Care Plan help for "Impaired Urinary Elimination"

  1. 0
    please help me with some wording....
    our instructors will nto allow us to use medical dx for our r/t.

    my pt has a uti, was retaining 1000ml of urine so they put in a foley.
    i cannot use:
    "impaired urinary elimination r/t uti aeb....... "
    i am drawing a complete blank with how to rephrase uti

    the pt was otherwise ok healthwise, she is weak and i plan to use a "risk for" dx as my second (w/instructor approval cuz there really was nothing else) this pt will be discharged soon.


    tia for any help!
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  4. 10 Comments so far...

  5. 0
    did they ever discover why she was retaining the urine? it would be nice to have that information because it will help to determine what the etiology of her urinary retention was. also, there is another nursing diagnosis that you could use for this based on her problem of the retained urine: urinary retention r/t inhibition of arc reflex aeb postvoiding residual urine of 1000cc [other symptoms might be absence of urine output, bladder distention, dribbling, dysuria, frequent voiding, overflow incontinence, sensation of bladder fullness, small voiding].

    there is information on how to choose and construct a nursing diagnoses on these two threads:
    basically, the nursing diagnostic statement has 3 parts: the pes
    p (problem)--e (etiology)--s (symptoms)
    the p is always the nursing diagnosis. the e is generally what is causing the symptoms. the s are the symptoms you are seeing in the patient. you determine the symptoms from your data collection during your assessment. in this case retaining 1000cc of urine is a symptom. the cause is probably the inhibition of the reflex arc, but i don't really know that. i really would have had to have seen more of the doctor's history and physical. but with a bladder of 1000cc of urine in it, the inhibited reflex arc is probably the likely culprit.
  6. 0
    sorry I left that out- she had another problem and was in an infusion center for 54 days receiving antibiotics to treat a leg infection.
    While there she didn't get up much, became weak...... and so on.

    oh, and if i use the Urinary Retention dx, where can I fit in the elevated WBC ?? I actually really do know how to formulate the care plan..just for some reason this one is stumping me in having to change UTI to something not a medical DX. The book the school required lists medical dx for almost every r/t for nursing dx- ie; impaired gas exchange r/t COPD. We cannot use COPD. We cannot even say r/t femur fracture, r/t hysterectomy, etc.
    Last edit by mkcrturner on Apr 29, '07
  7. 0
    Related to inflammation or maybe ureteral irritation, good luck
  8. 0
    r/t positive urine culture (if the UTI is indeed the cause) AEB inability to void, elevated WBC's, odorous urine, cloudy urine, 1000 ml urine in bladder....

    Poor women.... ouch
  9. 0
    So, now you have another symptom that you want to treat: an elevated white cell count. The first thing you need to do is go back to your knowledge of sciences and ask yourself what might be causing this elevated white cell count? Answer: infection, inflammation, stress, trauma, tissue necrosis or a leukemic process. Looks like the doctor has already determined that it's a UTI. I was also wondering if this UTI is a superimposed infection secondary to all the antibiotics she had been receiving before which would make this a problem of a compromised immune system. In any case, you have another symptom looking for a nursing diagnosis.

    I gave you Urinary Retention for the residual urine or 1000cc. The definition of this diagnosis is "Incomplete emptying of the bladder". So, obviously, an elevated white cell count can't possibly be a symptom of urinary retention, can it? You wanted to use Impaired Urinary Elimination, but the definition for that is "dysfunction in urine elimination". Not helpful here.

    Now, your patient has a UTI. The symptom is an elevated WBC count. What as a nurse can you do for an elevated WBC count without a doctor's order? Anything? The only thing I can see you doing with this symptom, as a nurse, is monitoring for signs and symptoms of her infection going into a system-wide septic shock situation. That brings to mind the nursing diagnosis of Risk for Ineffective Tissue Perfusion: cardiopulmonary and renal R/T decreased vascular resistance [which is what happens in cardiogenic shock due to sepsis]. Don't know if your instructors are allowing you to use "Risk for" diagnoses. The symptoms of this kind of septic shock that you would be monitoring her for would be:
    • flushed skin
    • altered level of consciousness manifested as agitation, irritability or shortened attention span
    • rapid shallow respirations
    • urine output the drops below normal parameters
    • rapid, bounding pulse
    • elevated blood pressure
    And you would develop nursing interventions and goals based upon these potential symptoms.

    And, that's about all I can see you doing with an elevated white cell count. Or, you could ignore it because you really can't perform any active nursing interventions for it. Point I am making is that just because there is a symptom doesn't necessarily mean that you have to do something about it. Sometimes there are things that are outside our scope of practice or beyond our control. If your instructors are saying you have to address every symptom, then I would do it as I've done above.

    Let me clarify with you that COPD is a general term used to describe a variety of conditions that result in obstruction of the airway. This is why NANDA allows the use of it as a related item in nursing diagnostic statements. It is not a good medical diagnosis for the doctor's to use. And, what you and many nurses don't know is that the billing departments will get after the doctors who use this term in their documentation of the patient's discharge diagnoses and they will inservice the doctors. If the doctor's don't specify what the underlying cause of the COPD is, the hospital could loose big time money when they bill for the services that were provided for the patient. COPD is either:
    • chronic obstructive bronchitis
    • emphysema
    • chronic obstructive asthma
    • chronic bronchitis with emphysema
    The pathophysiology, symptoms and treatment of each is different although there may seem to be some similarities.
  10. 0
    [quote=Daytonite;2181872]...<snip>Let me clarify with you that COPD is a general term used to describe a variety of conditions that result in obstruction of the airway. This is why NANDA allows the use of it as a related item in nursing diagnostic statements. It is not a good medical diagnosis for the doctor's to use. ....<snip>

    Thanks soo much for your in depth replies! They are a tremendous help that truly helped me over my "writers block"

    And regarding COPD- EXACTLY what I thought.... but then I am not the person grading these care plans... lololololol
    I am going with the theory that our instructor wants us to THINK, rather than copy the r/t from our books. ie; It is very simple to do impaired gas r/t COPD (per the book), but it takes some thinking to apply what little we know (1st level) to what is really causes the impaired gas exchange.

    Either that...or she is at home laughing at the thought of us trying to figure this out .
  11. 0
    Care plan for Urinary retention....

    http://www1.us.elsevierhealth.com/Ev...ex.cfm?plan=51
  12. 0
    Thanks to all who replied. This board is (and has been) a gift to me. From trying to get into school, and now to survive school.
    I am off to work on my care plan and study for test on 2 systems tomorrow- lymph and digestive.
    I truly appreciate the experioence you shared to help me get out of my rut.
  13. 0
    Quote from mkcrturner
    I am going with the theory that our instructor wants us to THINK, rather than copy the r/t from our books. ie; It is very simple to do impaired gas r/t COPD (per the book), but it takes some thinking to apply what little we know (1st level) to what is really causes the impaired gas exchange.

    Either that...or she is at home laughing at the thought of us trying to figure this out .
    You have to keep in mind that this is often what is asked of students doing college level work. They did this with us in my BSN program too. We couldn't use exact NANDA language--had to compose our own phrasing on any nursing diagnoses we used. You could spend sleepless nights trying to figure out how to reword the etiologies on these things. As long as you are staying with the definition of the nursing diagnosis and using the etiologies that NANDA has already listed for any particular diagnosis as a kind of guide for you, the wording you use can be your own creation. My recommendation: always keep the pathophysiology of what is going on in the patient as it specifically relates to the particular nursing diagnosis in the back of your mind and use a thesaurus. Once you are out in the working world, if you ever have to use the "related to" part on a nursing diagnosis it's probably not going to matter whether you copy it directly from NANDA's publications or write your own. There's going to be no instructor around to grade it for correctness.

    Good luck with this care plan!


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