A CARE FOR A PATIENT

AT 37 WEEKS OF
GESTATION WITH
COMMON ANTEPARTUM
COMPLICATION;
URINARY TRACT
INFECTION

Rivera, Geoffrey
Ruiz, Alliah
Saalan, Rayana
Sabtirul, Fatima Rayhana
Salih, Indira
Sanaani, Nur-Hathi
INTRODUCTION
 Patient Z is a 36-year-old female
Filipino who was diagnosed with
urinary tract infection in her third
trimester, specifically at 37 weeks of
gestation that is considered to be a
normal complication during
pregnancy.

 She went to the hospital with a chief

complaint of febrile temperature
compelled her to admit herself to the
hospital.
SIGNIFICANCE OF THE STUDY
Nursing Education. This study will help both researchers and other students
alike in obtaining newfound knowledge on antepartum urinary tract infection and
its signs, symptoms, etiologic agents, preventive measures, and treatment.
These can later help in situations with similar cases, such as imparting health
education on antepartum urinary tract infection.

Nursing Practice. Acquired knowledge and skills from the case of the pregnant
patient with UTI could be applied into actual clinical practice, either as a
refinement of existing skills or as an establishment of new ones. For instance,
subjective and objective cues related to antepartum urinary tract infection could
be interpreted more efficiently and effectively.

Nursing Research. Gathered data from this case study can contribute to the
increase of knowledge of patient with urinary tract infections in pregnancy. Data
can also be integrated into other clinical researches in the future.
OBJECTIVES
General:
To be able to provide a thorough and comprehensive
explanation of the case, from start to finish, as clearly, thoroughly, and
skillfully as possible.

Specific: By the end of this case study, we will be able to:

1. Present this case clearly.
2. Define normal antepartum urinary tract infection correctly.
3. Identify signs and symptoms accurately.
4. Discuss the anatomy and physiology of urinary tract during pregnancy.
Anatomy and Physiology
PATIENT MEDICAL HISTORY

Assessment: A. Biographic Data

Name of the Patient: PATIENT Z
Age: 36 years old Marital
Status: Married
Sex: Female
Attending Physician: Dr. Myra Abubakar Aranan
Medical Diagnosis: G2P0 (1000) 37 weeks AOG
with Urinary Tract Infection
Last Menstrual Period: November 22, 2018
Estimated Date of Confinement: August 29, 2019
Date Admitted: August 3, 2019
Date Discharged: August 9, 2019
B. Comprehensive Nursing History

Chief Complaint: Patient Z, is a 36 year-old

pregnant woman came in on August 3,
2019, with a chief complain of 3 days, and
does not lower down even when the patient
had taken Paracetamol (antipyretic and
analgesic) orally.
Marjorie Gordon’s 11 Functional Health Problem
PRE-CONFINEMENT
• Health Perception-Health Management Pattern
• Nutrition and Metabolic Pattern
• Elimination Pattern
• Activity- Exercise Pattern
• Cognitive- Perceptual Pattern
• Sleep Rest Pattern
• Sexuality-Reproductive
• Coping Stress Tolerance Pattern
• Roles- Relationship Pattern
• Values- Beliefs Pattern
CONFINEMENT
• Health Perception- Health Management Pattern
• Nutrition and Metabolic Pattern
• Elimination Pattern
• Activity- Exercise Pattern
• Cognitive- Perceptual Pattern
• Sleep Rest Pattern
• Sexuality-Reproductive
• Coping Stress Tolerance Pattern
• Roles- Relationship Pattern
• Values- Beliefs Pattern
PHYSICAL ASSESSMENTS
PHYSICAL APPEARANCE
BODY STRUCTURE Patient looks normal with an average estimated body proportion
during pregnancy thus the patient is also well-dress.

MOBILITY She has difficulty in walking by grabbing the edge of each bed
when going to the Comfort room. and complains a pain in
walking.

MENTAL STATUS
LANGUANGE The patient understands Chavacano, English, Filipino and Bisaya;
but can only speak Bisaya and Filipino.

ORIENTATION Patient ables to determine what month, year and date and where
she was.

ATTENTION SPAN Rated 30 in Mini Mental State Examination

LEVEL OF CONSCIOUSNESS Rated 15 in a Glasgow Coma Scale
 MOTOR FUNCTION
GROSS MOTOR AND BALANCE WALKING GAIT Shoulders back and the abdomen forward, creates a lordosis

Rationale: caused by the influence of both the ovarian

hormone relaxin and placental progesterone

HEEL TOE WALKING Patient verbalizes “hindi ko kaya nahihirapan ako mag lakad.”

TOE OR HEEL WALKING Patient verbalizes “hindi ko kaya nahihirapan ako mag lakad.”

INTEGUMENTARY
SKIN  The patient has reddish streaks in her abdomen due to
pregnancy.
 A linea nigra was also noted in her abdomen..
HAIR  A healthy hair characterize by shinny strand without lice
or scales.
NAILS  The patient was a little bit of pallor due to the presence
of air conditioner.
SKULL  Equally proportion and no indentions.
FACE  And lastly the was a dark pigmentation across the face
of the patient which considers to be the Melasma
 EYES AND VISION
EYEBROWS  Similar to the hair it was also healthy.
BULBAR CONJUNCTIVA  So signs of swelling and redness, pink and shiny.

PALPEBRAL CONJUCTIVA  So signs of swelling and redness, pink and shiny.

SCLERA  There’s no redness, nor presence of blood found in the

sclera. It is normal white and shiny.

LACRIMAL GLAND  No swelling and tenderness seen/

CORNEA
CORNEAL SENSITIVITY The patient was positive to sensitivity when her cornea was
touched by cotton.
FIELDS All cardinal was responsive.
PUPILS Black and equally round.

EYES AND EARS

AURICLE The auricles are symmetrical and no lesion, tenderness nor
swelling present.
HEARING ACUITY TEST The patient able to hear the whispering volume of the nurse’s
voice.
 NOSE AND SINUSES
EXTERNAL NOSE Symmetrical and no lesion, tenderness nor swelling present.

NASAL CAVITY A nasal congestion is presence.

NECK
HEAD MOVEMENT The patient able to move her neck approximately 90˚ to watch
television.
MUSCLE STRENGTH The client able to carry her 1000 mL tumbler independently.

LYMPH NODES There’s no enlargement of nodes visible through inspection.

THYROID GLAND The thyroid was a little bit enlarge through inspection.

THORAX AND LUNGS

BREATH SOUNDS Auscultation of lung sound reveals clear respiratory sounds

ANTERIOR THORAX The patient’s chest expansion goes vertically.

 ABDOMEN
AUSCULTATION OF THE FETAL HEART TONE 145 beats per minute

EXTREMITIES
UPPER EXTREMITIES Shiny and swelling (EDENMA), the wedding ring seems to be
too fitting for the fingers.

LOWER EXTREMITIES Shiny and swelling as well.

MUSCLES Movement during walking was a little bit limb and hard for the
patient. She needs assistance at some point.

PAIN
PAIN SENSATION The patient responses to the tight Blood pressure cuff.
LABORATORY RESULTS (URINALYSIS)
RESULTS NORMAL RESULT IMPLICATION

The patient might take several

medications (e.g.,
COLOR YELLOW Pale Yellow multivitamins can turn urine
bright yellow), or the result of
eating certain foods.

TRANSPARENCY Substances that cause

cloudiness but that are not
considered unhealthy include
Transparent/Clear/ mucus, sperm and prostatic
CLOUDY
Cloudy fluid, cells from the skin,
normal urine crystals, and
contaminants such as body
lotions and powders.

PROTEIN Proteinuria is present in the

+1 None patient because of stress,
exercise, fever.
GLUCOSE - <0.5g/day The patient does not have problems in
diabetes.

pH 6.0 4.5-7.8 pH The patient does not have any problems regarding
her urine pH

LEUKOCYTES TRACE None The patient develops an Inflammation of the

Kidney/Urinary Tract which can indicate a trace in
her urine.

BLOOD 2+ None Due to her infection the patient develops

haematuria.

EOSINOPHIL - None The patient does not have any parasitic infection.

KETONE - None The patient’s ketone leve is normal.

BILURUBIN - None The patient’s kidney is still intact and working.

COMPLETE BLOOD COUNT
VALUES NORMAL INDICATION RATIONALE
VALUES
RED BLOOD 3.65 3.75 – 5.0 Low During the patient
CELL cells/μL cells/μL pregnancy, has a
insufficient hemoglobin
in red blood cells in the
body. Since nutrition
plays a major role in a
pregnant woman’s
body, poor nutritional
status must be the
reason for the patient’s
slightly low amount of
red blood cells, thus,
not getting enough iron
inside the body.
WHITE BLOOD 12.2 5,000 – 15, 000 Normal The patient has a
CELL cell/μL cells/Μl normal white blood cell
count may indicate no
presence of viral
infection during the
patient’s pregnancy,
nor is she taking any
antibacterial
medication that can
lower the white blood
cell count.
HEMOGLOBIN 10.4 11.5-14 Low During pregnancy of
grams/dL grams/dL the patient, she
experience insufficient
haemoglobin and red
blood cells in the body.
Since nutrition plays a
major role in a
pregnant woman’s
body, poor nutritional
status must be the
reason for the patient’s
slightly low amount of
red blood cells, thus,
not getting enough iron
inside the body.
HEMATOCRIT 31% 32-42% Low When a pregnant
patient has a poor
nutritional value and
lacks knowledge
regarding the proper
nutritional intake
required for pregnancy,
anemia can be
developed which
results to the lowering
of red blood cells,
haemoglobin, and
haematocrit.
 15.2/L 20-25/L Suspiciously Low levels of
LYMPHOCYTES Low Lymphocytes in the
body is a normal
process during
pregnancy especially in
the process of
conception. It is helpful
during implantation in
the body and the
development of fetus
so the lymphocytes will
not think that the fetus
is a foreign body.
MONOCYTES 12.7/L 3-8/L Suspiciously The patient’s
High pregnancy allows level
of monocytes to
drastically increase
because the female
immune system has to
adapt the presence of
the semi-allogeneic
fetus and the
pregnancy itself to
compensate for the
changes in the specific
immune response.
EOSINOPHIL 1.6/L 2-4/L Suspiciously Eosinophil count
Low during pregnancy is
low because the
patient’s body see the
pregnancy as a
parasitic infection and
the decrease may help
in the changing of
specific immune
responses to the body.
DRUG STUDY
• Paracetamol (Oral)
• Atorvastatin (Oral)
• Tramadol (IV)
• Metoprolol (Oral)
• Betamethasone (IV)
• Furosemide (IV)
• Ampicilin (Oral)
NURSING CARE PLAN
CUES
The patient expresses her
unknowledgeable passive
behaviours toward her
medication as verbalize
“basta daghan man tung
medicina na gipa.inum
sa.akua, dili lang naku ma
huban.an ba unsa tu sila.”
(There are actually a lot of
medicines that they give me
for me to take. But I cannot
remember nor recall any of
those.)
Patient verbalize her
insufficient information
about her acquired disease
“wala man nako nahibal-an,
kung giunsa nako nakuha
ang sakit nga U.TI., ang
doctor wala gani moadto
aron sultihan ku paunsa naku
nakuha ni.”
(I don’t know how did I get
the disease, and even the
doctor did not also tell me
how did I acquired them)
NURSING GOALS AND NURSING INTERVENTION IMPLEMENTATION EVALUATION
DIAGNOSIS DESIRED
OUTCOME
Deficient Patient verbalizes Explain to the client about UTI risk factors, Patient able to answer the random
knowledge realistic prevention, and treatment. Give Health Teaching on question regarding to the medication that
regarding information and Rationale: Frequent recurrences of UTI may the medication given, she was using.
indicate that the client has no understanding of the
current disease knowledge of contraindication,
disease and its management.
and medication causes and indication and do’s and Patient able to verbalize that she now
related to treatment of UTI, Explain medication and its indication to the body. don’ts when given the understands the nature of the disease.
insufficient controls risk Rationale: Through their engagement with health medication.
knowledge. factors, and education, patient develops the confidence toward Patient able to verbalize that she now
completes medical the medication treatment, and for them to manage Give Health Teaching on understands importance of finishing the
treatment of UTI. their own well-being; make health-enhancing antibiotic therapy. antibiotic treatment.
choices, and plan.
Identify patient’s Give Health Teaching on Patient able to verbalize that she now
Encouraged the client to finish all prescribed
own strengths, antibiotics, even if symptoms resolve.
the importance of understands warning signs of the
individual needs, Rationale: In the first few days of antibiotic preventing urinary tract reoccurrence of disease.
and methods and therapy, urinary symptoms of burning, frequency, infection.
resources to meet and urgency usually resolve. However, Not finishing As observe the patient is now frequently
them. the antibiotic on the prescribed time will make the Hygienic measures void from time to time.
bacteria grow and multiply again. (showering rather than
bathe in a tub).
Encouraging the reporting of signs and symptoms of
recurrence urinary tract infection.
Rationale: 1 to 2 weeks after completing the
Avoid wearing tight-
antibiotic therapy is a common time frame for the fitting or constricting
signs and symptoms to recur. undergarments made of
non-breathing materials.
Teach the client about the importance of preventing
urinary tract infection.
Rationale: The goal of client teaching is to resolve
the current infection and prevent recurrence.
 CUES NURSING GOALS AND NURSING INTERVENTION IMPLEMENTATIO EVALUATION
DIAGNOSIS DESIRED N
OUTCOME
Objective cues: Anxiety Patient verbalizes Explain to the patient about UTI risk Give Health Teaching Patient verbalizes her insight on her
Poor Eye Contact related to cues in decrease factors, prevention, and treatment. on the patient towards capability to independently take care of
Scanning behavior experience anxiety, because Rationale: To lessen worry and provide the nature of disease, herself.“mas naka ginhawa ku, kaya
disease that of her treatment, client the capability to contribute in the the risk factors and pwede gani ku makatabang sa akuang
Subjective cues: might affect risk and treatment. treatment. kaugalingun.”
the fetus. diagnosis.
The patient expresses her Explain medication and its indication to Give Health Teaching (I am relief because I know that I can
anxiety towards her the body. on the medication help myself in this treatment)
illnesses as verbalize “Sa Rationale: Through their engagement given, contraindication,
una una pala na-hadlok with health education, patient develops the indication and do’s and
man ko uy, kay baka naa confidence toward the medication don’ts when given the
koy dengue ba baka treatment, and for them to manage their medication.
maunsa ang bata kay baka own well-being; make health-enhancing
mawala ba siya. Pero choices, and plan. Asked the patient if
katung nag ingun na si Dra they see things that are
na dili dengue pero UTI Encourage the patient to ask if they see less understood / not
nahadlok pud sa ko.” things that are less understood / not clear. clear.
Rationale: Unanswered questions lead to
(At first I was scared anxiety. Tell the patient that the
because I thought that it her active participation
would be dengue . Encourage the patient to engage directly and engagement will
However when the doctor and actively in their care. soon address the
tell me that it was not Rationale: The goal of client teaching is disease.
dengue I was relieved. to resolve the current infection through
However I’m bit scared) active participation of client.
DISCHARGE PLAN

• Medication
• Economy/ Exercise
• Treatment/ Therapy
• Health Teaching/ Hygiene
• Out- Patient Consultations
• Diet
• Sex
 EVALUATION
•The patient will able to answer the random question regarding to
the medication that she’s taking. The patient will be able to
verbalized that she now understands the nature of the disease.
• The patient will be able to verbalize that she now understand

warning signs of the reocurrence of disease.

• The patient is now frequently void from time to time.

• For the anxiety, the patient develops the confidence towards to

the medication treatment, and for them to manage their own well
being: make health- enhancing choices and plan.
• The patient will be able to verbalize her insight on her capability
to independently take care of her self.
RECOMMENDATION
• Merit further researches and study regarding life pregnancy
complication specifically urinary tract infection.

• Weekly visit the patient to observe and monitor regarding with her
health condition.

• Provide health teaching from her misconceptions regarding to her

current medication and to help her understand how does it affects
to her as well as the fetus.

• Explore more effective ways to provide guidance and care of a

pregnancy woman that acquires UTI in third trimester without the
use of medication.
 REFERENCES
● Link, R. (2019)0000. 6 home remedies for UTI (Urinary tract infection). [online] healthline. Available at:

https://www.healthline.com/nutrition/uti-home-remedies#section7

● Machalinski, A. (n.d). Urinary Tract Infection: 7 Best Way to prevent them retrieved from https://www.webmd.com/women/uti-risks

● Pregnancy and Medication. (n.d.). Retrieved from https://adaa.org/living-with-anxiety/women/pregnancy-and-medication

● Kelbach, J. (2017, January 08). How to Treat a UTI During Pregnancy. Retrieved from: https://www.healthline.com/health/pregnancy/treat-a-

uti#1

● Zimmermann, K.A. (2018, March 07). Urinary System: Facts, Functions & Diseases. Retrieved from:

https://www.livescience.com/27012-urinary-system.html

● Imam, T.H. (2018, June). Bacterial Urinary Tract Infections (UTIs). Retrieved from:

https://www.msdmanuals.com/professional/genitourinary-disorders/urinary-tract-infections-utis/bacterial-urinary-tract-

infections-utis
THANK
YOU!!!