INTRODUCTION: - My client name was Mrs. Rachna bai, she was came to the Dr.

Bhimrao Ambedker
hospital on 14/10/2021, with the complaints of a weakness, shortness of breath, lethargy, swelling,
confusion, problem in sleeping, decrease urine output, fatigue, puffiness around the eyes and loss of
appetite last 3 days. Doctor has seen the client in female medical ward, client’s general condition was
poor & after investigation & examination she was diagnosed Ureteritis.

PROFILE OF THE CLIENT

Name of client : Mrs. Rachna
Age/Sex : 40 yr/female
IP No. : C46688
Date of admission : 16/10/2021
Unit/ward : Female medical ward
Religion : Hindu
Education : 5th class
Occupation : House wife
Income : 20000/month (Family income)
Diagnosis : Ureteritis procedure
:
Date of procedure : 17/10/21
No. of dialysis : 1st
Address : Raipur C.G.
Date of care started : 16/10/2021
Date of care ended : 118/10/2021

CHIEF COMPLAINTS:-
My client present chief complains of a weakness, shortness of breath, lethargy, swelling, confusion,
problem in sleeping, decrease urine output, fatigue, puffiness around the eyes and loss of appetite last 3
days.

HEALTH HISTORY:-
Past medical history: - My client past medical history of a known case of hypertension. Before 2 year
she was diagnosed hypertension and she was under treatment advice tab – Amlodipine 20mg and
telmistran 5mg.

Present medical history: - - As per the history given by patient and his attainder my client is having a
weakness, shortness of breath, lethargy, swelling, confusion, problem in sleeping, decrease urine output,
fatigue, puffiness around the eyes and loss of appetite last 3 days. She was referring govt. hospital Dr.
Bhim Rao Ambedker hospital Raipur C.G. and patient go for chest x-ray, CECT abdomen and urine test.
After investigation patient diagnosed Ureteritis. After that investigation treatment advice by the
consultant Inj- Tazobact 4.5gm, Inj- Tramadol, Inj- Zofer, Inj- Aciloc, tab – Propranolol 2o mg and Inj-
Methimazole 20mg, Inj – lasix 20mg.

Past surgical history: - No any significant past surgical history of my client.

Present surgical history: - No any significant present surgical history of my client.

FAMILY HISTORY:-
 Name of the Relationship Age/Sex Educational Occupational Marital Health Status
Family with Patient Status Status Status
Member

Raj kumar Husband 45 yr./M 10th class Driver Married Healthy

Rachna bai Self 40 yr./F 5 class
th
House wife Married Ureteritis
Ravi Son 20 yr./M 12 class
th
Student Unmarried Healthy
Nisha Daughter 17 yr./F 11 class
th
Student Unmarried Healthy
• Family health history:- My client Rakhi bai she was suffer to Ureteritis with hypertension and my
client other family member are healthy, No any history of hereditary disease like
systemic illness (DM, hypertension, asthma, convulsion, malignancies), communicable
disease, psychiatric disease, cardiovascular disease and congenital disorders.

• Pedigree chart:-

Male
45 yr. /M 40 yr. /F
Raj Kumar rachna Bai
Female

20 yr. /M 17 yr. /F Patient

Ravi Nisha

FAMILY COMPOSITION:-

PERSONAL HISTORY:-

1. HABITS:-
 Smoking: My client has no habits of smoking.
 Tobacco chewing: - My client has habits of tobacco chewing last 5 year.
 Alcohol: No habits of drinking alcohol.
 Drug addict (specify): No any harmful drugs addiction of my client such a sedative
drug.

2. DIET:-
 Vegetarian: My client is a non-vegetarian.
 No. of meals per day: normally 3 times take meal per day but now my client intake
diet 2 time in a day.
 Any allergic to any food items: No any allergy.
3. SLEEP AND REST PATTERN:-
 Timing of sleep: - disturb sleeping pattern.
 Timing of rest: - only 4 hr rest in day time because of discomfort and irritable.

4. ACTIVITIES OF DAILY LIVING (ADLS):-

 Taking care and himself/herself: - able to self care and activities but some time require assistant.
 Needs assistance: not require assistance for daily activities and care.
 Any problems with ADL: my client able to move self activity and decrease mobility due to disease
condition
 Bladder frequency: Bladder control is impaired decrease urine out.
 Bowel condition: Bowel movement is impaired and my client not motion passed last 2 day.

5. RECREATIONAL AND HABITS:

 Exercise activity and tolerance (specify): My client doing no exercise regularly.
 Habits (specify): No habits of extra activity.
 Spiritual history: - my client believes in god prayer.

6. SOCIOECONOMIC STATUS:
 Social factors:- Good relationship with other family member, My client belong to joint family,
Monthly income is 20000-/-, my client house and own house, ventilation facilities is adequate,
electricity, drainage, lighting, water, waste disposal and latrine facilities available in own house,
availability of hospital under 2 km, clinic, health centres, market, temple, school and transportation
also present near house.
 Economic factors:- My client family income is 20000-/- and belong of lower middle class, Raj
Kumar is a bread winner of family, sources of income is a driving , financial status is adequate.

PHYSICAL EXAMINATION
GENERAL APPERANCE:
 Level of consciousness: My client is semiconscious.
 Orientation: My client are confused to place/time and person.
 Activity: My client activity is impaired and dull due to weakness and irritable.
 Body built: My client is obese.
 General grooming: Clean and appropriate.
 Position/posturing: Normal posture position.
 Facial expression: My client facial expression is dull and blank.
 Body language: No eye contacts with me and slow in movement.
 Other observations: My client feels very dull.

Vital sign:-
 Temperature:- 98.6 f
 Pulse:- 100b/m
 Respiration:- 24b/m
 BP:- 140/90mmHg
 RBS:- 134 mg/dl
 Spo2%- 97%
SKIN INSPECTION AND PALPATION (Integumentary System):
 Color and vascularity: My client skin color is black and pitting edema present in face and upper
and lower extremities and no any other abnormalities skin blushing and flushing.
 Turgor and mobility: My client skin elasticity is loss because of pitting edema.
 Temperature and moisture: My client skins are cold, clammy skin and excessive sweating over all
the body skin and other abnormalities oily skin is absent.
 Texture: My client skin texture is rough and puffy skin present in face and no any other
abnormalities rough, fine, thick and smooth skin are absent in my client.
 Nails: My client nails are clean and clean manicured and other abnormalities dry, hard, brittle,
cracking and clubbing nail are absent in my client.
 Nails beds and lunulae: My client nail beds are pale and other abnormalities pink, cyanotic, red,
blanching and spooning nail are absent in my client.
 Body hair growth: my client hair color is a black and thin.
 Skin integrity: moist, loss of elasticity and sweating skin.

HEAD INSPECTION AND PALPATION:

 Shape: My client head is round shape and other abnormalities like head injury, cephalic head and
cephalic disorder are absent in my client.
 Face: My client face is oval shape and puffiness face present due to edema.
 Facial (CN VII): My client facial expression is dulls, no smile.
 Hair: normal hair distribution in all over the head but thin hair and other abnormalities curly,
straight, permed, glossy, and shiny hair are absent in my client,
 Condition of scalp: My client’s scalps are clean, no dandruff seen.
 Messes and lumps: Not present any masses, surgical incision and lump in my client head.
 Facial puffiness: present.

EYES INSPECTION AND PALPATION:

 Eyebrows: My client eyebrows are thin and other abnormalities straight, curved, thick, scaly and
sparse eyebrows are absent in my absent.
 Eyelashes: My client eyelashes are short and other abnormalities curved, artificial and long
eyelashes are absent in my absent.
 Eyelids: My client eyelids are dark, protruding eye and close simultaneously and other
abnormalities swollen, inflamed, discharge, stye, entropion, ectropion, and lid leg are absent in my
client.
 Shape and appearance: My client eyes are sunken and tearing eye and other abnormalities almond,
rounded, squinty, nystagmus and strabismus shape are absent in my client.
 Sclera: White and other abnormalities creamy, yellowish, infected and pterygium sclera are absent
in my client.
 Conjunctiva: My client conjunctiva is pale pink and other abnormalities inflamed, swelling, nodule
and red conjunctiva are absent in my client.
 Iris: Black color and round shape no any abnormalities flat, coloboma, arcus, senile seen in iris. .
 Cornea: Clear and other abnormalities milky, Opague, and cloudy cornea are absent in my client.
 Pupils: Equal pupil size and round shape and other abnormalities anisocoria, consensual reaction,
constricted, fixed and unequal pupils are absent in my client.
 Lacrimal glands: Tearing and other abnormalities tender, inflamed, swollen are absent in my client.
 Visual field: Normal intact.
 Vision: Normal reading 6/6 in both eye.
 Use of glasses: No uses of any type of contact lens.

EARS INSPECTION AND PALPATION:

 Pinna: Large and Pinna shape are oval and other abnormalities Pinna irregular, skin intact, redness,
swelling tophi, cauliflower and furuncles ear are absent in my client.
 Level in relation to eyes: Top of Pinna level with outer canthus of the eye.
 Canal: Ear canal is clean and other abnormalities discharge, redness and foreign body are absent in
my client.
 Cilia: Present.
 Cerumen: Present.
 Tympanic membrane: Pearly white and no any inflamed, cone of light, land mark, scarring,
bubbles and fluid in my client.
 Hearing (audition-CN VIII): Present. Bone conduction test:-  Tuning fork test: Listen.
 Weber test: Lateralizes equally to left/right side.
 Rinne test: Air conduction is more than bone conduction.
 Hearing aids: No any type of hearing aids uses my client.

NOSE AND SINUSES INSPECTION AND PALPATION:

 Size and shape: My client nose is small and shape is nares symmetrical and other abnormalities
long, short, in proportion to face, flat, board based, thick, thin and swollen size and shape are absent
in my client.
 Nasal septum: Nasal septum normal located in midline and no any perforation seen in nasal
septum.
 Nasal mucosa and turbinate: Nasal mucosa is moist and cilia present and other abnormalities
redness, bluish, pink and pale nasal mucosa are absent in my client.
 Patency of nares: Right patent no partial obstruction
 Olfactory (CN I): My client correctly identifies the familiar odors.
 Sinuses: Normal and no any inflammation and tenderness absent in my client.

MOUTH AND PHARYNX INSPECTION:

 Lips: My client lips color is a slightly black, dry and cracked. Lips are symmetrical and thin.
 Teeth: My client’s teeth color is a brownish and other abnormalities notching, protruding, crowded
and loose teeth are absent in my client.
 Dental caries and fillings: dental caries present in my client due to tobacco chewing for long
period.
 Dental hygiene: Not properly maintain dental hygiene.
 Breathe odor: bad odor present and no any musty, acetone, fetid, odor of food or drug are absent in
my client.
 Gums: Color in pink, moist gum and sensitivity is present and other abnormalities hypertrophy,
nodules, irritated, ulcerated and spongy gums are absent in my client.
 Facial and glossopharyngeal (CN VII and IX): My client difficulty for the identifies the correct
taste.
 Tongue: My client tongue is brown color and thin and dry tongue and other abnormalities
macroglossia, microglossia, glossitis, and swollen tongue absent in my client.
 Hypoglossal (CN XII): Tongue movement are symmetrical.
 Mucosa: Intact and dry. No any lesion, leukoplakia and masses are absent in my client.
 Palate: Moist and no any other abnormalities dry palate and color changes are absent in my client.
 Uvula: Normal
 Pharynx: Normal, no seen any type of petechiae beefy, and dysphasia.
 Tonsils: Normal tonsil present. Not seen crept and beefy tonsils.
 Temporomandibular joint: Fully mobile symmetrical joint. Not any tenderness and crepitus.

NECK INSPECTION AND PALPATION:

 Appearance: My client neck is short symmetrical.
 Thyroid: normal thyroid gland, palpable and no any other abnormalities tenderness, swelling and
nodules are absent.
 Trachea: trachea present in midline. Not deviated right and left trachea  Lymph nodes: normal
lymph node.

THORAX AND LUNG EXAMINATION (Respiratory system):

 Inspection: rising chest due to increase breathing pattern and increased respiration and rhythm is
irregular.
 Palpation: pain in palpation and tenderness, pitting edema present.
 Percussion on lung field: normal percussion no any abnormalities.
 Lung auscultation: hoarseness sound present on auscultation of lung diaphragmatic exertion was
dull, increase respiration rate 24b/m.

BREASTS AND AXILLAE INSPECTION AND PALPATION:

 Female breasts: Breasts are symmetrical  Nipples: Present and symmetrical.
 Axilla: Odour present because of not proper maintains hygiene.

CARDIOVASCULAR EXAMINATION:
 Inspection: increase RR and increase HR as evidenced by deep breathing.
 Palpitation: normal palpitation S1 loudest at apex compares then S2 sound.
 Percussion: Normal percussion.
 Auscultation: S1,S2 sound heard, volume and rhythm is irregular beat, pulse rate is a high 100 b/m
and blood pressure is 140/90 mmHg

ABDOMINAL EXAMINATION:
 Inspection: Distended, dry, normal color and intact. No any lesion, striae, shiny and scar are absent.
 Palpitation: present tenderness due to distended abdomen.
 On percussion: Distended and dull because of presence of gas acidity evidence by empty stomach.
 Auscultation: bowel sound absent due to frequently bowel movement.

MUSCULOSKELETAL EXAMINATION:
 Back: normal functioning of both upper and lower extremities. Other abnormalities lordosis,
scoliosis and kyphosis are absent.
 Vertebral column alignment: Straight
 Joints: all joint are normal and complete range of motion present.
 Range of motion: all extension, flexion of lower limb and trunk flexion and extension movement
are active.
 Extremities: Symmetrical lower and upper extremities and pitting edema present in both
extremities.

GENITOURINARY AND RECTUM INSPECTION:

 Rectum: Swelling and edema present.
 Female genitalia: Normal pubic hair distribution and edema present.

NEUROLOGICAL EXAMINATION:
 Mental status examination:
• Difficulty in concentrating.
• Level of alertness: my client is semiconscious.
• Orientation: my client is confused time, place and person.
• Memory: present long time memory.
• Language and speech: My client languages are Hindi and speak slowly.
• Responsiveness: not proper respond to verbal command.
 Motor response: normal both lower limb and upper limb joint are normal.
 Reflex: Normal elicit gag reflex, blink reflex, coughing reflex and sneezing reflex are present.
 Coordination: abnormal co-ordinations test done in left hand through finger method.
 Sensory response: all facial touch sensation, identify all familiar odor, normal bone conduction test,
fine touch sensation over all body, normal 6/6 and all sensory function is normal.
 Cranial nerves: all cranial nerve are normal functioning no any significant problem in cranial
nerve.

INVESTIGATION:-
VESTIGATION ORMAL VALUE TIENT VALUE EMARK
Hemoglobin 14-18gm% 9.5gm% Low
WBC 4000-11000/cumm 19000/cumm High
R.B.C. count 4.5-6.5mil./cumm 4.31 mil./cumm Low
Neutrophil 50-65% 82% High
Lymphocytes 20-45% 10% Low
Platelet count 150000-450000/cumm 120000/cumm Low
Hematocrit 40-54% 33.7% Low
ESR 2-10mm/hr 72mm/hr High
Urea nitrogen 20-40mg% 46% High
Serum creatinine 0.5-1.5mg/dl 6.4mg/dl High
Sodium 135-145mmol/L 156mmol/L High
Glucose <140 mg/dl 144mg/dl High
S. urea 10-45mg/dl 69mg/dl High
Bilirubin total .2-1.2mg/dl 3mg/dl High
Bilirubin direct 0-3mg/dl 4mg/dl High
Potassium 3.5-5mg/dl 5.2mg/dl High
DRUG DOSE ROUT TIME INDICATION CONTRA SIDE EFFECT NURSES
E INDICATION RESPONSIBILTY
Inj-ceftriaxone 1 gm I/V BD Prescribed for certain low • Central Nervous System: • Caution should be
bacterial infections such as Prothrombin, Dizziness, Headache. • exercised in patients with
gonorrhea, pelvic vaginal Gastrointestinal: Diarrhea, nausea history of penicillin allergy;
inflammatory disease, inflammation, hyper and vomiting. severe renal impairment;
middle ear infection, sensitivity, • Blood: High concentration pregnancy and lactation;
meningitis (inflammation not good for super of eosinophils, platelet counts in the problem with digestive
of the covering of the infection sensitivity
blood, decrease in white blood cells, system, especially colitis
brain), and infections of and lactation
low (inflammation of the large
the lungs, ears, skin,
urinary tract, blood, bones Prothrombin levels, bleeding. • intestine), malnutrition (you
and joints and typhoid. Lab tests: Increase in liver enzyme, do not eat or cannot digest
elevated BUN the nutrients needed for good
(Blood urea, nitrogen). health), super infection.
• Local: • Be sure for the full
Indurations/tightness/warmth. course of treatment. If you do
not, the medicine may not
clear up your infection
• Genitourinary: Vaginal completely.
inflammation.
• Miscellaneous: Fatal
ceftriaxone-calcium precipitates in
lung and kidneys of neonates.

Inj- Pantocid 40 mg I/V BD Prescribed for gastro Hypersensitivity and • Gastrointestinal: Nausea, • Long-term therapy
esophageal reflux disease lactation. vomiting, diarrhea, pain, may lead to bacterial
(GERD), ulcers, constipation, rarely inflammation of overgrowth in the GI tract,
ZollingerEllison

0
Syndrome, and pancreas. atrophic gastritis.
• Genitourinary: Urinary • Monitor liver
function

1
erosive esophagitis. It frequency, urinary tract regularly (if enzymes
decreases the amount of infection, kidney disease, increase, discontinue)
acid made in the stomach. creatinine increased. • because it may lead to liver
Blood: Pancytopenia- decrease of damage.
all types of blood cells, including • Caution needed during
red and white blood cells pregnancy; not recommended
as well as in children <18 year. •
platelets. Patient may develop with
• Liver: Increased liver increased risk of Clostridium
enzymes, liver cells damage leading difficile associated diarrhea
to jaundice and liver failure. (CDAD)
• Local: Injection-site
reactions (including abscess,
thrombophlebitis).
• Metabolic: Increase in fat,
sugar, cholesterol, weight changes,
and uric acid in the blood.
• Musculoskeletal:
Joint pain, back pain, neck
pain. • Respiratory: Asthma,
cough, difficulty in breathing, upper
respiratory tract
infection.
• Miscellaneous: Chest
pain, flu syndrome, infection,
severe and life-threatening

2

Tab - Losartan 50mg P/O OD This medicine is an
angiotensin II receptor
blocker (ARB), prescribed
for high blood pressure. It
is also used for prevention
of stroke, and diabetic
nephropathy.
3
reaction.
Contraindicated in • Most Frequent: Swelling, • Caution should be exercised
patients with severe abdominal pain, chest pain, nausea, in patients with history of
kidney problem, headache, inflammation of pharynx, blood vessel problems, poor
during third diarrhea, indigestion, muscle pain, blood circulation, fluid
trimester of retention, heart, liver or
sleeplessness, cough and sinus
pregnancy, and kidney problems, diabetes,
disorder. • Body as a Whole:
hypersensitivity stroke, recent heart attack,
Facial swelling, fever and fainting.
electrolyte problem, any
• Heart: Chest pain, low blood
allergy, during pregnancy and
pressure, heart attack, fast heart rate breastfeeding.
and slow heart rate.
• Gastrointestinal: Loss of
appetite, constipation, tooth pain,
dry mouth, flatulence, stomach
inflammation and vomiting.
Inj - Zofer 4mg I/V BD This medicine is a 5- The concomitant use • Heart: Chest pain, fast • It may affect heart
HT3 receptor antagonist, of heart rate. rhythm, cause severe liver
prescribed for nausea and apomorphine with • Central Nervous System: impairment.
vomiting caused by cancer ondansetron is Headache, seizures, • Caution needed
chemotherapy, radiation contraindicated dizziness. when used in cardiac
therapy and surgery. It and known
• Skin: Rash. diseases, patients who are on
blocks serotonin receptors hypersensitivity. medications that can prolong
in • Gastrointestinal: Dry
QT or patients with
mouth, constipation, abdominal electrolyte
pain.

the vomiting center and on • Metabolic: Low potassium abnormalities, during

nerves supplying the in blood, increased level of liver pregnancy and
digestive system. enzymes. breastfeeding.
• Respiratory: Asthma. • It may
mask progressive
• Genitourinary:
ileus and/or gastric distension.
Gynecological disorder, urinary
retention. • Miscellaneous: Fever,
anaphylaxis, weakness.

4
Tab- Captopril 50mg P/O BD This medicine is an Contraindicated • Heart: Fast heart rate, • Caution should be exercised
angiotensin- in patients with chest pain, heart attack, congestive in patients with history of
converting enzyme known heart failure, stroke, low blood swelling of the lips, eyes or
inhibitor (ACE inhibitor), hypersensitivity pressure and fainting. • Body tongue, poor blood
prescribed for high blood circulation, diabetes, heart
as a whole: Allergic reactions.
pressure (hypertension), disease, autoimmune disease,
• General: Weakness and any allergy, who are taking
congestive heart failure, breast enlargement in males, taste
myocardial infarction and other medications,
disturbances. • Skin: Rash, children, during pregnancy
kidney problems caused by
itching, redness, skin disorders and and breast feeding.
diabetes. It decreases
scaling.
certain chemicals actions
that tighten the blood • Gastrointestinal:
vessels. Inflammation of pancreas/tongue
and difficulty in swallowing.
• Blood: Anemia.

5
 ANATOMY AND PHYSIOLOGY OF RENAL SYSTEM

KIDNEY

6
 • Shape- Bean shape
• Colour: Paired brownish red structures located retroperitoneally .
• Location: T12-L3 (in Adult) ,  Weight: 120-170 gm .
• Dimension: 12 cm long x 6 cm wide x 2.5 cm thick ,
• Kidney has two distinct region (Renal parenchyma and renal pelvis) Renal parenchyma
• It is further divided into cortex and medulla.
• Cortex contain glomeruli, proximal and distal tubules and cortical collecting duct.
• Renal medulla contains pyramids.
Renal pelvis
• Renal pelvis or hilum: Area through which artery, vein and nerves enter and leave kidney.
Glomerulus
• Renal artery is a branch of abdominal aorta.
• Renal artery divides into smaller and smaller vessels and form glomerulus.
• Glomerulus is the capillary bed responsible for filtration:
 Afferent arterioles: Blood enters into the glomerulus through it (Remember: A before E-
Entry before exit)
 Efferent arterioles: Blood leaves the glomerulus through it.
• Normal GFR: 90-120 ml/min METABOLIC WASTE
• Protein- Ammonia
• Muscle- creatinine
• HB- Bilirubine
• Nucleic Acid/purine- uric Acid
NEPHRONS
• Functional unit of kidney
• Each nephron consists of glomerulus, Bowman's capsule, proximal tubules, loop of Henle, distant
tubule and collecting duct.
• Collecting duct empty into minor calyx then to major calyx and it opens to renal pelvis.  Two types
of nephrons are there
1. Cortical nephron - Found in the cortex of kidney
2. Juxtamedullary nephron - Seen adjacent to medulla
PARTS OF NEPHRONS
1. Bowman's capsule: Double walled capsule which surrounds glomerulus. Glomerular filtrate filtered
into bowman's space .

7
 2. Proximal convoluted tubules: It receives glomerular filtrate from bowman's capsule Reabsorb water
and clectrolyte through active and passive transport.
3. Descending loop of Henle- Passively reabsorbs water.
4. Ascending loop of Henle - Passively reabsorbs sodium and chlorine
5. Distal convoluted tubules actively and passively removes sodium and water. ADH makes DCT and
collecting duct permeable to water
URETER

• Fibromuscular tube which connects kidney and bladder.

• Urine formed in the nephron drains into ureter.
• 24-30 cm in length; 3-4 mm in diameter
• Originates in the lower portion of renal pelvis and terminate at trigons of bladder.
• Right ureter is slightly shorter than the left (due to position of the kidney)
• Ureter is lined with transitional epithelium.
• It has three narrowed portions:
 Ureteropelvic junction
 Ureteral part near sacroiliac segment
 Urterovesical junction
 Narrowed portions of the ureter are more prone to develop stricture and calculi.
URINARY BLADDER

• Muscular hollow organ located behind pubic bone.

• Four layers (from inside to outside):
 Mucosa (inner most)
 Submucosa
 Muscularis
 Serosa or adventitia (outer most)

• In infancy, bladder is an abdominal organ. Later it descends into the pelvic cavity.
• Capacity: 300-600 ml of urine in adult
• Bladder is lined with transitional epithelium.
• In adult, bladder filling and emptying is mediated by sympathetic and parasympathetic nervous
system while in an infant it is controlled by the micturition center located in the pons area of brain
stem

8
 URETHRA

• In males, it passes through penis while in female it opens just anterior to vagina
• Female: 4 - 5 cm long, Urethra is only for urinating • Male: 18-20 cm long, common for urination
and ejaculation
• Urethritis is more common among females than male.
• Hypospadias: Urethra opens on the underside (ventral surface) of penis.
• Epispadias: Urethra opens on the topside (dorsum) of penis.

FUNCTIONS OF KIDNEY
Urine Formation

• Urine is formed in the nephrons through three steps:

o Glomerular filtration o Tubular reabsorption o Tubular secretion

• Regulation of water in the body o It is under the control of ADH hormone secreted by posterior
pituitary.
o ADH secretion occurs in response to hypovolemia, Increasce sodium level and in dehydration.

• Regulation of blood pH o Blood pH is controlled through buffer system o Carbonic acid and
Sodium-bi-carbonate are blood buffers to maintain its pH.
o ADH makes DCT and collecting duct to reabsorb more water and there by produce
concentrated urine.
o Lack of ADH hormone leads to diabetes insipidus.

• Regulation of sodium and Potassium in the body o Controlled by two hormones; Aldosterone &
Angiotensin II
o Aldosterone mechanism: Retention of potassium is the most life threatening complication of
Ureteritis.
o Renin-Angiotensin-Aldosterone mechanism Increased sodium and water reabsorption leads to
increased blood volume and BP.
o Concentration of carbonic acid Under the control of respiratory system o Concentration of
bicarbonate - Under the control of kidney.
o Sodium is reabsorbed in DCT in exchange for hydrogen or potassium ion.

9
 • Regulation of RBC production: When there is decreased oxygen tension in the renal blood flow
kidney produces erythropoietin hormone which stimulates RBC production.
Vitamin D synthesis - Kidneys are also responsible for final conversion of inactive form of vitamin D to its
active form 1, 25 dihydroxy- cholecalciferol.

10
 KNOWLEDGE ABOUT URETHRITIS

INTRODUCTION
• The meaning of ureteritis is inflammation of a ureter.
• Ureteritis is a medical condition of the ureter that involves inflammation. One form is known as
"ureteritis cystica". Eosinophilic ureteritis has been observed. Ureteritis is often considered part of a
urinary tract infection.
• Urethritis typically causes pain while urinating and an increased urge to urinate. The primary cause of
urethritis is usually infection by bacteria.
• Urethritis is not the same as a urinary tract infection (UTI). Urethritis is an inflammation of the
urethra, while a UTI is an infection of the urinary tract. They may have similar symptoms, but require
different methods of treatment depending on the underlying cause of the urethritis.

DEFINITION
• According to Mosby “Urethritis is the inflammation and swelling of the urethra, the narrow tube that
carries urine from the bladder to the outside of the body. It leads to difficulty or pain when urinating.”
• According to Joyce M. Black “Urethritis is a condition in which the urethra, or the tube that carries
urine from the bladder to outside the body, becomes inflamed and irritated.”
• According to Wikipedia “Ureteritis is a medical condition of the ureter that involves inflammation.”

11
TYPES OF URETHRITIS
There are different types of urethritis, classified by the cause of the inflammation. They are gonococcal
urethritis and nongonococcal urethritis.
1. Gonococcal urethritis is caused by the same bacterium that causes the STI gonorrhea. It accounts for
20 percent of cases of urethritis.
2. Nongonococcal urethritis is urethritis caused by other infections that are not gonorrhea. Chlamydia
is a common cause of nongonococcal urethritis, with other STIs also being a probable culprit.

URETHRITIS CAUSES
1. Most episodes of urethritis are caused by infection by bacteria that enter the urethra from the skin
around the urethra's opening. Bacteria that commonly cause urethritis include:
• Gonococcus, which is sexually transmitted and causes gonorrhea.
• Chlamydia trachomatis, which is sexually transmitted and causes chlamydia.
• Bacteria in and around stool.
2. The herpes simplex virus (HSV-1 and HSV-2) can also cause urethritis. Trichomonas is another cause
of urethritis. It is a single-celled organism that is sexually transmitted.
3. Sexually transmitted infections like gonorrhea and chlamydia are usually confined to the urethra. But
they may extend into women's reproductive organs, causing pelvic inflammatory disease (PID).
4. In men, gonorrhea and chlamydia sometimes cause epididymitis, an infection of the epididymis, a
tube on the outside of the testes. Both PID and epididymitis can lead to infertility.

OTHER CAUSES
Urethral syndrome has various causes. Common causes may include physical problems with the urethra,
such as abnormal narrowing or urethral irritation or injury.
The following can cause irritation to the urethra:
• scented products, such as perfumes, soaps, bubble bath, and sanitary napkins
• spermicidal jellies
• certain foods and drinks containing caffeine
• chemotherapy and radiation
Injury to the urethra can be caused by certain activities, such as:
• sexual activity
• diaphragm use
• tampon use

12
 • bike riding

URETHRITIS SYMPTOMS
The main symptom of urethra inflammation from urethritis is pain with urination (dysuria). In addition to
pain, urethritis symptoms include:

SYMPTOMS IN MEN
Males with urethritis may experience one or more of the following symptoms:
• Burning sensation while urinating
• Itching or burning near the opening of the penis
• Presence of blood in the semen or urine
• Discharge from the penis

SYMPTOMS IN WOMEN
Some symptoms of urethritis in women include:
• More frequent urge to urinate
• Discomfort during urination
• Burning or irritation at the urethral opening
• Abnormal discharge from the vagina may also be present along with the urinary symptoms

OTHER SYMPTOMS OF URETHRITIS INCLUDE:

• Pain during sex
• Discharge from the urethral opening or vagina
• In men, blood in the semen or urine
• Feeling the frequent or urgent need to urinate
• Difficulty starting urination
• Urethritis can also cause itching, pain, or discomfort when a person is not urinating.

DIAGNOSTIC TEST
Depending on symptoms and the results of physical exam, additional tests and imaging studies may help
doctor reach a diagnosis. They include:

13
 • CT scan
• Cystoscopy
• Kidney and bladder ultrasound
• MRI scan
• Radionuclide scan
• Tests for sexually transmitted diseases
• Urodynamic test
• Voiding cystourethrogram
• Complete blood count (CBC)
• C-reactive protein test
• Tests to check for stis, such as gonorrhea or chlamydia
• Urine test

URETHRITIS TREATMENT

1. Treating urethritis caused by bacteria: Antibiotics can successfully cure urethritis caused by bacteria.
Many different antibiotics can treat urethritis, but some of the most commonly prescribed include:
• Doxycycline (Adoxa, Monodox, Oracea, Vibramycin)
• Ceftriaxone (Rocephin)
• Azithromycin (Zithromax, Zmax)
2. Urethritis due to trichomonas infection (called trichomoniasis) is usually treated with an antibiotic
called Flagyl (metronidazole). Tindamax (tinidazole) is another antibiotic that can treat trichomoniasis.
Urethritis that does not clear up after antibiotic treatment and lasts for at least six weeks is called chronic
urethritis. Different antibiotics may be used to treat this problem.
3. Treating urethritis caused by a virus: Urethritis due to the herpes simplex virus can be treated with a
number of medications, including:
• Famciclovir (Famvir)
• Valacyclovir (Valtrex)
• Acyclovir (Zovirax)
COMPLICATION: Urethritis is preventable and curable, but can lead to permanent damage to the urethra
as well as other organs in women. Common complications from urethritis include:  Bladder infection
(cystitis)
• Cervicitis
• Pelvic inflammatory disease (pid)

14
 • Urethral strictures

PREVENTION OF URETHRITIS
Many of the bacteria that cause urethritis can pass to another person through sexual contact. Because of this,
practicing safe sex is an important preventive measure. The tips below can help reduce your risk:
• Avoid having intercourse with multiple partners.
• Use condoms every time you have sex.
• Get tested regularly.
• Protect others. If you find out you have an STI, inform others who are also at risk of an infection.

LIST OF NURSING DIGNOSIS

1. Fluid volume excess related to decreased glomerular filtration rate, decrease urine output and

sodium retention as evidenced by weight gain, edema, and decrease urine output, jugular

vein distention, shortness of breath and orthopnea.

2. Imbalanced nutrition less than body requirements related to protein catabolism; dietary

restrictions to reduce nitrogenous waste products, increased metabolic needs, vomiting,

dietary restriction as evidenced by weakness and weight loss.

3. Activity intolerance related to generalized weakness as evidenced by breathing difficulty in

activity.

4. Risk for decreased cardiac output related to fluid overload, fluid shifts, fluid deficit, and

electrolyte imbalance (potassium, calcium), severe acidosis.

5. Risk for infection related to immune Suppression and malnutrition as evidenced by increase

WBC count and fever.

15
 URETERITIS
NURSING CARE PLAN FOR
ASSESSMENT NURSING GAOL PLANNING INTERVENTION RATIONALE EVALUVATION
DIAGNOSIS
SUBJECTIVE Fluid volume excess Maintenance 1. Monitor weight daily at 1. Check weight 1. A weight gain of -Display appropriate
DATA:- related to decreased of normal fluid same time, report gain of and recorded. more than 0.5kg/day urinary output with specific
glomerular filtration and greater than 2 pounds. suggests fluid retention. gravity and other laboratory
My client is having rate, decrease urine electrolyte studies near normal; stable
breathing output and sodium levels and 2. Assess for and report 2. These are weight and vital signs
difficulty, retention as proper body shortness of breath, 2. Check vital sign symptom of heart within client’s normal
edema and decrease evidenced by weight weight without tachycardia, crackle in temp-98.6F, RR- failure that may range; and absence of
urine output. gain, edema, and excess of fluid lungs, frothy sputum, heart 24b/m, HR- 89b/m, accompany fluid edema
decrease urine and absence irregularities, hypotension, Spo2%- 90%. overload.
output, jugular vein of edema. cold and clammy skin.
distention, shortness
of breath and 3. Watch for new onset of
orthopnea. neck vein distension with 3. Provide semi flower 3.Fluid overload causes
OBJECTIVE patients head raised to 30 right sided heart failure
position and check
DATA:- to 45 degree angle. resulting in distended
jugular vein.
neck veins.
I observe my client
is having breathing 4. Assess skin, face, and 4.Edema is a symptom of
difficulty related to dependent area of edema, fluid overload.
4. Perform physical
excess fluid volume evaluate degree of edema.
examination and
as evidenced by check edema and
decrease urine degree of edema.
output, edema, and
5. Administer and restrict 5. Stop 5.Fluid restriction will be
shortness of breath excess IV
fluids, as indicated. determined basis of
and distension of therapy and water
Maintain sodium and fluid weight, urine output.
jugular vein. intake.
restrictions as ordered.

16
 NURSING CARE PLAN FOR URETERITIS
ASSESSMENT NURSING GAOL PLANNING INTERVENTION RATIONALE EVALUVATION
DIAGNOSIS
SUBJECTIVE Imbalanced Maintaining proper 1. Monitor daily 1. Send blood 1. Weight and lab results After 2 day of
DATA:- nutrition less than nutritional intake. weight and serum investigation and provide information intervention -patient
body requirements protein, albumin, treat the patient about nutrition status. blood report serum
My client is related to protein electrolyte, BUN, according blood protein and albumin
having catabolism; dietary creatinine, value levels. levels
transferrin, and iron are
restlessness, restrictions to
levels. within normal limit
weakness and reduce nitrogenous 2. Dietary intake aids in and normal skin
thirst due to waste products, identifying
2. turgor Without
imbalanced nutritional increased metabolic Assess and 2. Strictly charting deficiencies and edema.
intake. needs, vomiting, document dietary intake. intake fluid and urine dietary needs.
dietary restriction output and recorded.
-Maintain or regain
as evidenced by 3. Minimize anorexia weight as indicated by
weakness and 3.Provide frequently, small 3. Provide semi liquid and nausea associated
feedings. Smaller feeding individual situation; be
OBJECTIVE weight loss. diet in small quantity. with uremic state.
is better tolerated and free of edema.
DATA:-
reduces risk of nausea.
I observe my client 4. Complete proteins are
is having weakness 4.Promote intake of high
provided for positive
related to inadequate biologic value proteins
foods: eggs, dairy 4. Provide biological nitrogen balance
nutrition intake as protein diet milk and needed for growth and
evidenced by lack of products, meats.
eggs. healing.
activity, weakness
and weight loss. 5. Provide only enough
fluid intakes to replace
5. Enough fluid intakes
urine output. 5. Administer IV fluid avoid edema caused
according to urine by excessive fluid
output. intake.

17
 NURSING CARE PLAN FOR URETERITIS

ASSESSMENT NURSING GAOL PLANNING INTERVENTION RATIONALE EVALUVATION

DIAGNOSIS

18
SUBJECTIVE Risk for decreased Maintaining 1. Monitor blood 1. Check vital sign 1.Fluid volume excess, combined Maintain cardiac output
DATA:- cardiac output adequate pressure and heart temp- 98.6F, RR- with hypertension. as evidenced by BP and
related to fluid cardiac output. rate at regular 90b/m, HR and rhythm within
My client is having overload, fluid intervals. HR-98b/m, BP- client’s normal limits
breathing difficulty, shifts, fluid 140/90mmHg, and peripheral pulses
unable to normal deficit, and Spo2%- 89%. strong and equal, with
breathing and electrolyte 2.Changes in electromechnical adequate capillary refill
tachycardia. imbalance 2. Observe 2. Take ECG and function may become evident time.
(potassium, electrocardiogram or check any abnormal in response to progressing
telemetry for changes rhythm. Ureteritis/ accumulation of
calcium), severe
in rhythm. toxins
acidosis.
OBJECTIVE and electrolyte imbalance.
DATA:- 3.Pallor may reflect
vasoconstriction or anemia.
I observe my client is 3. Assess color of skin, 3. Perform physical
having breathing mucous membranes, examination and
difficulty , unable to and nail beds. Note check skin color and
4.Reduces oxygen consumption/
self breathing related to capillary refill time. recorded.
cardiac overload.
decreased cardiac 4. Maintain bed rest or
output as evidenced by encourage adequate
tachycardia, breathing rest and provide 4. Provide semi
difficulty, ABG report assistance with care flowers position and
and shortness of and desired activities. provide adequate
5.Maximum available oxygen for
breath. environment.
myocardial uptake to reduce
5. Provide supplemental
cardiac workload and cellular
oxygen if indicated.
hypoxia.
5. Administer 2 liter
oxygen through the
nasal probe.

19
 NURSING CARE PLAN FOR URETERITIS

ASSESSMENT NURSING GAOL PLANNING INTERVENTION RATIONALE EVALUVATION

DIAGNOSIS

20
SUBJECTIVE Risk for infection Prevent from 1. maintain 1. Promote good hand 1. Reduces risk of -Experience no signs or
DATA:- related to infection hygiene washing by client and staff. crosscontamination. symptoms of infection
immune 2. Avoid invasive like fever and
My client is having mild Suppression and 2. select best procedures, instrumentation, 2. Limits introduction of tachycardia
fever related malnutrition as and manipulation of indwelling bacteria into body. Early detection
clinical
to urinary infection evidenced by technique catheters whenever possible. and treatment of developing
increase WBC Use aseptic technique when infection may prevent sepsis.
count and fever. caring for IV and invasive
lines.
3. Provide routine
OBJECTIVE catheter care and promote
DATA:- meticulous perianal care. 3. Reduces bacterial
4. Encourage deep colonization and risk of ascending
I observe my client
3. provide breathing, coughing, and UTI.
body is warm and catheter care frequent position
breathing difficulty changes
4. Prevents atelectasis and
as evidenced by mobilizes secretions to reduce risk
4. provide 5. Assess skin integrity. of pulmonary infections.
T- 101.F comfortable (Refer to CP: Ureteritis:
RR-26 b/m position and Chronic; ND: risk for impaired 5. Excoriations from
HR-105 b/m exercise Skin Integrity.) 6. Monitor scratching may become
WBC count - vital signs. secondarily infected.
15000/cuum 5. complete
physical
assessment
6. Fever higher than
100.4°F (38.0°C) with increased
pulse and respirations is typical of
6. check increased metabolic rate resulting
vital sign from inflammatory process.

21
 NURSING CARE PLAN FOR URETERITIS
ASSESSMENT NURSING GAOL PLANNING INTERVENTION RATIONALE EVALUVATION
DIAGNOSIS
SUBJECTIVE Activity Improve the 1. assess 1. Note reports of 1. May reflect effects of Free of physiological
DATA:- intolerance related general the increasing fatigue and anemia and cardiac response signs of intolerance
to generalized activity vital sign weakness. Observe for necessary to keep cells (e.g., pulse,
weakness as tachycardia, pallor of skin and oxygenated. respirations, and blood
evidenced by mucous membranes, dyspnea, pressure remain within
breathing and chest pain. client’s normal range).
OBJECTIVE difficulty in 2. Monitor level of
DATA:- activity. consciousness (LOC) and 2. Anemia may cause
behavior. cerebral hypoxia manifested by
2. perform
changes in mentation,
the Glasgow
orientation, and behavioral
coma scale
3. Evaluate response to responses.
activity and ability to perform 3. Anemia decreases
tasks. Assist as needed and tissue oxygenation and increases
3. perform develop schedule for rest. fatigue, which may require
physical 4. Monitor laboratory intervention, changes in activity,
examination studies, such a RBCs, and rest.
Hgb/Hct. 4. Uremia decreases
production of erythropoietin and
4. send depresses RBC production and
blood 5. Administer fresh survival time.
investigation blood and packed red cells 5. May be necessary when
(PRCs), as indicated. client is symptomatic with
anemia. PRCs are usually given
when client is experiencing fluid
5. blood overload or receiving dialysis
transfusion as per 6. Administer treatment. 6. Stimulates the
doctor medications, as indicated, for production and maintenance of
order example: RBCs
Erythropoietin

6. give
medication as per
doctor order.

22
NURSES RECORD
CLIENT NAME:- Mrs.
Rachnabai
AGE/SEX:-40yr /female
DIAGNOSIS;-URETERITIS
S.NO. DATE/ MEDICATION INTAKE OUTPUT VITAL SIGN NURSES NOTE SIGN
TIME T P R BP O2%
1. 16/10/21 Inj –ceftriaxone 1gm Tea-20ml, 250ml by 98.F 100b/m 24b/m 140/90mmhg 98% Assess the patient condition and
10am in 100ml ns, Tab- Water- 500ml, urine check vital sign especially BP,
Losartan 50 mg, Iv fluid – 500ml. strictly watch urine out every hr,
Tab- every day send serum electrolyte
Captopril 50mg and test. Check complication of drug
inj- zofer 4mg, Inj
administration and avoid sodium
Pantocid
diet.
40mg. inj-
Erythropoietin

2. 17/10/21 Inj –ceftriaxone 1gm Milk-200ml, 250ml by 98.6F 88b/m 20b/m 130/90mmhg 96% Assess the patient condition and
10am in 100ml ns, Tab- Iv fluid 500 ns, urine check vital sign especially BP,
Losartan 50 mg, water- 500ml strictly watch urine out every hr,
Tab- every day send serum electrolyte
Captopril 50mg and test. Check complication of drug
inj- zofer 4mg, Inj
administration and avoid sodium
Pantocid
diet.
40mg. inj-
Erythropoietin

23
 NURSING CARE PLAN FOR URETERITIS
18/10/21 Inj –ceftriaxone 1gm Milk-200ml, 275ml by 98.6F 80b/m 22b/m 120/90mmhg 97% Assess the patient condition and
in 100ml ns, Tab- Iv fluid 1000 ns, urine check vital sign especially BP,
Losartan 50 mg, water- 200ml strictly watch urine out every hr,
Tab- Tea-25ml every day send serum electrolyte
Captopril 50mg and test. Check complication of drug
inj- zofer 4mg, Inj
administration and avoid sodium
Pantocid
diet.
40mg. inj-
Erythropoietin

24
COMPLICATION
1. Blood clots
2. Poor nutrition
3. HTN
4. Infections
5. Pulmonary Edema
6. Hypothyroidism
7. Venous Thrombosis
8. High blood cholesterol
9. Elevated blood triglycerides
10. Chronic kidney disease
11. Microcytic Hypochromic Anaemia
12. Growth Retardation
13. Vitamin D deficiency

PREVENTION
1. Strict aseptic technique should be used during invasive procedures.
2. Isolate the child as he is on immunosuppressive therapy. 3. Reduce the
amount of fat and cholesterol in your diet
4. Monitor vital signs for early signs of infection.
5. Prevention of infection
6. Avoid dehydration
7. Mobilize patient
8. Avoid sepsis

SUMMARY:-
My client skin color is black and pitting edema present in face and upper and lower
extremities and no any other abnormalities skin blushing and flushing. My client skin
elasticity is loss because of pitting edema. My client skins are cold, clammy skin and
excessive sweating over all the body skin and other abnormalities oily skin is absent. My
client skin texture is rough and puffy skin present in face and no any other abnormalities
rough, fine, thick and smooth skin are absent in my client. My client nails are clean and
clean manicured and other abnormalities dry, hard, brittle, cracking and clubbing nail are
absent in my client. My client nail beds are pale and other abnormalities pink, cyanotic,
red, blanching and spooning nail are absent in my client. my client hair color is a black
and thin. moist, loss of elasticity and sweating skin.

0
 CONCLUSION:-
My client name was Mrs. Rachna bai, she was came to the Dr. Bhimrao Ambedker
hospital on 16/10/2021, with the complaints of a weakness, shortness of breath, lethargy,
swelling, confusion, problem in sleeping, decrease urine output, fatigue, puffiness around
the eyes and loss of appetite last 3 days. Doctor has seen the client in female medical
ward, client’s general condition was poor & after investigation & examination she was
diagnosed URETERITIS.

SUMMARY
A urine specific gravity test is a straightforward test that looks at a person’s urine
concentration. The person will need to collect a clean urine sample for testing in a laboratory.
Urine concentration can show how well the kidneys are functioning or indicate an underlying
condition that is altering the body’s fluid status. A urine specific gravity test cannot diagnose
a condition, but it can play a role in identifying underlying health conditions ranging from
kidney failure to dehydration.

1
 HEALTH EDUCATION

• Avoiding drinking softened water, because of the sodium content. Make sure to read
the label on bottled water for sodium content.
• Avoid over-the-counter medicines that contain sodium bicarbonate or sodium
carbonate. Read labels carefully
• Avoid whole-grain breads, wheat bran, and granolas.
• Avoid milk, buttermilk, and yogurt.
• Avoid nuts, seeds, peanut butter, dried beans, and peas.
• Avoid beer, cocoa, dark colas, ale, chocolate drinks, and canned ice teas.
• Avoid cheese, milk, ice cream, pudding, and yogurt.
• Avoid liver (beef, chicken), organ meats, oysters, crayfish, and sardines.
• Move around and bend your legs to avoid getting blood clots when you rest for a long
period of time.
• Weigh yourself every day. Do this at the same time of day and in the same kind of
clothes. Keep a record of your daily weights.
• Take your medicines exactly as directed.
MEDICATION

• Advice the client proper takes medicine.

HYGIENE
• Advised the client maintain personal hygiene.
• Advised the client for take daily bath.
• Advised the client clean for perineal area.  Advised the client change for cloth.

REST AND SLEEP

• Advised the client for proper take rest and sleep.
DIET
• Advised the client take healthy diet, egg, green leaf, vegetables.
• Advised the client take fruit and juice.
• Advised the client take 3-4 litre amount of water daily.
EXERCISE
• Advised the client daily do exercise.
• Advised the client daily do relaxation therapy.
FOLLOW UP
• Educate the patient follow up check-up.

2
 BIBLIOGRAPHY
Teacher’s references
• Ansari, Javed. A Text Book Medical Surgical Nursing (Part A) .S.Vikas & Compeny
publisher; 1st edition 2015.
• Black, Joyce M. Medical Surgical Nursing – II. Mosby an Affiliate of Elsevier Science
Publication; 7th edition 2003.
• Davis durg guide, eblott’s publication, second edition.
• Hinkle, Janice L.S.Brunner & Suddarths Texbook of Medical Surgical Nursing – I.
wolters Kluwor India publication; 8th edition 2015.
• Liwis, Sharon L. Lewis's .Medical Surgical Nursing – I. Elevier India publisher; 26th
edition 2013.
• Polaski, Arlene L. Luckmann's .Care Principles & Practice of Medical Surgical
Nursing. Jaypee Brothers Medical Publisher; 1st edition 2014.

Student’s references
• Black, Joyce M. Medical Surgical Nursing – II. Mosby an Affiliate of Elsevier Science
Publication; 7th edition 2003.
• Davis durg guide, eblott’s publication, second edition.
• Liwis, Sharon L. Lewis's .Medical Surgical Nursing – I. Elevier India publisher; 26th
edition 2013.

Internet:-
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