Urinary Sepsis/Nanda Dx? ....Help!

[twinbee25]

Hi,

I am working on a concept map for homework on a pt who has a primary dx of urinary sepsis and seizures, with other dx of a foot wound (decubitis stage 3/4), and constipation. She has a hx of strokes and is severely contractured (whole body), aphasic and on a peg tube. She also has a foley cath. I had this pt once last semester, and her wound (the same one) is worse than it was last semester. Last semester, when I worked w/her, she didnt have a cath, but wore adult diapers. She is admitted often from the nursing home to the hospital.

My question is in trying to determine the nursing dx for her (problem boxes in the concept map), for the medical dx of urinary sepsis. Nanda doesnt have one for that specifically. the urinary sepsis is localized, so is why she isnt in intensive care. In talking w/my instructor to determine what exactly is urinary sepsis, we determined it is localized and worse than a UTI.

I have come up with so far "Ineffective Tissue Perfusion" and "Impaired Tissue Integrity". I was going to use "Impaired Urinary Elimination" as another nursing diagnosis for a problem box in my concept map... but I am having a hard time with the intervention on that one...using Nanda as a guide. This pt has no communication means and simply lays there. After having her 2 days in clinicals, I picked up a "sense of personality" from her each time I performed oral care on her w/swabs. She doesnt like that, and will clamp her mouth shut and grunt when I tell her it will make her feel better...the nurse and I both felt she was trying to laugh...though we dont know for sure.

Anyway...my problem comes in using Nanda as a guide...the interventions listed for "Impaired Urinary Elimination" (or similar urinary incontinence) doesnt have anything (that I can see) for this particular pts condition, being that she cant communicate, nor has much hope for improvement of her overall condition.

So I am asking for advice from any nurses that deal in nursing care plans, what would be an acceptable intervention for a pt like this? And I also have to list evaluations for each of my nursing dx problem boxes.

Thanks for any advice/help!!!

twinbee

[kaseysmom, LPN]

I have this book it's called Handbook of Nursing Diagnosis - its by Lippincotts. It was very helpful to me. However, the only nrsng diagnosis that I could find with regard to urination were:

Impaired urinary elimination, urinary retention, total urinary incontinence, functional urinart incont., reflext urin. incont., urge urin. incont., risk for urge urin. incont., stress urin. incont., and meturational enuresis.

To be honest, I don't think that any of those would apply to your pt the way it needs to. Urinary sepsis is obviously a urinary infection - perhaps something related to infections even though it may not be specific to urine?? Sorry I wasn't more of a help

[twinbee25]

I have this book it's called Handbook of Nursing Diagnosis - its by Lippincotts. ...perhaps something related to infections even though it may not be specific to urine?? Sorry I wasn't more of a help

I have the Ackley book of nursing dx. Urinary sepsis is more than a UTI...it is sepsis of the whole urinary system...at least from what I can see by researching online. I was up till 1:30am trying to finish my 2 concept maps... they are due today. this particular lady was hard for me to do one on b/c 1. I was wanting some super-duper problem fixer to make her get better...and 2. It seems Nanda nursing diagnosis lacks interventions for the terminal pt. In my evaluation I had to write also, I ended up suggesting consultations be made for her to receive hyberbaric treatment for her wound, and also be considered for hospice care since it seems (to me at least), that her track record of "bouncing back and forth" b/w nursing home and hospital hasnt improved her situation/conditions. So ... I will wait to find out how I did on it w/my grade when I get it back next week.

Thanks for your input...it did help as I did have to use the infection avenue also.

[manna, BSN, RN]

Anyway...my problem comes in using Nanda as a guide...the interventions listed for "Impaired Urinary Elimination" (or similar urinary incontinence) doesnt have anything (that I can see) for this particular pts condition, being that she cant communicate, nor has much hope for improvement of her overall condition.

Goals or nursing interventions?

As far as interventions go, how about...

Monitor I&O

Assess abd discomfort, bladder distention

Monitor patency of urinary cath, keep tubing free from kinks, keep drainage bag below level of bladder

Clean urinary meatus according to policy, maintain closed drainage system

Admin abx as ordered

Admin pain med as ordered

Monitor WBC

Assess VS q4h and PRN