I.

Introduction

Urinary Tract Infection (UTI) is a bacterial infection that affects any part of the urinary tract. The main causitive agent is

Escherichia coli. Although urine contains a variety of fluids, salts, and waste products, it usually does not have bacteria in it. When

bacteria get into the bladder or kidney and multiply in the urine, they cause a UTI. The most common type of UTI is a bladder

infection which is also often called cystitis. Another kind of UTI is a kidney infection, known as pyelonephritis, and is much more

serious. Although they cause discomfort, urinary tract infections can usually be quickly and easily treated with a short course of

antibiotics.

The diagnosis is confirmed by examining a sample of the child's urine under a microscope for bacteria and white blood cells.

The urine may also be cultured identify the bacteria and test to see which medications will provide the most effective treatment. The

treatment is with antibiotics.

Urinary tract infections are a serious health problem affecting millions of people each year. Infections of the urinary tract are

the second most common type of infection in the body. Urinary tract infections (UTIs) account for about 8.3 million doctor visits each

year. About 3% of girls and 1% of boys have had a recognized urinary tract infection (UTI) by age 11. The symptoms are not always

obvious. They may range from just an unusual smell of the urine or mild burning on urination to very severe pain and high fever.
Recognizing and treating urinary tract infections is important. A urinary tract infection in a child may be a sign of an abnormality in

the urinary tract that could lead to repeated problems and serious kidney damage.

Another diagnosis to be considered in the patient is Dengue Fever. Dengue fever is a disease caused by a family of viruses that

are transmitted by mosquitoes. It is an acute illness of sudden onset that usually follows a benign course with headache, fever,

exhaustion, severe joint and muscle pain, swollen glands, and rash. The presence of fever, rash, and headache is particularly a

characteristic of dengue.

This case study took place at Jose P. Rizal Hospital and it will be presented by the students of Group 8 section 2BSN2 of Colegio

de San Juan de Letran-Calamba. All information about the client shall only be confined to the aforementioned witnesses of the case

presentation and shall remain confidential.

 A. ANATOMY AND PHYSIOLOGY 

Anatomy of the Urinary System

Begins at the kidneys and includes the paired ureters, unpaired urinary bladder, and the urethra.
 The urinary system is the principal system responsible for water and electrolyte balance. It also functions to excrete urea and

creatinine (nitrogenous compounds).

Kidneys -2 (paired) = normal condition. The left is higher than the right due to the presence of the liver.

Kidney structure Has two layers

            1. Outer cortex - many capillaries

            2. inner medulla - many blood vessels and tubules

                        a. renal pyramids - tubules (tips = renal papilla)

                        b. renal columns - separate pyramids. Transmit blood vessels

Nephron - the functional unit of the kidney. It functions to produce urine. It is made up of many tubules and their associated blood

vessels. There are over 1 million nephrons

 Glomerulus - A tuft of capillaries with fenestrations

Glomerular (Bowman's) capsule - surrounds the glomerulus. Together they form the renal corpuscle. The epithelium of the glomerular

capillaries contains pores called fenestrae. These allow filtrate but NOT proteins to pass from the blood into the glomerular capsule.
 The glomerular capsule has a parietal and a visceral layer. The parietal layer is for structure only and does not play a role in filtration.

The visceral layer is made up of highly specialized cells called podocytes. These cells have foot processes (pedicels) which line the

basement membrane of the glomerulus. Between the foot processes we see filtration slits which allow the filtrate to pass into the

capsular space.

Proximal convoluted tubule - Here we see cuboidal cells with a brush border (microvilli) These cells resorb substances from the

filtrate as well as secrete substances into the filtrate. The microvilli greatly increase the ability to resorb water.

 Loop of Henle - has both ascending and descending limbs

 Descending limb - (thin segment) is simple squamous epithelium and is highly permeable to water.

Ascending limb - (thick segment) the epithelium is cuboidal or even low columnar.

Distal convoluted tubule - here the cells are cuboidal and thinner than those seen in the proximal convoluted tubule. This shows that

these cells play a role in secreting substances into the filtrate rather than removing substances from it. Here we also see two cell types:

1. Intercalated cells (cuboidal with microvilli) - these function in acid/base balance of the blood.

            2. Principal cells (no microvilli) - these function in body Na+ and water balance.
 Collecting duct - not a part of the nephron. The distal convoluted tubules connect to collecting ducts. Passes through the renal

pyramids and ends at the renal papillae where it empties into a minor calyx.

 Two types of Nephrons:

1. Cortical nephrons: these make up 85% of our nephrons. With the exception of the tip of the loop of Henle these nephrons
are located in the renal cortex.

2. Juxtamedullary nephrons: here the renal corpuscles are located in the cortex, yet very near the cortex-medulla junction.

Blood supply

Renal arteries feed into segmental arteries, which turn into interlobar arteries (in renal columns) which feed into arcuate

arteries (branched out at the level between the cortex and medulla). Interlobular arteries branch off of the arcuate arteries and run out

into the cortex. From these branch the afferent arterioles which bring blood to the glomeruli (blood filtrate enters the urinary tubules).

Blood leaving the glomerulus enters an efferent arteriole which takes the blood to peritubular capillaries around the convoluted tubules

OR vasa recta surrounding the ascending and descending limbs of Henle. At this point the blood enters veins that parallel the arteries.

That is, interlobular veins to arcuate veins to interlobar veins to renal veins to the IVC.

Ureters - are retroperitoneal and paired.

 - enter the urinary bladder

The wall of the ureter has 3 layers (tunics)

1. Inner mucosa - continuous with the lining of the urinary bladder. It has transitional epithelium that secretes a protective

mucous (lubrication)

2. Middle layer - muscularis. It has an inner longitudinal and outer circular layer of smooth muscle.

            The proximal 1/3 also has an outer longitudinal layer of smooth muscle.

3. Outer layer - fibrous coat made of loose CT. This coat covers the ureter and anchors it in place.

Urinary bladder - storage bag for urine. It is located behind the pubic symphysis yet in front of the rectum in males and in front of

the uterus in females.

 The wall has 4 layers:

1. Muscoa - innermost layer. Has transitional epithelium. Will find many folds (rugea) except in the area known as the trigone. This is

a triangular area demarcated by three points, the two openings of the ureters and the exit point for the urethra.

2. Submucosa - supports the mucosa

3. Muscularis - has three layers called detrusor muscle. This muscle helps to form the internal urethral sphincter.

4. Serosa - outermost layer. It is found only on the superior surface of the bladder. It is actually a continuation of the peritoneum.

Urethra - female = short. Approx. 4 cm long

                 male = longer. Consists of three regions

                        1. prostatic urethra - passes through the prostate gland

                        2. membranous urethra - passes through the UG diaphragm

                        3. Penile (spongy) urethra - passes the length of the penis.

 Urethral wall -The inside of the wall is lined by mucous membrane surrounded by a thick layer of smooth muscle. We also see

urethral glands which secrete mucous into the urethral canal. There is an external urethral sphincter which is composed of voluntary

skeletal muscle.

 Micturition - urination, which is a reflex action. Stretch receptors activate the detrusor muscle and relax the internal urethral

sphincter. The external urethral sphincter is under voluntary control after approx. 2 years of age. This has to do with growth of the

spinal cord and appropriate nerves.

 B. PATHOGENESIS

 Most UTIs result from bacteria ascending from the urethra.

 Haematogenous seeding of the kidneys may occur when a patient is bacteraemic with organisms such as S. aureus or Candida,

but this rarely occurs with Gram negative enteric bacteria.

 Most bacteria causing UTIs originate in the bowel. They colonise the lower vagina and periurethral mucosa before colonising

the distal urethra. From there they may ascend the urethra into the bladder, and from there up the ureters into the renal

parenchyma. Establishment of a UTI by the bacteria colonising the urethra is dependent on interactions between bacterial

factors and host factors.

Bacterial factors

 Most UTIs are caused by only a few serotypes of Escherichia coli: “uropathogenic clones”. These are selected

from the colonic flora by virulence factors that enhance adhesion and invasion of the urinary tract. Some of these

virulence factors are:

- Type 1 fimbriae: bind to mannosides present on urinary epithelial cells. These adhesins are imp ortant for

colonisation of the lower urinary tract and bladder.

  Other bacterial virulence factors may enhance their ability to produce UTI:

- Motility: assists movement up the ureter

- Gram negative endotoxin: inhibits ureteric peristalsis

- Bacterial K antigen: inhibits leucocyte phagocytosis

- Bacterial haemolysin: damages renal tubular epithelium and parenchyma

- Bacterial aerobactin: iron scavenging protein (siderophore) found in uropathogenic bacteria

Host factors

 Consider first the host’s defence mechanisms against UTI:

- Antibacterial activity of urine: low pH, high [urea], prostatic secretions, Tamm-Horsfall protein from cells of loop of Henle

(hypothesis: mannose containing side chains of THP bind to E. coli type 1 fimbriae, preventing them from binding to mannose

containing epithelial cell receptors).

- Flushing action of urine

- Bladder surface mucopolysaccharide (glycosaminoglycan) inhibits bacterial adherance

Host factors predisposing to UTI:

- In some women, defective local perineal and vaginal defence mechanisms leading to increased colonisation

is postulated (eg. reduced local antibody production)

- Genetic predisposition to produce particular receptors for uropathogenic bacteria.

- Raised vaginal pH.

- Estrogenic hormones may influence bacterial attachment.

- Diaphragm and spermicides.

- Sexual intercourse: moves bacteria from distal urethra towards bladder.

- Impairment of urinary flow (eg. congenital abnormalities of ureters or urethra, prostatic enlargement, calculi,

polycystic kidney disease).

- Incomplete bladder emptying (eg. due to mechanical or neurogenic reasons).

- Presence of foreign material, such as catheter or stent.

 C. Rationale for choosing the case

This case study, Urinary Tract Infection t/c Dengue Fever was chosen because it could enable us to contribute to the research

and information regarding the problem and it could help us to gain more understanding and knowledge.

It is an opportunity for us to research and get information about this case so that we can explain and make our client

understand.

D. Significance of the study

Through this study, the patient can receive a quality, personalized, and holistic care coming from the student nurses. The result

of the study can provide additional insights or knowledge about Urinary Tract Infection not only to the students and the patient. This

study will also provide a chance to test the student’s skills regarding a thorough patient assessment and quality nursing care in the

clinical setting. Critical thinking will also be exercised by the students in relating the patient’s problem to the interventions to correct

the problem, as well as the rationale for each intervention given.

E. Scope and limitation of the study

This study focuses on a patient who was diagnosed with a Urinary Tract Infection t/c Dengue Fever. The study also includes

the assessment of the physiological and psychological status, adequacy of support systems, and care given by the family as well as

other health care providers.

The scope of this study would include:

 Data collected via assessment, observation and clinical records during duty

 The client’s profile, family history, health history, medical orders and rationale, anatomy and physiology,

the pathophysiology of the condition, and nursing system review chart, drug study, and evaluation.

 The development of plans of care that will reduce identified predicaments and complications.

 Coordination and delegation of interventions within the plan of care, to team members, in order to assist the

client to reach maximum functional health. An array of factors influencing the limitations of the this study

includes:

The focus of this study will be on the problem of the patient which is Urinary Tract Infection t/c Dengue Fever. The

assessment phase includes the subjective and objective data of the patient through observation and interview. This case study

shall focus on a nursing diagnosis which is constipation related to irregular defecation habits as evidenced by absence of stool

for two days. The planning, implementation, and evaluation phases are focused on the gathered subjective and objective data

and most importantly the establishment of proper nursing care to proved wellness for the patient.
II. Clinical Summary

A. General Data

Name: Patient X

Sex: Female

Age: 5 yrs old and 11 months

Birthplace: Calamba City, Laguna

Religion: Catholic

Address: Villa Remedios Subd., Calamba City, Laguna

Admitting Date and Time: December 4, 2009 at 3:10 pm

Admitting Medical Diagnosis: Urinary Tract Infection to consider Dengue Fever

Admitting Vital Signs:

T: 39.2 ˚C RR: 42 bpm

PR: 152 bpm

B. Chief Complaint

The patient has a chief complaint of fever.

C. History of Present Illness

The patient has a history of fever and low platelet count.

D. Past Medical History

The patient has been confined at San Pablo City last August 2008.

E. Family History

There is no family history of any illnesses or any family member has been deceased.
III. PHYSICAL ASSESSMENT

Parts, senses and systems to Techniques Normal findings Findings from the Clinical Analysis
be assessed patient

Hair >Inspect the evenness >Evenly distributed hair >The hair of the >The hair growth is normal.
of growth of the scalp. patient is evenly
distributed.

>Has thick hair

>Hair thickness
>Thick hair
>She has silky,
>Hair texture or
>Silky, resilient hair resilient hair
oiliness
>No infection or
>Note presence of any
infestion is noted
infections, for dandruff, >No infection or
lice infestion

>Inspect the amount of >Variable >Variable

body hair
Skin >Inspect skin color >Varies from light to >The patient has >The patient has a normal
deep brown; form ruddy deep brown color findings for the skin, no
pink to light pink; from edema and other infections
yellow overtones to olive except that the client is cold to
touch.
>Inspect uniformity of >Generally uniform
color except in areas exposed >There is uniformity
to the sun; areas of of color
lighter
pigmentation(palms, lips,
nail bed) in dark-skinned
people

>Assess for edema.

>No edema
Measuring the >There is no edema
circumference of the present
extremity by using a
tape measure.
 >Inspect, palpate and
describe skin lesions.
>Freckles, some >No freckles and
Apply gloves if
birthmarks, some flat and lesions are present
possible
raised nevi; no abrasions
>Observe and palpate or other lesions
skin moisture
>Moisture in skin folds
and the axillae (varies >The patient is cold
with the environmental and clammy to touch
temperature and
humidity, body temp. and
activity)

>Note for skin turgor

>When pinch, skin goes >Has a good skin

back to previous state turgor

Nails >Inspect fingernail >Convex curvature;angle >The patient has this >There are no abnormalities
plate shape to of nail plate about 160˚ findings has seen in the nails.
detremine its curvature
and angle

>Inspect fingernail and

>Smooth texture >She does have a
toenail texture.
smooth texture

>Highly vascular and

> Inspect toenail bed
pink in light skinned >Met this ff.
color
clients; dark skin clients characteristics
may have brown or black
pigmentation in
longitudinal streaks

> Inspect tissues

>Intact epidermis >She has intact
surrounding nails
epidermis

>Less than 4 sec. the

>Prompt return of pink
>Perform blanch test of normal color of the
or usual color (generally
capillary refill. Press nail bed is returned.
less than 4 sec.)
 two or more nails
between your thumb
and index finger; look
for blanching and
return of pink color to
nail bed

Skull and face >Inspect the skull for >Rounded >Has normal > No abnormalities seen, the
size shape and (normocephalic and findings for the patient complied for the ff.
symmetry. symmetric, with frontal, following with 52cm procedures to check for the
parietal and occipital of circumference facial movements
prominences) smooth
skull contour.

>Palpate skull for any >Smooth, uniform

nodules or massess of consistency; absence of >(-) massess and
depression. Use a nodules with smooth
 gentle rotating motion nodules or massess and uniform
with fingertips. Begin consistency
at the front and palpate
down the midline, then
palpate each side of the
head.

>Note symmetry of
facial movements. Ask >Symmetric facial
the client to move movements >She has symmetric
eyebrows, close ey3e movements and does
tightly, puff cheeks and follow the following
smile show teeth steps we have.

Eye structures >Inspect eye brow for >Hair evenly distributed; >The skin is intact >The eye structures and visual
and visual acuity hair distribution skin intact and the hair of eye acuity are normal. No lesions
brow is evenly and edema
distributed
>Inspect eyelashes for >Equally distributed
evenness and hair
>Normal and equally
growth .
distributed.

>Inspect the eyelids for

the surface >Skin intact; no
characteristics, position discharge; no >(-) abnormalities
in relation to the discoloration
cornea, ability to blink
>Lids close
and frequency of
symmetrically
blinking. Elevate
eyebrows with thumb >Approximately 15-20
and index fingers, have involuntary blinks per
the client close the minute; bilatera blinking
eyes.

Inspect also the other

>When lids open, no
eyelids
visible sclera above
corneas and upper and
lower borders of cornea
are slightly covered.
>Inspect the bulbar >Transparent; capillaries
conjunctiva for color, sometimes evident;
>normal findings of
lesions and texture. sclera appears
bulbar conjunctiva
Exert pressure over the white(darker or
upper and lower bony yellowish and with small
orbits and ask if the brown macules in dark-
client feel pain. skinned patients

>Inspect the palpebral >Shinny,smooth, pink or

conjuctiva by invertiing red >The pt. has a good
eyelids findings of the
palpebral conjuctiva.
>Inspect lacrimal sac,
>No edema and lesions
duct ,gland. > (-) edema and
infections

>Constrict pupil when

>Inspect pupil
light is directed or near
dilatation by using pen >The pupil is equally
light >Dilated pupil when round, reacted to
light is far and indirect light.
 >For visual acuity use >Does read the ff. letters
any of the magazines despite of the distance
>She met the
which available. Place
standards
the client 20 feet
distance from the
resourced chart. Ask
the client if she can
read the ff. letters that
is directed

Ears and hearing >Inspect the auricles >Color same as facial >Normal findings, >There are no abnormalities
for the color, texture, skin symmetrical, and the while assessing the ff.
size and position auricle is aligned w/ procedures. The client has
>Symmetrical
outer canthus of eye. normal findings.
>auricle aligned w/ outer
canthus of eye, about 10
from the vertical

>Palpate auricles for

texture >No pain and no lesions >(-) lesions and pain

- Push in tragus (ask

client if does feel pain)
- Push mastoid process
ask also if does fell
pain

>Assess the client if

responses for the voice
tones

>Perform watch tick

>Normal voice tones >Normal
test, and ask client if
audible
does hear any ticks. >The client hear the
>Able to hear ticking w/ tick of the watch
--The tuning fork test
both ears with both ear

>Perform Weber’s test

>Sound is hear in both >Met the ff. normal
by holding the fork on
ears or is localized at the findings
its base
center of the head
>Perform Rinne’s test
 by asking to block the >Air conducted hearing >Normal findings
hearing in one ear is greater than bone
intermittently by conducted hearing
moving fingertip in and
out.

Nose and sinuses >Inspect external nose >Symmetry and straight; >Normal findings is >The client has normal
for size, shape or color no discharge or flaring; met. findings of the nose and
and flaring or discharge uniform in color sinuses, there are no lesions or
from the nares. any abnormalities.

>Observe presence of
>Mucosa pink; clear,
redness, swelling, >Mucosa is pink,
watery discharge ;no
growths and discharges with clear and
lesions
watery discharge and
(-)lesions
>Inspect nasal septum
>Nasal septum intact and >The septum is
between the nasal
in midline intact and in midline
chamber

Mouth and Oropharynx >Lips and buccal >Uniform in color; soft, >The client is met >Some of the findings are not
moist, smooth texture;
 mucosa symmetry of contour and the normal findings normal
ability to purse
--Inspect outer lips for
symmetry of contour,
color, and texture. Ask
the client to purse lips
as if to whistle

Teeth and gums

>Smooth shinny tooth

>The number of the
enamel
>Inspect the number of teeth is not complete,
teeth some of the teeth is
broke.
>Buccal mucosa is
need to be assessed

Neck >Assess for muscle >Equal strength >The client has the >The client has normal
strength by turning the equal strength findings in neck, (-)lymph
head of the patient in nodes, (-) thyroid gland
one side and to the visiblity
other side

>Assess for lymph

>No palpable lymph
nodes for any palpable
nodes >No palpable lymph
 lymph nodes nodes

>Palpate trachea for >central placement in >The patient’s

lateral deviation midline of neck; spaces trachea is in central
are equal on both sides placement in midline
of neck; spaces are
equal on both sides
>Not visible inspection
>No visibility

>Inspect thyroid gland

Thorax and lungs >Assess posterior and >No abnormalities, >No abnormalities is >The client’s thorax is normal
anterior thorax for scoliosis, and any seen both posterior and anterior.
symmetry and shape, distention
assess for deformities,
abnormalities

>Auscultate by using
stethoscope >Vesicular and broncho
>With vesicular and
vesicular sounds
bronchovesicular
sounds

Abdomen >Assess for skin >Unblemished skin >The client has >The client has distention and
integrity distention and with with bowel sounds
 >Assess for any >No distention bowel sounds
distention

>Inspect for bowel

>Audile bowel sounds
sounds

>Absence of friction rub

>Auscultate abdomen

Muscoloskeletal system >Inspect the muscles >Equal size on both sides >The client’s muscle >The client’s muscluloskeletal
for size. Compare the of body has equal size. system is normal. The muscles
muscles on one side of are firm and of equal size.
the body to the same
muscle on the other
side. For any
discrepancies, measure
the muscles with a
tape.

>Inspect the muscles

>No contractures >No contractures
and tendons for
contractures.

>Palpate muscles at
rest to determine
muscle tonicity >Normally firm >The client’s muscle
is firm
Bones:

>Inspect skeleton for

structure >There are no
>No deformities
deformities found

>Palpate the bones to

>No tenderness or
locate any areas of >There is no
swelling
edema or tenderness. tenderness or
swelling.
Joints:

>Inspect the joint for

swelling. >No swelling >There is no
swelling.
>No tenderness,
swelling, crepitation, or
nodules.
VI. ECOLOGIC MODEL

A. Hypothesis

A urinary tract infection is an infection involving the organs that produce urine and carry it out of the body. These structures

include the kidneys, ureters bladder and urethra. Upper urinary tract infections usually occur because bacteria travel up from

the bladder into the kidney. Sometimes, they occur when bacteria travel from other areas of the body through the bloodstream

and settle in the kidney.

B. Pre-disposing Factors

Host

 Female
  5 yrs. old

Agent

 Bacteria in the urinary tract

Environment

 Living conditions

 Lifestyle

 Diet

C. Analysis

The agent-host-environment model is primarily use in predicting illness rather than promoting wellness, although identification

of risk factors that result from the interactions of agent, host, and environment are helpful in promoting and maintaining health.

Because each of the agent-host-environment factors constantly interacts with others, health is an ever changing state. Health is seen

when all three elements are in balance while illness is seen when one, two, or all three elements are not in balance.
(Fundamentals of Nursing by Kozier 2004)

Urinary Tract infection is mostly caused by bacteria and it infects the urinary tract. Factors that can contribute to the condition

are age, lifestyle, habit, and environment. Urinary tract infection in children (symptomatic or asymptomatic) is associated with a high

incidence of urinary tract abnormalities (vesico-ureteric reflux, ureteral duplication, trabeculated bladder, hydroureter, ureteropelvic

junction obstruction) which may require correction.

D. Conclusion

The patient is suffering from Urinary Tract infection probably due to her lifestyle and habit. Other risk factors may also

involve such as age and the way of living.

VII. GORDON’S 11 FUNCTIONAL PATTERN

Health Perception-Health Management Pattern

 Before the patient’s hospitalization, she perceives health in a way that she is not suffering from any disease or illness. Her

mother always reminded her to take vitamins for her to improve her health and to protect him from acquiring any disease or

from being sick.

  During her hospitalization, the patient feels so unhealthy according to his mother because of her condition. She is obedient in

taking her medications and is participative in all the nurses’ interventions.

Nutritional-Metabolic Pattern

 Before her hospitalization, the patient takes her meal three times a day without any restrictions. According to her mother, she

has food preferences on meats. She has no difficulty in swallowing and she usually eat junk foods when its snack time. She

drinks 3-4 glasses of water a day and she takes vitamins.

 During her hospitalization, her appetite moderately decreased. Her fluid intake increased for about 5-7 glasses of water a day.

Elimination Pattern

 Before her hospitalization, the patient used to eliminate at least once a day. She usually urinates 2 times a day with the normal

light yellow color and aromatic odor. She also perspires every time she plays.
  During her hospitalization, the patient’s elimination became ineffective. She also perspires but it’s due to the hot environment

not from any activity since she just stays on bed.

Activity-Exercise Pattern

 Before her hospitalization, she used to play outside with his cousins or friends. They usually play dolls and the usual games of

her age. She stops playing when she feels tired.

 During her hospitalization, she used her time reading and coloring books together with her mother. Most of her time was spent

for resting and sleeping.

Sleep-Rest Pattern

 Before her hospitalization, she usually sleeps 8-9 hours.

  During her hospitalization, the patient sleeps early but has sleep disturbances when the nurses take her vital signs, administer

medicines and also due to the environment.

Cognitive-Perception Pattern

 Before her hospitalization, the patient is normal in terms of her cognitive abilities. She has no problems with her senses.

 During her hospitalization, she relates to us actively. She responded to our questions enthusiastically. She also related to us

some of her toys and books.

Self-Perception/ Self-Concept Pattern

 According to the patient’s mother, she is a good daughter though sometimes she tends to disobey her parents. She said this is

normal for her age.

Role-Relationship Pattern

 The patient has a close relationship with her family.

Sexual-Reproductive Pattern
  Prior to her age, the patient is not yet oriented with any sexual matters.

Coping Stress- Tolerance Pattern

 According to her mother, when she has problems she always approach her parents.

 During her hospitalization, she feels unsafe with people when her mother is not with her.

Value-Belief Pattern

 She is a Roman Catholic. They attend mass regularly. She is afraid to do something bad because she believes that God will

punish her.

VIII. DRUG STUDY

DRUG CLASSIFICATION ACTION INDICATION CONTRAINDICATION ADVERSE NURSING

NAME EFFECTS RESPONSIBILITIES
Amikacin Anti-infective Interferes Severe Hypersensitivity to Hearing loss, Inform the patient that the
with protein systematic aminoglycosides deafness, loss of drug may cause hearing
synthesis in infections caused balance, oliguria, loss, seizures, and other
bacterial cells by sensitive Parkinsonism proteinuria, neurologic problems. Tell
by binding to strains of  increasing serum him to report these
ribosomal pseudomonas Breast feeding creatinine, symptoms immediately
subunit, aeruginosa, urinary casts, red (hearing loss, tinnitus,
leading to E.coli, an white blood ataxia and vertigo)
bacterial cell anterobacter cells in urine,
death. azotemia,
decreased serum
 magnesium.

Cefuroxime Anti-infective Binds Treatment for Contraindicated in  Hyper- Assess for infection at
bacterial cell urinary tract hypersensitivity sensitivity beginning and during
wall infection, skin cephalosphorins reactions therapy
membrane, and skin Elevations in
causing cell structures, bone Serious hypersensitivity to serum creatinine,  
death and joint penicillin nausea, vomiting
infection, and
gynecologic
infections 
Ascorbic Vitamin Water- Recommend Prolonged use of excessive  Dizziness, Too-rapid intravenous
acid soluble dietary allowance doses contraindicated in temporary injection is to be avoided.
vitamin with diabetes mellitus, sodium- faintness
antioxidant restricted diet, concurrent
properties, anticoagulation use, and
stimulates history of  recurrent renal
collagen calculi
formation
and enhances Use cautiously in
tissue repair hypersensitivity to
tartranize or sulfites, before
tests for occult blood in
stool and breastfeeding
patients.

Ranitidine Antiulcer drug Reduces Active duodenal Headache, agitation, Cardiac Tell patient he may take
gastric acid ulcer anxiety arrhythmias, oral drug with or without
secretion and Bradycardia, food. Advice him to take
increased To maintain Nausea, vomiting, diarrhea, headache, once daily prescription
gastric mucus healing of constipation, abdominal fatigue, drug at bedtime
and duodenal ulcer discomfort or pain. dizziness,
bicarbonate depression, Caution patient to avoid
production Hepatitis, rash, Pain at IM Nausea, driving and other
creating a injection site, burning or vomiting, hyper- hazardous activities
protective itching at IV site, sensitivity
coating on hypersensitivity reaction reactions.
gastric
mucosa

IX. IV FLUIDS
Infusion Indication Classification Contraindication Nursing Responsibilities

D5 0.3 NaCl Dextrose and Sodium Isotonic crystalloid Reactions which may Check the label, expiration date, and
Chloride Injection, solution occur because of the indication.
USP is indicated as a solution or the
source of water, technique of Dextrose injections with low
electrolytes, and administration include electrolyte concentrations should not
calories. febrile response, be administered simultaneously with
Replenish fluid, infection at the site of blood through the same
nutrient and injection, venous administration set because of the
electrolyte thrombosis or possibility of hemolysis. The
phlebitis extending container label for these injections
from the site of bears the statement: Do not
injection, administer simultaneously with
extravasation and blood.
hypervolemia.

D5LR Lactated Ringer's and Hypertonic crystalloid Solutions containing Check the label, expiration date, and
5% Dextrose dextrose may be indication.
Injection is indicated contraindicated in
Lactated Ringer's and 5% Dextrose
as a source of water, patients with known
Injection should be used with great
electrolytes and allergy to corn or corn
care, if at all, in patients with
calories or as an products.
congestive heart failure, severe renal
alkalinizing agent.
insufficiency, and in clinical states in
which there exists edema with
sodium retention.
 X. NURSING CARE PLAN

Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation

Subjective: Constipation related At the end of the >Instruct client and >To improve The goal is partially
to irregular nursing intervention the patient’s mother consistency of stool met after the end of
“Hindi siya defecation habits as the client will be to have a diet of and facilitate the nursing
makadumi simula evidenced by able to regain balanced fiber and passage through intervention. The
kahapon.” as absence of stool for normal pattern of bulk, and fiber colon client was able to
verbalized by the two days. bowel functioning. supplements regain a normal
patient’s mother pattern of bowel
functioning.
>Promote adequate
Objective: fluid intake, >To promote
including high fiber passage of soft stool
>No stool for 2 days
fruit juices, suggest
>Straining with drinking warm,
defecation stimulating fluids

>Distended
abdomen

>Percussed
abdominal dullness >Encourage patient >To stimulate
to exercise within contractions of the
limits of individual intestine and
ability encourage
elimination
>Identify elements >To eliminate the
that usually interfering factors
stimulate bowel which hinders
activity and any elimination
interfering factors.

>Administer stool
softeners, mild >Stool softeners
stimulants, or bulk- help in establishing
forming agents, as proper elimination
ordered or routinely,
when appropriate
XI. Discharge Planning

Medications Continue taking the medications prescribed by the physician.

Exercise/Economic Factor The client should maintain regular exercise by doing simple activities suited for
her age.

Treatment The client should maintain the required treatment or therapy for her.

Health teaching The client should know things that will aggravate her condition, and be able to
avoid things that may worsen or bring forth again a complication.

Out patient Follow-up Regular check-up as scheduled on her physician.

Diet The client should eat 3 times a day with balanced diet.