pyelonephritis

When I had nephritis many years ago, I had very little energy. Was that part of your assessment? Also, is she supposed to rest as part of her recovery. (I was.) Is there something related to activity intolerance or the need to limit activity that is a possibility for you? (I don't have a NANDA list in front of me and haven't used NANDA in years.)

care planning is accomplished through critical thinking and use of the nursing process which is a 5-step method. adapted to care planning the nursing process goes like this:

1. assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
   
   • 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) with the disease
     
   • 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 disease or condition 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.
     
     • use: https://allnurses.com/forums/f205/medical-disease-information-treatment-procedures-test-reference-websites-258109.html - medical disease information/treatment/procedures/test reference websites
       

[*]determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use). it helps to have a book with nursing diagnosis reference information in it. there are a number of ways to acquire this information.

• your instructors might have given it to you.
  
• you can purchase it directly from nanda. nanda-i nursing diagnoses: definitions & classification 2007-2008 published by nanda international. cost is $24.95 http://www.nanda.org/html/nursing_diagnosis.html
  
• many authors of care plan and nursing diagnosis books include the nanda nursing diagnosis information. this information will usually be found immediately below the title of a nursing diagnosis.
  
• the nanda taxonomy and a medical disease cross reference is in the appendix of both taber's cyclopedic medical dictionary and mosby's medical, nursing, & allied health dictionary
  
• there are also two websites that have information for about 75 of the most commonly used nursing diagnoses that you can access for free:
  
  • http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/
    
  • http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm
    

[*]planning (write measurable goals/outcomes and nursing interventions)

• goals/outcomes are the predicted results of the nursing interventions you will be ordering and performing. they have the following overall effect on the problem:
  
  • improve the problem or remedy/cure it
    
  • stabilize it
    
  • support its deterioration
    

  [*]interventions are of four types

  • assess/monitor/evaluate/observe (to evaluate the patient's condition)
    
    • note: be clear that this is assessment as an intervention and not assessment done as part of the initial data collection during step 1.
      

    [*]care/perform/provide/assist (performing actual patient care)

    [*]teach/educate/instruct/supervise (educating patient or caregiver)

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

[*]implementation (initiate the care plan)

[*]evaluation (determine if goals/outcomes have been met)

diagnosing, or determining what the problem is, requires that you do some investigation first. police detectives investigate a crime before arresting a suspect. a car mechanic checks under the hood of the car and tinkers around first before he starts replacing defective parts. before you can say what a patient's nursing problems are (nursing diagnoses), you must perform some kind of nursing assessment (see #1 above).

step 1 assessment - collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology

• pyelonephritis - you need to look up information about the pathophysiology, signs/symptoms, complications, usual tests ordered, and medical treatment of this medical disease. the -itis part of this medical diagnosis tells you there is inflammation going on. what is the pathophysiology and resulting manifestations of inflammation? there are 4: redness, heat, swelling, and pain (in that order). what do you suppose happened to the other 3 symptoms that preceded the pain?

step #2 determination of the patient's problem(s)/nursing diagnosis part 1 - make a list of the abnormal assessment data - i'm assuming this was a fictional patient. so, the symptoms you listed are what the scenario gave you. since that is all you were given that is all you have to work with as far as actual problems are concerned:

• abdominal pain
  
• sharp right flank pain
  
• limited rojm on her right arm (can't raise it up over her head)

step #2 determination of the patient's problem(s)/nursing diagnosis part 2 - match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use - the symptoms above become the evidence of nursing problems. every nursing diagnosis has defining characteristics (this is nanda terminology for symptoms). if you have a nursing diagnosis reference like the nanda-i nursing diagnoses: definitions & classification 2007-2008 or use a nanda taxonomy or a medical disease cross reference you will look for nursing diagnoses whose definitions sound like the patient's problem and that have one or more defining characteristics that match with the same ones the patient has.

• impaired physical mobility r/t [??? - perhaps the pathophysiology of pyelonephritis will yield some clues to the etiology here] aeb limited inability to raise right arm over her head
  
• acute pain r/t inflammation of the kidneys aeb abdominal pain and sharp right flank pain