Christine Rombawa

NURS 360

Deficient knowledge
Educate pt. on signs
and symptoms of
infection.
Educate pt. on signs
and symptoms of UTI.
Promote hydration,
toileting hygiene, and
proper handwashing.
Educate pt. on UTI
prevention
Educate pt. on
importance oof
completing all
prescribed antibiotics.

Impaired renal function

Infection

UTI
Febrile
Monitor BUN and
Temp: 101.4F
creatinine
Blood culture pending
Chief
Medical
CBC:
Monitor urinary output.
WBC: 17.5 (H)
Diagnosis:
Monitor VS, HR, BP
Neutrophils: 83.8 (H)
Pyelonephritis
UA Culture
Monitor peripheral
urine
with Cloudy
Sepsis
pulses, capillary refill.
Leucocyte Esterase:
Large
Na: 127(L)
Bacteria: Moderate
Blood: Moderate
Albumin 2.6 (L)
WBC: >100
Fatigue
Hematuria
Dysuria Pain
Weakness
Medication:
4/10
flank pain
Ciprofloxacin
500mg
tab PO Q12hrs.
Dysuria
Azetreonam 1,000mg
Acetaminophen 650 mg
in 50ml Sodium
PO Q4hrs PRN
Chloride IVtab
Qhrs
Ceftriaxone 1g in
50ml sodium chloride
IV Q8hrs
Deficient Fluid volume
Acetaminophen
Febrile 101.4F
650mg tab PO Q4hrs
PRN
UO <30ml hr
Tachycardia
Dry skin
Weight daily
Tenting
Dry skin
Monitor I & O
Increase fluid intake
2L QD
Normal saline
1,000mg IV 100ml/h

Christine Rombawa
NURS 360

Nursing Interventions and Outcomes

Desired Outcomes
Infection

Interventions
Infection

Patient is free of infection as evidenced by clear,

nonfoul-smelling urine; pain-free urination;
normal WBC count; and absence of fever, chills,
flank pain, and suprapubic pain, negative blood
and urine culture.

1. Assess for signs and symptoms of UTI.

2.Monitor VS
3. Assess results of urinalysis/culture and
sensitivity for presence of RBCs, WBCs,
bacteria, and identify causative organism
necessary for selecting most effective anx.
4.Assess results of blood test results; WBC,
blood culture, bacteria
5. Encourage pt. to drink extra fluid
6. Instruct pt. to void often (every 2-3 hrs) and
to empty the bladder completely.
7. Suggest cranberry or prune juice, vitamin C
500-1000 mg/day to decrease pH of urine.
8. Educate pt. on importance of completing all
prescribed antibiotics.
9. Limit the use of indwelling catheters.
10. Educate on proper perineal hygiene.

Pain
Patient reports satisfactory pain control at a
level less than 3 to 4 on a scale of 0 to 10.

Pain
1. Assess the patients description of pain.
Inquire as to the quality, nature, location, and
severity of pain.
2. Administer analgesics and/or antispasmodics
as prescribed.
3. Use nonpharmacological techniques
whenever appropriate.
4. Apply heating pad to suprapubic area or
lower back.
5 .Instruct the patient in the use of a sitz bath.
6. Evaluate effectiveness of pain medication.
7. Position for comfort.
8. Monitor nonverbal signs of pain.

Patient uses pharmacological and

nonpharmacological pain relief strategies.
Patient exhibits increased comfort such as
baseline levels for, BP, HR, respirations, and
relaxed muscle tone or body posture.

Deficient fluid volume

Patient is normovolemic as evidenced by

Deficient fluid volume

1. Assess for the early warning signs of

Christine Rombawa
NURS 360

systolic BP greater than or equal to 90 mm Hg

(or patient's baseline), absence of orthostasis,
HR 60 to 100 beats/min, urinary output greater
than 30 mL/hr, and normal skin turgor.

hypovolemia, including changes in the level of

consciousness.
2 .Assess VS: HR, BP, and pulses, temp, resp.
3. Monitor for BP orthostatic changes.
4. Record and evaluate intake and output, daily
weight.
5. Assess skin turgor, thirst, and mucus
membranes.
6. Initiate IV replacement fluids as ordered.
7. Monitor blood tests: Hgb & hct, coagulation
studies, fluid and electrolytes.
8. Encourage oral fluid if able to tolerate.

Impaired renal function

Impaired renal function

Patient achieves optimal urinary elimination,

as evidenced by the following: urine output
>30 mL/hr; electrolytes, BUN, creatinine
within or near normal levels; and normal
specific gravity.

1. Monitor and record the patients intake and

output. Report an output of <30ml/hr.
2. Monitor the urine specific gravity.
3. Monitor BUN, creatinine, sodium,
potassium, magnesium.
4. Monitor urinalysis for protein, blood,
sodium levels and creatinine clearance
5. Monitor daily weights using same scale,
same time of day, and patient wearing same
amount of clothing.
6. Monitor for S&S of excess fluid volume:
edema, jugular vein distention, HTN, crackles,
Increased respiratory rate.
7. Administer fluids and diuretics as
prescribed.

Deficient knowledge

Deficient knowledge

Patient verbalizes knowledge of causes,

treatment, and prevention of UTI that could

1. Assess the patients knowledge of UTI risk

factors, prevention, and treatment.

Christine Rombawa
NURS 360

lead to a reoccurrence of pyelonephritis,

controls risk factors, and completes medical
treatment of UTI.

2. Teach the patient the importance of

prevention and follow up care and need for
follow up urine and blood cultures.
3. Teach importance of frequent bladder
emptying, hygiene measures: showering is
preferable to tub bathing, perineal hygiene with
bowel elimination.
4. Educate importance for daily changing of
underwear, wearing well ventilated clothing,
and avoiding tight or constricting underwear,
pantyhose or pants.
5. Teach the patient to complete the full course
of antibiotic medication, even if symptoms
resolve.
6. Encourage the reporting of signs and
symptoms of recurrence.

Reference:
Gulanick, Meg, Judith Myers. Nursing Care Plans: Diagnoses, Interventions,
and Outcomes, 8th Edition. Mosby, 2014. VitalBook file.
Evaluation:
Patient is free of infection as evidenced by clear, nonfoul-smelling urine;
pain-free urination; normal WBC count; and absence of fever, chills, flank
pain, and suprapubic pain, negative blood and urine culture. Patient reports
satisfactory pain control at a level less than 3 to 4 on a scale of 0 to 10.
Patient uses pharmacological and nonpharmacological pain relief strategies.
Patient exhibits increased comfort such as baseline levels for, BP, HR,
respirations, and relaxed muscle tone or body posture. Patient is
normovolemic as evidenced by systolic BP greater than or equal to
90 mm Hg (or patient's baseline), absence of orthostasis, HR 60 to 100
beats/min, urinary output greater than 30 mL/hr, and normal skin turgor.
Patient achieves optimal urinary elimination, as evidenced by the following: urine output
>30 mL/hr; electrolytes, BUN, creatinine within or near normal levels; and normal specific
gravity. Patient verbalizes knowledge of causes, treatment, and prevention of
UTI that could lead to a reoccurrence of pyelonephritis, controls risk factors,
and completes medical treatment of UTI.

Christine Rombawa
NURS 360

Discharge Plan/Teaching
Patient will be discharged back to her residence. Her support system includes her
husband and daughter. She does not require any assistance with her ADLs, but husband and
daughter are willing and available to help with household duties. She does not require any
equipment, she is able to ambulate independently without assistance. Will provide verbal and
written directions and education regarding medication management and compliance, along with
risk, prevention, and signs and symptoms of infection and UTI. Patient will verbalize
understanding of direction and education prior to discharge and schedule a follow up
appointment with PCP to monitor effectiveness of treatment, resolution of problem, or any
further required treatments.