pyelonephritis

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Specializes in OB.

Hi, I have to do a care plan for a patient diagnosed with pyelonephritis. She was admitted with abdominal pain and right flank pain (sharp). Aside from acute pain what other nursing diagnois could I use? Our proffessor wanted us to look at infection but I don't think NANDA's Risk for Infection applies here since the patient already has an infection.

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Doesn't NANDA have an Infection: Actual type of dx?

What is her illness doing to her ability to urinate? What complications of pylonephritis can the pt's nurse prevent via interventions?

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Specializes in OB.

When asked patient denied having any issues urinating, no burning, no frequency, Pt main issue is the pain. Regarding nursing interventions I'm thinking education about hydration, possibly hygenie to avoid reoccurence of infection? But I still don't know how I would word that "risk for infection r/t history of infection?

Doesn't NANDA have an Infection: Actual type of dx?

What is her illness doing to her ability to urinate? What complications of pylonephritis can the pt's nurse prevent via interventions?

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Specializes in ICU.

What about Ineffective Health Maintenance r/t deficient knowledge regarding self care, treatment of disease, or prevention of further UTIs aeb....

and

Risk for urge urinary incontinence: risk factor: irritiation of urinary tract

Also, I remember many moons ago when I had this infection, I had afternoon fevers (hyperthermia r/t increased metabolic rate) and fatigue (its own nanda). Is she well hydrated (fluid volume nandas)?

Just some thoughts as I work on my psych care plans over here :clown:

HTH!

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Specializes in Trauma/Burn ICU, Neuro ICU.

In Ackley:

Acute pain

Impaired urinary elimination

Ineffective Health Maintenance

Insomnia r/t urinary frequency

Risk for urge urinary incontinence

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Specializes in Nursing Professional Development.

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.)

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Specializes in OB.

She is on bed rest but was able to get out of bed without any assitance and showered on her own as well. She does have limited ROJM on her right arm (can't raise it up over her head) NANDA does have Activity intolerance listed

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.)
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Specializes in med/surg, telemetry, IV therapy, mgmt.

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.

[*]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.

[*]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

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doesn't nanda have an infection: actual type of dx?

what is her illness doing to her ability to urinate? what complications of pylonephritis can the pt's nurse prevent via interventions?

acute pyelonephritis is a potentially organ- and/or life-threatening infection that characteristically causes some scarring of the kidney with each infection and may lead to significant damage to the kidney (any given episode), kidney failure, abscess formation (eg, nephric, perinephric), sepsis, or sepsis syndrome/shock/multiorgan system failure. more than 250,000 cases occur in the united states each year (1995 estimate), and approximately 200,000 patients require hospitalization (1997 data). wide variation exists in the clinical presentation, severity, options, and disposition of acute pyelonephritis.

http://www.emedicine.com/med/topic2843.htm

so, ndx (high) risk for ???

interventions:

would strict i&o be important for such a pt?

labs- blood and urine? not only c&s, cbc w/ differential, but what about kidney function?

abt?

s/s

how would the pt feel?

in pain?

fatigued?

fearful?

v/s

febrile?

tachy?

what would the goals be for a pt in pain, febrile, dehydrated, &/or abnomal labs (high wbcs)?

what would you teach this pt to do and not to do? i.e. are bubble baths ok? how should she wipe after voiding?

use the nursing process.

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