i'm all out of ideas for interventions!

[tspink08]

i have a concept map due at the end of this week, and one of my dx is urine elimination, we need 3 goal and 3 interventions for each goal, i'm out of interventions! all i need is one more! can any one give me an idea?

[Daytonite, BSN, RN]

i can see that you are truly "out of ideas for interventions" (and goals, as far as i can tell). i don't usually post this much detail, but i can tell you are spinning your wheels here and at a dead end.

first of all, did you look up the definition of dysuria? did you do any reading about it? i think that is a big part of your situation here. you have to know what you are dealing with. i think that will help open up a few blocks in your thinking on this problem.

dysuria is

painful or difficult urination

commonly accompanied by

urinary frequency, urgency, or hesitancy

. inflammation is the most frequent cause, but other pathology includes cystitis, urethritis, trigonoitis, carbuncles of the urethra, obstructions of the urinary tract, cancers, neurologic disorders, diabetic neuropathy or foreign bodies that have irritated the urinary tract such as catheters. it is most commonly due to lower urinary tract infection (uti) and is more common in women than men. it also frequently is the result of lower urinary tract irritation or inflammation which stimulates the nerve endings in the bladder and urethra that result in the typical symptoms of dysuria. (references:

nurse's 5-minute consult: signs & symptoms

, pages 196-7,

signs & symptoms: a 2-1 reference for nurses

, pages 236-239,

differential diagnosis in primary care

, pages 144-145)

note the symptoms which i highlighted in green.

there are four types of nursing interventions (actions) that you can order in your care plan for patients. they are:

1. assess/monitor/evaluate/observe (to evaluate the patient's condition)
   
2. care/perform/provide/assist (performing actual patient care)
   
3. teach/educate/instruct/supervise (educating patient or caregiver)
   
4. manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)
   

for each patient symptom, you should be able to come up with one intervention of each type.

assess/monitor/evaluate/observe (to evaluate the patient's condition)

• have patient describe the severity and location of the pain, what precipitates it, aggravates it, alleviates it
  
• physically assess the urethra meatus for any discharge or irritation
  
• assess for cva (costovertebral angle) tenderness
  
• monitor vital signs
  
• monitor intake and output

care/perform/provide/assist (performing actual patient care)

• increase daily fluid intake unless this is contraindicated
  
• frequent urination is desired and the bladder should be emptied completely every 2 to 3 hours
  
• encourage a diet high in acid and ash, such foods as cranberry juice, meat, eggs, cheese, nuts, prunes, plums, and whole grains [fyi. . .we used to keep a water pitcher filled with cranberry juice along with a pitcher of water at the bedside of our patients with utis or urinary problems--keep the cranberry juice flowing!] (acidifies the urine and decreases bacterial growth)
  
• avoid coffee, tea and alcohol as these tend to irritate the bladder
  
• administer any drugs (antibiotics, urinary antiseptics) as ordered and monitor for any adverse effects.
  
• collect urine for urinalysis or culture and sensitivity tests as ordered
  
• prepare patient for any special testing to be done (cystoscopy, ivp, voiding cystogram, cystometrics)
  

teach/educate/instruct/supervise (educating patient or caregiver)

• teach:
  
  • the importance of maintaining increased fluid intake (helps to flush bacteria from the urinary tract)
    
  • the importance of maintaining frequent urination
    
  • how to perform proper perineal care after toileting
    
    • wipe perineum from front to back after urinating (to prevent fecal contamination)
      

    [*]that wearing cotton underwear will allow better ventilation and absorption

    [*]that after discharge:

    • it is best to take showers rather than tub baths
      
    • females should not douche
      
    • the importance of taking prescribed medications
      
    • if the patient is sent home on antibiotics explain the importance of completing the full course of antibiotics even if the symptoms of dysuria have subsided
      
      
    • the possible side effects of any medications ordered
      
    • to report any signs or symptoms of a uti to their physician:
      
      • pain or tenderness over the bladder
        
      • hematuria
        
      • fever
        
      • cloudy, foul-smelling urine
        

      [*]to report any unusual discharge to their physician

manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)

• notify urologist of consult with patient, if so ordered
  

you can also get an idea for goals from these four classifications of interventions. goals aim to improve, stabilize or support the patient's symptom(s) or etiology underlying the nursing problem (the nursing diagnosis you are addressing). it is important that you understand that everything in the plan is related to those dog gone symptoms that the patient has! this post will give you specific information on how to construct a goal statement: https://allnurses.com/forums/2509305-post157.html

long-term-goal: upon discharge the patient will demonstrate an understanding of their condition by being able to state the cause, signs, symptoms and possible aggravating factors of their dysuria.

short-term goal: within 24 hours patient will increase their 24-hour fluid intake to 3 liters.

short-term goal: in two days the patient will have no symptoms of pain upon urination, urinary frequency, urgency, or hesitancy.

i'll let you sort out and assign the interventions that go with the goals. feel free to change the goals if you don't like them. hope that helps you straighten out this issue.