Case Study Final Rle 5 BSN3B

Southville International School and Colleges
1281 Tropical Avenue Corner Luxembourg, BF Homes International,

Las Pinas, 1740 Philippines
NURSING CARE MANAGEMENT FOR PATIENT WITH RENAL PROBLEMS
A Case Study presented to the
College of NURSING
In partial fulfillment of the requirements for the course Care of Clients with
Problems in Oxygenation, Fluid & Electrolytes, Infectious, Inflammatory,
Immunologic, Cellular Aberrations (acute & chronic) RLE
Prepared by:
RLE 5 | BSN 3B
Erencio, Katrina
Fuller, Rasheed
Herrera, Andrew
Kumar, Gywneth
Lat, Jillianne
Mabeza, Isaiah
Miyagawa, Ryuta
Nuevo, Jasmin
Praxides, Maria Victoria
Quidric, Carlos Alfonso J.
Santos, Nina
Solis, Jazmin
1
ACKNOWLEDGEMENT
Fulfilling this study required the time and collaborative effort between all group
members. With this effort, fulfillment of this study became possible to meet all the
necessary objectives. The researchers want to give their sincerest gratitude to the
following people for helping us in achieving to complete this study:
To Ms. Liza Jimenez, RN, MAN for thoroughly looking into our case study and
gave advice regarding content and what more should be done accordingly
To the other Clinical Instructors for the support, knowledge and the inspiration
they give to this Group for Related Learning Experiences and Lecturing.
To the other people who contributed in fulfilling this presentation. We extend our
deepest gratitude.
2
TABLE OF CONTENTS
TITLE PAGE……………………………………………………………………………... 1
ACKNOWLEDGEMENT………………………………………………………………... 2
TABLE OF CONTENTS………………………………………………………………... 3
CASE SCENARIO……………….……………….…………….……...……………...... 4
INTRODUCTION……………….……………….……………….…………………….... 6
OBJECTIVES……………….……………….……………….……………………...…... 7
CHIEF COMPLAINT……………….……………….……………….………………...... 8
PATIENT PROFILE……………….……………….……………….…………………... 8
DIAGNOSTIC AND LABORATORY EXAMINATIONS……………….……….……. 10
CLINICAL FINDINGS, SIGNIFICANT SIGNS AND SYMPTOMS…………….…... 13
PATHOPHYSIOLOGY……………….……………….……………….………….……. 14
PROBLEM LIST (PRIORITIZATION OF PROBLEMS) ……………………….….... 15
NURSING CARE PLAN……………….……………….……………………….……... 18
DRUG STUDY……………….……………….……………….………………………... 20
BIBLIOGRAPHY……………….……………….……………….……………………... 30
3
CASE SCENARIO
Patient ZC, is a 4-year-old boy who was brought to the emergency room of Las
Piñas Doctors Hospital (LPDH) on January 22, 2019 at 8:45 PM with the chief complaint
of fever since the night before, and abdominal pain. He took paracetamol at 6 PM on
the same day. Initial assessment of vital signs and weight are as follows:
 Temperature of 39.1°C,
 Pulse rate of 153 bpm,
 Respiratory rate of 28 cycles per minute,
 Oxygen saturation of 98%, and
 Weight of 18kg
Further assessment by the ER physician revealed that he has been experiencing

pain upon urination or dysuria, and groin pain. He has no cough, cold, nor loose bowel
movement. Monitoring of his temperature shows a decreasing trend from 40.5°C at 10
PM to 38.3°C at 5:35 AM. Student nurse handled patient ZC in the emergency room on
January 23, at 7AM. His temperature reading was 37.9°C. The initial diagnosis is T/C
UTI. The urinary tract can be divided into two sections: the upper portion of the tract
consisting of the kidneys and ureters, and the lower portion of the tract consisting of the
bladder and the urethra.
4
MANAGEMENT
In the management of urinary tract infection in pediatric patients, treatment with

empiric antibiotics after obtaining an appropriate sample for culture is recommended to
prevent renal damage. The full course of treatment should always be completed to
reduce the risk of antibiotic resistance. This is also because symptoms of UTI can
disappear before the infection is fully cleared. Intravenous therapy is recommended for
seriously ill children and for those who cannot take oral therapy, but this should be
switched to oral therapy once patient has been afebrile for 24 hours and is able to take
oral medications
 Amoxicillin-clavulanate: 20-40 mg/kg/d Q8 PO, or

 Cefuroxime: 20-30 mg/kg/d PO Q12
 Ampicillin-Sulbactam: 100-200 mg/kg/d Q6 IM or IV infusion over 10-15 min, or
 Cefuroxime: 75-150 mg/kg/d Q8 (Max dose: 6 g/d)
Children with acute pyelonephritis can be treated effectively with oral antibiotics
for 10 to 14 days or with short courses of intravenous therapy (2 to 4 days) followed by
oral therapy. Response to therapy is evaluated in 24-48 hours. Antibiotic therapy is
reassessed if the patient’s condition does not improve within the time interval. A kidney
and urinary bladder ultrasound should be requested to visualize abnormalities in the
urinary tract and bladder. If abnormal, the patient should be referred to a pediatric
nephrologist for further work-up
Lab tests are important to diagnose UTI and to differentiate between upper UTI
and lower UTI.
A urinalysis looks for evidence of infection, such as bacteria and white blood cells
in a urine sample. Urine culture, on the other hand, identifies the bacteria or yeast that
is causing the infection. The National Institute for Clinical Excellence in the United
Kingdom describes a clean catch urine sample as the recommended method for urine
collection. A complete blood count may help in diagnosis. Imaging tests such as a
kidney and bladder ultrasound may be required, especially since patient ZC is a boy, to
detect structural abnormalities in the urinary tract. Ideally, a cystography and
ultrasonography should be performed with a first-time UTI
5
INTRODUCTION
Urinary tract infection (UTI) is caused by pathogenic microorganisms in the

urinary tract (kidney, bladder, and urethra). Most of these urinary infections are caused
by the bacteria Escherichia coli (E. Coli) and are normally found in our digestive system.
In some instances bacteria can overcome the natural and immune defenses in our body
and lead to the infection.In pediatric patients is described by the presence of a single
pathogen in urine culture, supported by findings in history taking, physical examination,
and tests such as a urinalysis and urine culture to identify appropriate treatment.
Children who have bacteriuria and a fever of 38°C or higher should be

considered to have acute pyelonephritis or upper urinary tract infection. If bacteriuria is
present but there are no systemic signs or symptoms, cystitis or lower urinary tract
infection should be considered (DOH, 2017).
UTI’s are classified into two parts and these are namely: Upper Urinary Tract
Infection and Lower Urinary Tract Infection. Infection from E.coli can affect the
genitourinary parts urethra (urethritis), bladder (cystitis), and can spread to the upper
urinary tract that causes infection of the kidneys (pyelonephritis). There are signs and
symptoms of Urinary Tract Infection, these include: fever, chills, burning or pain in
urinating, increase in urinary frequency, foul-smelling urine, and for women, pelvic pain.
In the case of patient ZC, while further work-up is needed to aid in diagnosis,
upper UTI is the assumed case. In relatively normal urinary tracts, the most common
UTI-causing pathogens are strains of Escherichia coli. Pharmacological treatment
includes antibiotics for this reason.
6
OBJECTIVES
General objective
This group case study aims to enhance our comprehension as nursing students
for Urinary Tract Infection (UTI).
Specific objective
a) To increase general knowledge and improve critical thinking with regard to

approach on Urinary Tract Infection as one of the major renal problems
b) To be able to understand laboratory and diagnostic studies in UTI
c) To formulate the appropriate Nursing Care Plans and Prioritization listing
d) To identify the appropriate intervention required for the client after UTI
e) To enhance our understanding about the drugs/medication presented in the case
f) To properly illustrate and break down the pathophysiology of Urinary Tract
Infection
7
CHIEF COMPLAINT
Patient ZC went to the emergency room at 8:45 PM with a chief complaint of

fever since the night before, and abdominal pain. The patient stated that he has been
experiencing pain upon urination and groin pain.
PATIENT’S PROFILE
PATIENT NAME Patient ZC
AGE 4 Years Old
STATUS Patient is feverish and showing signs of

abdominal pain.
RELIGION Not stated
ADMITTING PHYSICIAN Not stated
CHIEF COMPLAINT ● Fever

● Abdominal pain
8
ADMITTING DIAGNOSIS Urinary Tract Infection
FINAL DIAGNOSIS Acute Pyelonephritis
9
DIAGNOSTIC AND LABORATORY EXAMINATIONS
Diagnostic and laboratory examinations for UTI may include a urinalysis, which is
a test that can microscopically identify evidence of infection in the urine such as bacteria
and white blood cells. It is a diagnostic tool that helps to rule out UTI and helps
determine when to start the patient with antibiotics. Another diagnostic exam includes a
urine culture wherein the urine is collected to identify bacteria or yeast that may be
causing the infection. According to Fisher (2019), obtaining urine through a midstream,
clean-catch specimen is allowed for children who have the ability to urinate. On the
other hand, children with difficulty urinating would undergo suprapubic aspiration. A
complete blood count can also be conducted to evaluate the cells circulating in the
blood including red blood cells (RBCs), white blood cells (WBCs), platelets, and others.
An imaging test will also be conducted to detect structural abnormalities in the

urinary tract. A kidney and bladder ultrasound will be done, since the patient is a boy, to
investigate growths, foreign objects, and infection in the urinary tract. A cystography
may also be required for first-time UTI patients as it can take an X-ray of the kidney,
ureter, and bladder (KUB) to further determine the causes of UTI such as dysuria. Since
UTIs are 14 times more frequent in women than men, these imaging tests can further
diagnose if an individual has probable UTI. This difference is attributed to the following
factors: The urethra is shorter in women. In women, the lower third of the urethra is
continually contaminated with pathogens from the vagina and the rectum.
Laboratory Tests Normal Laboratory Values
Red blood cell count (RBC) 3.9–5.3×106 /μL
White blood cell count (WBC) 5.0–14.5 ×103/μL
Hematocrit (Hct) 34-40%
Hemoglobin (Hbg) 11.5-14.5 g/dL
Mean corpuscular volume (MCV) 76.0–90.0 fL
Mean corpuscular hemoglobin (MCH) 25.0–30.07 pg
10
Mean corpuscular 32.0-36.0 g/dL

hemoglobin concentration (MCHC)
Red cell distribution width (RDW) 11.5–15.0 %
Platelet count 150,000–450,000/μL
Specific gravity 1.001–1.035
Urine Culture > 100,000 CFU/ml
Kidney Ultrasound
11
Voiding Cystography
12
CLINICAL FINDINGS AND SIGNIFICANT SIGNS AND SYMPTOMS
Patient ZC manifested significant signs and symptoms:
➢ Fever
➢ Abdominal pain
➢ Pain upon urination (dysuria)
➢ Groin pain
13
PATHOPHYSIOLOGY
14
PROBLEM LIST (PRIORITIZATION OF PROBLEMS)
Actual Problems: Dysuria
Criteria Prioritization Justifications

(Score)
Nature of the problem 3/3 x 1= 1 Health deficit because

dysuria causes pain to the
patient during urination.
Modifiability of the problem 1/2 x 2 = 1 Partially modifiable

because the patient will
receive medication to treat
this problem however, it
may not always relieve him
from all the pain.
Preventive potential 2/3 x 1=.67 Moderately preventable

because medication can
be given but pain may not
cease.
Salience 2/2 x 1= 1 Needs immediate attention

because the patient is a
child and is in pain.
15
Actual Problems: Abdominal Pain

(Score)
Nature of the problem 3/3 x 1= 1 Health deficit because the

client is in pain. Pain
usually indicates a problem
with the body and can
affect the patient’s mental
health.
Modifiability of the problem 1/2 x 2= 1 Partially modifiable

because the patient is able
to take medications for it
however, it may not
completely relieve him
from pain.
2/3 x 1 = .67 Moderately preventable

Preventive potential because medication is
given
Salience 2/2 x 1 This needs immediate

attention because the
patient is a young child and
is very expressive about
pain.
16
Actual Problems: Fever

(Score)
Nature of the problem 2/3x1=0.67 The patient is febrile; at a

high temperature of 39.1C
which is a health threat.
Modifiability of the problem 1/2x2=1 The patient would be able

to lessen the effects of a
fever by taking medication
that may alleviate the
temperature.
Preventive potential 1/3x1=0.33 The body’s way of fighting

various diseases is to
increase the body’s
temperature in order to
make the environment less
favorable for the pathogen
Salience 2/2x1=1 The patient's temperature

is extremely high so it is a
serious problem that needs
immediate attention
because the condition can
worsen.
NURSING CARE PLAN
17
18
NURSING CARE PLAN
19
DRUG STUDY
Drug Name Mechanisms of Indication Contra- Adverse/ Nursing

Action indication Side responsibilities
Effects
Ampicillin Used to treat *hypersensitivity G.I: Monitor signs of

Ampicillin is a certain to ampicillin or glossitis, allergic reactions
Brand Names: penicillin infections other penicillins stomatitis, and anaphylaxis:
Sulbactam derivative used that are nausea,
for the treatment caused by vomiting, pulmonary
Antibiotic of a variety of bacteria such *Cephalosporin enterocolitis symptoms
Class: infections as meningitis; hypersensitivity , (tightness in the
Penicillin caused by and infections pseudomem throat and chest,
(aminopenicillin gram-positive of the throat, * Patients with branous wheezing, cough
) and gram- sinuses, mononucleosis colitis, and dyspnea) or skin
negative lungs, are more likely diarrhea. reactions (rash,
Therapeutic bacteria as well reproductive to develop a pruritus, urticaria).
uses: as some organs, skin rash
Treat certain anaerobes. urinary tract, Notify physician or
infections that and Drug nursing staff
are caused by interference with gastrointestin immediately if
Interactions
bacteria cell wall al tract. these reactions
synthesis by occur.
-Allopurinol
Dosage: attachment to
100-200 penicillin-binding -Atenolol
mg/kg/d Q6 proteins (PBPs), -Contraceptive
-Lansoprazole
Route: -Live Typhoid
Intramuscular Vaccine
or Intravenous -Omeprazole
-Pantoprazole
Frequency: -Probenecid
Infusion over -Rabeprazole
10-15 min
20
DRUG STUDY

Action indication Side Effects responsibilities
Generic Name: Cefuroxime is a Zinacef is Zinacef is Most common ● Patient

Cefuroxime bactericidal indicated for contraindicat side effects should be
agent that acts the treatment ed in patients ● Swelling reminded to
Brand Name: by inhibition of of patients with known , avoid other
Zinacef bacterial cell with urinary allergy to the redness, β-lactam
wall synthesis. tract cephalospori or pain antibacterial
Classification: infections n group of at the drugs.
Cephalosporin caused by antibiotics. injection ● Monitor
antibiotic Escherichia site may renal,
coli and occur hepatic, and
Dosage: Klebsiella hematologic
75-150 mg/kg/d spp. Serious side function
effects periodically
Route: ● Easy with
Intravenous bruising/ prolonged
route bleeding therapy.
● Unusual ● Monitor
Frequency: tirednes signs of
Every 8 hours s pseudomem
(Q8) (3x day) ● Uncontr branous
ollable colitis,
moveme including
nts diarrhea,
● Mental/ abdominal
mood pain, fever,
changes pus or
● Seizures mucus in
● Signs of stools, and
kidney other severe
problem or prolonged
s GI problems
● Signs of (nausea,
liver vomiting,
problem heartburn).
s Notify
physician or
21
nursing staff
immediately
of these
signs.
● Monitor
signs of
allergic
reactions
and
anaphylaxis,
including
pulmonary
symptoms
(tightness in
the throat
and chest,
wheezing,
cough
dyspnea) or
skin
reactions
(rash,
pruritus,
urticaria).
Notify
physician or
nursing staff
immediately
if these
reactions
occur
● Instruct
patient and
family/caregi
vers to
report other
troublesome
side effects
such as
severe or
prolonged
22
skin
problems
(rash, hives,
dermatitis)
or GI
problems
(nausea,
vomiting,
diarrhea,
cramps).
DRUG STUDY
23
Action indication Side Effects responsibilities
Generic Name: Cefuroxime is a Ceftin is Ceftin is Most common ● Patient

Cefuroxime bactericidal indicated for contraindicat side effects should be
agent that acts the treatment ed in patients ● Diarrhea reminded to
Brand Name: by inhibition of of adult with a known ● Nausea take
Ceftin bacterial cell patients and hypersensitivi ● Vomiting medication
wall synthesis. pediatric ty (e.g., appropriatel
Classification: patients with anaphylaxis) Serious side y as
Cephalosporin mild to to CEFTIN or effects prescribed
antibiotic moderate to other β- ● Severe and to not
infections like lactam stomach exceed the
Dosage: UTI. antibacterial pain maximum
20-30 mg/kg/d drugs (e.g., ● Painful dose.
penicillins urination ● Monitor
Route: and ● Fever renal,
Oral route cephalospori hepatic, and
ns). hematologic
Frequency: function
Every 12 hrs periodically
(Q12) (2x day) with
prolonged
therapy.
● Monitor
signs of
pseudomem
branous
colitis,
including
diarrhea,
abdominal
pain, fever,
pus or
mucus in
stools, and
other severe
or prolonged
GI problems
(nausea,
vomiting,
heartburn).
24
Notify
physician or
nursing staff
immediately
of these
signs.
● Monitor
signs of
allergic
reactions
and
anaphylaxis,
including
pulmonary
symptoms
(tightness in
the throat
and chest,
wheezing,
cough
dyspnea) or
skin
reactions
(rash,
pruritus,
urticaria).
Notify
physician or
nursing staff
immediately
if these
reactions
occur
● Instruct
patient and
family/caregi
vers to
report other
troublesome
side effects
such as
25
severe or
prolonged
skin
problems
(rash, hives,
dermatitis)
or GI
problems
(nausea,
vomiting,
diarrhea,
cramps).
DRUG STUDY
Drug Name Mechanisms Indication Contra- Adverse/ Nursing

of Action indication Side Effects responsibilities
26
amino- Amoxicillin is ● nausea

Amoxicillin Act by penicillin, contraindicate ● vomiting Before:
binding to created by d in patients
Generic penicillin- ● diarrhea ● Monitor Vital
adding an extra with a known
Name: binding amino group to serious ● change
Amoxicillin signs
proteins that penicillin to hypersensitiv s in
trihydrate inhibit a ● Patients
battle ity reaction taste
(Amoxycillin) process called should be
antimicrobial (i.e.,
transpeptidatio ● headac reminded to
resistance. anaphylaxis)
Brand Name n take OTC
Amoxicillin to other beta- he
Trimox, meds
covers a wide lactams. ● rash
Moxatag, Amoxicillin appropriately
variety of gram- Patients with
Amoxil administration positive ● skin as
allergies or
can also be in bacteria, with blisters prescribed
atopic
Classificatio combination and to not
some added conditions or
n with a beta- exceed the
gram-negative including peeling
Penicillin like lactamase maximum
coverage asthma,
antibiotics inhibitor. ● itching dose.
compared to eczema, hives
Some ● hives ● Nurses must
penicillin. Like (urticaria), or
Therapeutic: examples of ensure
penicillin, it hay fever may ● wheezin
Antibiotic these are antibiotics are
covers most have a greater
clavulanic acid Streptococcus g monitored
risk for
Pharmacolog and ● difficulty and
species and is hypersensitivit
ic : sulbactam. administered
also effective y reactions to swallowi
Aminopenicill These beta- correctly.
against Listeria penicillins. ng or
ins lactamase ● Patients with
monocytogene
inhibitors work s and breathin mononucleosi
by binding g s shouldn’t
Dosage: Enterococcus
irreversibly to receive
species. It also ● swelling
the catalytic amoxicillin
Suspension covers of the
site of an because this
for 7 days Haemophilus
organism’s face, class of drugs
influenza,
beta- may cause
some throat,
lactamase erythematous
Escherichia tongue,
Route: enzyme, rash
coli,
which causes Actinomyces lips, and ● USe drug
Oral resistance to eyes cautiously in
species,
the original patients with
Clostridium ● severe
beta-lactam hepatic
species, diarrhea
ring of impairment
Salmonella
Frequency amoxicillin. (watery ● Monitor
species,
hepatic and
27
Shigella or renal function

OD These species, and and CBC,as
bloody
drugs do not Corynebacteria ordered,in
have inherent species stools)
patients on
bactericidal that prolonged
activity; may therapy
however, they ● Use
occur
may broaden cautiously in
amoxicillin's with or breastfeeding
spectrum to without and elederly
organisms that fever patients
produce the ● Expect to
beta- and
start therapy
lactamase stomac before culture
enzyme when h and sensitivity
combined with results are
cramps
amoxicillin known .
(may
occur
up to 2 PATIENT
TEACHING:
months
● Tell the
or more patient to
after refrigerate
your reconstituted
suspension
treatme and to shake
nt) well before
each use.
Amoxicillin
may cause
other side
effects. Call
your doctor if
you have any
unusual
problems while
taking this
28
medication.
BIBLIOGRAPHY
Andropoulus, D.B. (2020, March 20). APPENDIX B: Appendix: Pediatric Normal

Laboratory Values. https://doi.org/10.1002/9781119371533.app2
CDC. (2021, October 6). Urinary Tract Infection. Retrieved from

https://www.cdc.gov/antibiotic-use/uti.html
Cefuroxime. Ciccone C.D.(Ed.), (2016). Davis's Drug Guide for Rehabilitation

Professionals. McGraw Hill. https://fadavispt.mhmedical.com/content.aspx?
bookid=1873&sectionid=139004990
29
CHoP. (N.D.). Pediatric Ultrasound. Retrieved from

https://www.chop.edu/treatments/ultrasound
Drugs.com. (2020, August 30). Cefuroxime. Retrieved from

https://www.drugs.com/ppa/cefuroxime.html
EMPR. (N.D.). Cefuroxime Rx. Retrieved from https://www.empr.com/drug/cefuroxime/
Fisher, D.J. (2019, March 19). Pediatric Urinary Tract Infection Workup. Retrieved from
https://emedicine.medscape.com/article/969643-workup#showall
Gerasimov, S. (2004). Probiotic Prophylaxis in Pediatric Recurrent Urinary Tract

Infections. Clinical pediatrics. 43. 95-8.
https://doi.org/10.1177/000992280404300113
RxList. (2020, November 4). Ceftin (cefuroxime axetil) drug. Retrieved from
https://www.rxlist.com/ceftin-drug.htm
RxList. (2021, May 27). Zinacef (cefuroxime) drug. Retrieved from

https://www.rxlist.com/zinacef-drug.htm
SimpleNursing. (N.D.). Nursing care plan for UTI. Retrieved from

https://simplenursing.ph/nursing-care-plan-for-uti/
WebMD. (N.D.). Zinacef 1.5 Gram Intravenous Solution - Uses, Side Effects, and More.
Retrieved from https://www.webmd.com/drugs/2/drug-18605/zinacef-
intravenous/details
30

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Southville International School and Colleges

1281 Tropical Avenue Corner Luxembourg, BF Homes International,

NURSING CARE MANAGEMENT FOR PATIENT WITH RENAL PROBLEMS

A Case Study presented to the

Southville International School and Colleges

Praxides, Maria Victoria

Quidric, Carlos Alfonso J.

DIAGNOSTIC AND LABORATORY EXAMINATIONS……………….……….……. 10

CLINICAL FINDINGS, SIGNIFICANT SIGNS AND SYMPTOMS…………….…... 13

PROBLEM LIST (PRIORITIZATION OF PROBLEMS) ……………………….….... 15

NURSING CARE PLAN……………….……………….……………………….……... 18

Further assessment by the ER physician revealed that he has been experiencing

In the management of urinary tract infection in pediatric patients, treatment with

 Amoxicillin-clavulanate: 20-40 mg/kg/d Q8 PO, or

Urinary tract infection (UTI) is caused by pathogenic microorganisms in the

Children who have bacteriuria and a fever of 38°C or higher should be

a) To increase general knowledge and improve critical thinking with regard to

Patient ZC went to the emergency room at 8:45 PM with a chief complaint of

PATIENT NAME Patient ZC

AGE 4 Years Old

STATUS Patient is feverish and showing signs of

RELIGION Not stated

ADMITTING PHYSICIAN Not stated

CHIEF COMPLAINT ● Fever

ADMITTING DIAGNOSIS Urinary Tract Infection

FINAL DIAGNOSIS Acute Pyelonephritis

DIAGNOSTIC AND LABORATORY EXAMINATIONS

An imaging test will also be conducted to detect structural abnormalities in the

Laboratory Tests Normal Laboratory Values

Red blood cell count (RBC) 3.9–5.3×106 /μL

White blood cell count (WBC) 5.0–14.5 ×103/μL

Hematocrit (Hct) 34-40%

Hemoglobin (Hbg) 11.5-14.5 g/dL

Mean corpuscular volume (MCV) 76.0–90.0 fL

Mean corpuscular hemoglobin (MCH) 25.0–30.07 pg

Mean corpuscular 32.0-36.0 g/dL

Red cell distribution width (RDW) 11.5–15.0 %

Platelet count 150,000–450,000/μL

Specific gravity 1.001–1.035

Urine Culture > 100,000 CFU/ml

CLINICAL FINDINGS AND SIGNIFICANT SIGNS AND SYMPTOMS

Patient ZC manifested significant signs and symptoms:

PROBLEM LIST (PRIORITIZATION OF PROBLEMS)

Actual Problems: Dysuria

Criteria Prioritization Justifications

Nature of the problem 3/3 x 1= 1 Health deficit because

Modifiability of the problem 1/2 x 2 = 1 Partially modifiable

Preventive potential 2/3 x 1=.67 Moderately preventable

Salience 2/2 x 1= 1 Needs immediate attention

PROBLEM LIST (PRIORITIZATION OF PROBLEMS)

Actual Problems: Abdominal Pain

Criteria Prioritization Justifications

Nature of the problem 3/3 x 1= 1 Health deficit because the

Modifiability of the problem 1/2 x 2= 1 Partially modifiable

2/3 x 1 = .67 Moderately preventable

Salience 2/2 x 1 This needs immediate

PROBLEM LIST (PRIORITIZATION OF PROBLEMS)

Actual Problems: Fever

Criteria Prioritization Justifications

Nature of the problem 2/3x1=0.67 The patient is febrile; at a

Modifiability of the problem 1/2x2=1 The patient would be able

Preventive potential 1/3x1=0.33 The body’s way of fighting