nurs360 pyelonephritis care map

8/18/2019 NURS360 Pyelonephritis Care Map

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Christine RombawaNURS 360

Impaired renal function

Monitor BUN and

creatinine

Monitor urinary output.

Monitor VS, R, B!

Monitor periphera"

pu"ses, capi""ary re#"".

Na$ %&'()*

+"bumin &.6 ()*

ati-ue

ea/ness

Deficient knowledge

ducate pt. on si-ns

and symptoms o1

in1ection.

ducate pt. on si-ns

and symptoms o1 U2.

!romote hydration,

toi"etin- hy-iene, and

proper handwashin-.

ducate pt. on U2

pre4ention

ducate pt. on

importance oo1comp"etin- a""

prescribed antibiotics.

InfectionU2ebri"e

2emp$ %0%.5B"ood cu"ture pendin-

CBC$BC$ %'. (*Neutrophi"s$ 73.7 (*U+ Cu"tureC"oudy urine)eucocyte sterase$

)ar-eBacteria$ ModerateB"ood$ ModerateBC$ 8%00ematuria9ysuria

Medication$Cipro:o;acin 00m-

tab !< =%&hrs.+>etreonam %,000m-

in 0m" Sodium

Ch"oride V =hrsCe1tria;one %- in

0m" sodium ch"oride

V =7hrs+cetaminophen

60m- tab !< =5hrs

!RN

Chie1 Medica"

9ia-nosis$

!ye"onephritis

with Sepsis

Deficient Fluid volume

ebri"e %0%.5

U< ?30m" hr

2achycardia

9ry s/in

ei-ht dai"y

2entin-

9ry s/in

Monitor @ <

ncrease :uid inta/e&) =9

Norma" sa"ine

%,000m- V %00m"Ah

Pain

5A%0 :an/ pain

9ysuria

+cetaminophen 6

tab !< =5hrs !RN




Nursing Interventions and Outcomes

Desired Outcomes Interventions

Infection

Patient is free of infection as evidenced by clear,

non–foul-smelling urine; pain-free urination;

normal WBC count; and absence of fever, chills,

flank pain, and suprapubic pain, negative blood

and urine culture.

Infection

. !ssess for signs and symptoms of "#$.

%.&onitor '(). !ssess results of urinalysis*culture and

sensitivity for presence of +BCs, WBCs,

bacteria, and identify causative organism

necessary for selecting most effective an..!ssess results of blood test results; WBC,

blood culture, bacteria

. /ncourage pt. to drink etra fluid

0. $nstruct pt. to void often 1every %-) hrs2 andto empty the bladder completely.

3. (uggest cranberry or prune 4uice, vitamin C

55-555 mg*day to decrease p6 of urine.

7. /ducate pt. on importance of completing all

prescribed antibiotics.

8. 9imit the use of ind:elling catheters.

5. /ducate on proper perineal hygiene.

Pain

Patient reports satisfactory pain control at a

level less than ) to on a scale of 5 to 5.

Patient uses pharmacological andnonpharmacological pain relief strategies.

Patient ehibits increased comfort such as

baseline levels for, BP, 6+, respirations, and

relaed muscle tone or body posture.

Pain

. !ssess the patients description of pain.

$n<uire as to the <uality, nature, location, and

severity of pain.

%. !dminister analgesics and*or antispasmodics

as prescribed.). "se nonpharmacological techni<ues

:henever appropriate.

. !pply heating pad to suprapubic area or

lo:er back. .$nstruct the patient in the use of a sit= bath.

0. /valuate effectiveness of pain medication.

3. Position for comfort.7. &onitor nonverbal signs of pain.

Deficient fluid volume

Patient is normovolemic as evidenced byDeficient fluid volume

. !ssess for the early :arning signs of




systolic BP greater than or e<ual to 85 mm 6g

1or patient>s baseline2, absence of orthostasis,

6+ 05 to 55 beats*min, urinary output greater

than )5 m9*hr, and normal skin turgor.

hypovolemia, including changes in the level of

consciousness.% .!ssess '(? 6+, BP, and pulses, temp, resp.

). &onitor for BP orthostatic changes.

. +ecord and evaluate intake and output, daily

:eight.. !ssess skin turgor, thirst, and mucus

membranes.

0. $nitiate $' replacement fluids as ordered.3. &onitor blood tests? 6gb @ hct, coagulation

studies, fluid and electrolytes.

7. /ncourage oral fluid if able to tolerate.


Patient achieves optimal urinary elimination,

as evidenced by the follo:ing? urine outputA)5 m9*hr; electrolytes, B", creatinine

:ithin or near normal levels; and normal

specific gravity.


. &onitor and record the patients intake and

output. +eport an output of )5ml*hr.

%. &onitor the urine specific gravity.

). &onitor B", creatinine, sodium,

potassium, magnesium.

. &onitor urinalysis for protein, blood,

sodium levels and creatinine clearance

. &onitor daily :eights using same scale,

same time of day, and patient :earing same

amount of clothing.

0. &onitor for (@( of ecess fluid volume?

edema, 4ugular vein distention, 6#, crackles,

$ncreased respiratory rate.

3. !dminister fluids and diuretics as

prescribed.

Deficient knowledge

Patient verbali=es kno:ledge of causes,

treatment, and prevention of "#$ that could

Deficient knowledge

. !ssess the patients kno:ledge of "#$ risk

factors, prevention, and treatment.




lead to a reoccurrence of pyelonephritis,

controls risk factors, and completes medical

treatment of "#$.

%. #each the patient the importance of

prevention and follo: up care and need for

follo: up urine and blood cultures.

). #each importance of fre<uent bladder

emptying, hygiene measures? sho:ering is preferable to tub bathing, perineal hygiene :ith

bo:el elimination.

. /ducate importance for daily changing of

under:ear, :earing :ell ventilated clothing,

and avoiding tight or constricting under:ear,

pantyhose or pants.

. #each the patient to complete the full course

of antibiotic medication, even if symptoms

resolve.

0. /ncourage the reporting of signs and

symptoms of recurrence.

+eference?

u"anic/, Me-, udith Myers. Nursing Care Plans: Diagnoses, Interventions,and Outcomes, 8th Edition. Mosby, &0%5. Vita"Boo/ #"e.

/valuation?

!atient is 1ree o1 in1ection as e4idenced by c"ear, nonD1ou"Esme""in- urineFpainE1ree urinationF norma" BC countF and absence o1 1e4er, chi""s, :an/pain, and suprapubic pain, ne-ati4e b"ood and urine cu"ture. !atient reportssatis1actory pain contro" at a "e4e" "ess than 3 to 5 on a sca"e o1 0 to %0.!atient uses pharmaco"o-ica" and nonpharmaco"o-ica" pain re"ie1 strate-ies.!atient e;hibits increased com1ort such as base"ine "e4e"s 1or, B!, R,respirations, and re"a;ed musc"e tone or body posture. !atient isnormo4o"emic as e4idenced by systo"ic B! -reater than or eGua" toH0 mm - (or patientIs base"ine*, absence o1 orthostasis, R 60 to %00

beatsAmin, urinary output -reater than 30 m)Ahr, and norma" s/in tur-or.Patient achieves optimal urinary elimination, as evidenced by the follo:ing? urine output

A)5 m9*hr; electrolytes, B", creatinine :ithin or near normal levels; and normal specificgravity. !atient 4erba"i>es /now"ed-e o1 causes, treatment, and pre4ention o1U2 that cou"d "ead to a reoccurrence o1 pye"onephritis, contro"s ris/ 1actors,and comp"etes medica" treatment o1 U2.




Discharge Plan*#eaching

Patient :ill be discharged back to her residence. 6er support system includes her

husband and daughter. (he does not re<uire any assistance :ith her !D9s, but husband and

daughter are :illing and available to help :ith household duties. (he does not re<uire any

e<uipment, she is able to ambulate independently :ithout assistance. Will provide verbal and:ritten directions and education regarding medication management and compliance, along :ith

risk, prevention, and signs and symptoms of infection and "#$. Patient :ill verbali=eunderstanding of direction and education prior to discharge and schedule a follo: up

appointment :ith PCP to monitor effectiveness of treatment, resolution of problem, or any

further re<uired treatments.

nurs360 pyelonephritis care map

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