,
glucose, ketones,
Trace Trace
and blood and -Proteinuria may result from renal
leukocyte failure of disease
esterase. In addition,
the urine is Acidic-increased formation of
examined pH: acids in the urine
microscopically for
RBC’s WBC’s, Acidic Alkaline Fixed specific gravity in which
casts, crystals and
values remain 1.010 regardless of
bacteria this
fluid intake occurs in chronic
procedure was done
glumerolonephritis with several
to our pt. to check
Specific gravity: renal damage.
test if there is any
complication/ingesti
on on her kidney or 1.0200 - Indicates presence of infection
if her kidney’s
functioning well. 1.001-1.035

Pus cells:

2.3/HPF None -Abnormal transport and exchange


of oxygen to the tissues and carbon
dioxide from the tissues.

Bacteria Many Indication of UTI

Glucose Negative Glycosuria is usually an indicator


of significant hyperglycemia and
diabetes milletus.
Diagnostic and
Indication(s) or Analysis and
Laboratory Results Findings
Purpose(s) Interpretation
procedure(s)

Ultrasound It is a non- invasive test Sonically normal kidneys Sonographic examination Sonically normal
performed which and urinary bladder. reveals bilaterally normal kidneys and
provides images of the size kidneys with smooth urinary bladder.
renal and urinary cortical outlines.
bladder. Echogencity is within
normal. No evident renal
or suprarenal mass lesion
noted.
No lithiasis or
hydronephrosis seen.
Perirenal area are
unremarkable.

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 fluids
Medical General Description Indication Client’s initial Client’s response to
management / reaction to noted the treatment
Treatment
D5 LRS 1L It is a hypertonic solution To replace fluid loss and Patient has no Patient tolerated IV
that has an osmolarity electrolyte loss, maintain complain regarding his infusion. He does not
higher than serum patient’s hydration, IV infusion. complain of any pain or
osmolarity when a patient nutritional status and fluid irritation.
relieves a hypertonic IV balance. It is use to supply
solution; serum osmolarity the necessary nutrient to
initially increases causing the patient.
fluid to be pulled from the
intestine and intracellular
compartments into the
blood vessels.

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 Ceftriaxone binds · Lower respiratory Hypersensitivity to Superinfection; · Culture infection and
to one or more of infections cephalosporins; anaphylaxis; diarrhea; arrange for sensitivity test.
BRAND NAME the penicillin- · UTI’s cause byE. hyperbilirubinaemic local reactions; blood · Reconstitute with sterile
Rocephin binding proteins coli neonates. Do not use dyscrasias; rash, water for IM injection.
(PBPs) which · Gonnorhea calcium or calcium- fever, pruritus;
CLASSIFICATION inhibits the final · Intra abdominal containing solutions or elevated
Antibiotic transpeptidation infections products with or within transaminases and
Cephalosporin (third step of · Skin and skin 48 hr of ceftriaxone alkaline phosphatase;
generation) peptidoglycan structures infection administration due to risk leucopenia,
synthesis in · Septicemia of calcium-ceftriaxone neutropenia.
AVAILABLE bacterial cell wall, · Bone and joint precipitate formation. Potentially Fatal:
FORMS thus inhibiting infections Pseudomembranous
Powder for injection biosynthesis and · Meningitis colitis; nephrotoxicity.
-2g arresting cell wall · Perioperative
Injection assembly resulting prophylaxis
- 1, 2 g in bacterial cell
death.
GENERIC NAME ACTION INDICATION CONTRAINDICATION ADVERSE NURSING
EFFECT INTERVENTION
Paracetamol Unknown. Thought Mild pain. Fever. Contraindicated in: HEMAT: hemolytic · Alert: Many OTC and
to produce Previous htpersensitivity. anemia, neutropenia, prescription products
BRAND NAME analgesia by Products containing leukopenia, contain acetaminophen; be
Tempra blocking pain alcohol, aspartame, pancytopenia. aware of this when
impulses by saccharin, sugar, or HEPATIC: jaundice. calculating daily dose.
CLASSIFICATION inhibiting synthesis tartrazine should be META: · Use liquid form for
Non-opioid of prostaglandin in avoided in patients who hypoglycemia. children and patients who
analgesics and the CNS or of other have hypersensitivity or DERM: rash, have difficulty swallowing.
antipyretics substances that intolerance to these urticaria. · In children, don’t exceed
sensitize pain compounds. GU: renal failure five doses in 24 hours.
AVAILABLE receptors to (high doses/chronic · Tell parents to consult
FORMS stimulation. The use). prescribes before giving
Tablets: 160 mg, 500 drug may relieve GI: hepatic failure, drug to children younger
mg. fever through hepatotoxicity than age 2.
Oral susp.: 80 mg/ central action in the (overdose) · Advise patient that drug is
0.8 ml, 120 mg/ 5 hypothalamic heat- only for short-term use.
ml. regulating center.

Therapeutics:
Analgesia,
Antipyresis.
Problem #1: Acute pain related to frequency of urination

Assessment Nursing diagnosis Scientific Objective Interventions Rationale Expected outcome


explanation
S>Ø Acute pain related Atrophied Short-term >Assess pain >To identify extent Short-term goal:
characteristics: of pain.
to frequency of parenchyma goal: after 3 hours after 3 hours of
location, quality,
O>patient urination brought about by of nursing severity, onset and nursing
duration.
manifested: narrowing of the interventions, interventions,
>guarding behavior calyx neck and patient will be able >Observe and >Some people deny patient shall have
monitor signs and the experience of
>facial grimaces scarring of to verbalize ways to verbalized ways to
symptoms of pain pain when it is
parenchyma causes decrease pain. such as BP, heart present. decrease pain.
rate, temperature,
The pt. May urine retention and
color and moisture of
manifest: which further Long term goal: the skin. Long term goal:
>suprapubic causes unpleasant after 3 days of after 3 days of
>Anticipate need for >Early intervention
tenderness sensation to the nursing pain relief may decrease the nursing
total amount of
>low back pain or patient thereby by interventions the interventions the
analgesia required.
flank pain resulting to pain. patient will be able patient shall have
>fever to report less pain reported less pain
>chills or increase pain >Eliminate >Pt. May experience or increase pain
additional stressors exaggeration in pain
>fatigue tolerance. tolerance.
or sources of or a decreased
>anorexia discomfort whenever ability to tolerate
possible. painful stimuli if
environmental,
intrapersonal factors
are further stressing
them.

>Provide rest periods >The pt’s


to facilitate comfort, experiences of pain
sleep and relaxation. may become
exaggerated as the
result of fatigue.

>Use non- >Decreases one’s


pharmacologic pain- awareness and
relief methods: experience of pain.
distraction Some methods are
techniques, breathing
relaxation modifications and
techniques, music nerve stimulation.
therapy.

>Notify physician if >To prescribe


interventions are medication if
unsuccessful or if possible.
current complaint is
significant change
from past
experience.

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


Assessment Nursing diagnosis Scientific Objective Interventions Rationale Expected outcome
explanation
S>” Panay ang ihi Impaired urinary The most common Short term: >Note the age and >To gather Short term: the
ko” elimination related mechanism by After 1-3 hours of sex of the client baseline data patient shall have
to disease which a UTI nursing (UTI’s are prevalent verbalized
O> patient conditions. develops is via interventions patient among women and understanding of the
manifested: ascending and will be able to older men) condition
>Frequency of invading bacteria. verbalize
urination understanding on >Determine client >Contribute to
(5-6x/day) The organism the health teachings previous pattern of immobility
>Body malaise triggers an given elimination and
>A febrile inflammatory compare with
response in the current situations
lining of the urinary Long term: Long term:
Patient may tract. After 2 days of >Determine client >To obtain The patient shall
manifest: nursing intervention usual daily fluid baseline data have demonstrated
>dysuria the patient will be intake behavior and
>Incontinence able to demonstrate techniques to
behavior techniques >Encourage client >To provide prevent urinary
to prevent urinary to verbalize fear and comfort infection
tract infection concern

>Instruct client to >To adjust care as


increase fluid intake indicated

>Recommend >For continuity of


avoidance of gas care
forming foods in
presence of
uterosigmoidostom
y as flatus can cause
urinary
incontinence

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


Assessment Nursing Scientific Objectives Interventions Rationale Expected Outcome
Diagnosis Explanation
S> Report of Impaired Pain is an Short Term: >Monitor V/S and >to obtain baseline Short Term:
pain and physical unpleasant After 3hrs of NPI, the Record data After 3 hrs of NPI, the
mobility r/t sensation that patient will be able to patient shall have
O> irritability acute pain can range from verbalize willingness to and >Observe >to note any verbalized willingness to
>Gait changes mild, localized demonstrate participation in patient’s incongruence with and demonstrate
>pain ranges discomfort to activities. movements reports of abilities. participation
from 6 out of 10 agony. Pain has
both physical
and emotional Long Term: >Schedule >to reduce fatigue Long Term:
components. After 3 days of Nursing activities with After 3 days of
The physical Intervention, the patient adequate rest Nursing Intervention, the
part of pain will be able to demonstrate periods during the patient shall have
results from techniques/behaviors that day demonstrated
nerve enable resumption of techniques/behaviors that
stimulation. Pain activities. >Encourage >enhances self- enable resumption of
is mediated by participation in concept and sense activities.
specific nerve self-care, of independence.
fibers that carry occupational,
the pain diversional,
impulses to the recreational
brain where their activities
conscious
appreciation
may be modified
by many factors.
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.

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