help with a NANDA label

Do you mean 5 nursing diagnoses? A care plan "allows a nurse to identify a patient's problems and select interventions that will help solve or minimize these problems" (page 3, Nursing Care Planning Made Incredibly Easy) and is a "statement of the goals and objectives of the nursing care [to be] provided for the patient and the activities or tasks required to accomplish the plan, including the criteria to be used to evaluate the effectiveness and appropriateness of the plan" (page 1487, Taber's Cyclopedic Medical Dictionary, 18th edition).

A nursing diagnosis is a patient problem that is identified by the nurse after assessing the patient and comparing the findings to what is considered to be normal.

Nursing diagnoses are ALWAYS based upon the symptoms (abnormal data) your patient is having. For nursing diagnosing, the symptoms we look for are not only the same ones the doctors focus on, but also include patients responses to their diseases and conditions as well as their ability to perform their ADLs. This information comes from your assessment of the patient. Every nursing diagnosis has a list of signs and symptoms (NANDA calls them defining characteristics) and before you assign any nursing diagnosis to a patient you should check a nursing diagnosis reference to make sure that a diagnosis you are contemplating using has one or more of your patient's symptoms, or defining characteristics, listed for it. You should also double check the definition of the nursing diagnosis to make sure it is indeed the correct problem that the patient has.

You've listed no data in relation to this situation so it would be very difficult to advise you what nursing diagnoses might be appropriate to use.

With my years of med/surg experience, and reading the brief history you provided of the UTI, leukocytosis, nausea and fever. . .I wouldn't even touch a psychosocial problem related to her grandson unless this patient is making a lot of comments about her relationship with (and more likely, away from) her grandson being a situational crisis causing manifested emotional or behavioral responses. Especially, if you haven't done any psych nursing principles and assessment yet. She has plenty of physiological things going on that you should be able to come up with 5 diagnoses. People with UTIs are hospitalized for treatment that can only be done in the hospital, otherwise they are allowed to be at home on oral antibiotics. Your assessment of the patient should include:

• most importantly
  • a physical assessment of the patient
  • assessment of the patient's ability and any assistance they need to accomplish their ADLs (activities of daily living)
• data collected from the medical record (information in the doctor's history and physical, information in the doctor's progress notes, test result information, notes by ancillary healthcare providers such as physical therapists and dietitians
• knowing the pathophysiology, signs/symptoms, usual tests ordered, and medical treatment for the medical diseases or conditions that the patient has. This includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications. If this information is not known, then you need to research and find it. You can use the links on this thread to help you:
  • http://allnurses.com/forums/f205/medical-disease-information-treatment-procedures-test-reference-websites-258109.html - Medical Disease Information/Treatment/Procedures/Test Reference Websites
    

• bladder pain
• hematuria
• fever
• cloudy, foul smelling urine

• what a UTI is, how it is diagnosed and treated
• what tests are being done and the preparation required for them
• why completing a prescribed course of antibiotics is important
• what drugs they are being given, why, and possible side effects
• the correct way to wipe herself after voiding (from front to back)

• damage to the urinary track lining
• infection of adjacent organs and structures
• sepsis (http://allnurses.com/forums/f205/pathophysiology-uti-septicemia-268443.html)