You are on page 1of 61

I.

Introduction Nursing is an art: and if it is to be made an art, it requires an exclusive devotion as hard

a preparation, as any painter's or sculptor's work; for what is the having to do with dead canvas or dead marble, compared with having to do with the living body, the temple of God's spirit? It is one of the Fine Arts: I had almost said the finest of Fine Arts. ~Florence Nightingale

A urinary tract infection (UTI) is a bacterialinfection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a simple cystitis (a bladder infection) and when it affects the upper urinary tract it is known as pyelonephritis (a kidney infection). Symptoms from a lower urinary tract include painful urination and either frequent urination or urge to urinate (or both), while those of pyelonephritis include fever andflank pain in addition to the symptoms of a lower UTI. In the elderly and the very young, symptoms may be vague. The main causal agent of both types is Escherichia coli, however other bacteria, viruses or fungusmay rarely be the cause. Urinary tract infections occur more commonly in women than men, with half of women having an infection at some point in their life. Recurrences are common. Risk factors include sexual intercourse as well as family history. Pyelonephritis usually follows a bladder infection but may also occur from a blood borne infection. Diagnosis in young healthy women can be based on symptoms alone. In those with vague symptoms, diagnosis can be difficult because bacteria may be present without there being an infection. In complicated cases or if treatment has failed, a urine culturemay be useful. In those with frequent infections, low dose antibiotics may be taken as a preventative measure. In uncomplicated cases, urinary tract infections are easily treated with a short course of antibiotics, although resistance to many of the antibiotics used to treat this condition is increasing. In complicated cases, longer course or intravenous antibiotics may be needed, and if symptoms have not improved in two or three days, further diagnostic testing is needed. In women, urinary tract infections are the most common form of bacterial infection with 10% developing urinary tract infections yearly.

Glomerulonephritis, also known asglomerular nephritis, abbreviated GN, is arenal disease (usually of both kidneys) characterized by inflammation of the glomeruli, or small blood vessels in the kidneys.[1] It may present with isolated hematuria and/orproteinuria (blood or protein in the urine); or as a nephrotic syndrome, a nephritic syndrome, acute renal failure, or chronic renal failure. They are categorised into several different pathological patterns, which are broadly grouped into non-proliferative or proliferative types. Diagnosing the pattern of GN is important because the outcome and treatment differs in different types. Primary causes are ones which are intrinsic to the kidney, whilst secondary causes are associated with certain infections (bacterial, viral or parasitic pathogens), drugs, systemic disorders (SLE, vasculitis) or diabetes. Acute glomerulonephritis (AGN) is active inflammation in the glomeruli. Each kidney is composed of about 1 million microscopic filtering "screens" known as glomeruli that selectively remove uremic waste products.The inflammatory process usually begins with an infection or injury (e.g., burn, trauma), then the protective immune system fights off the infection, scar tissue forms, and the process is complete. There are many diseases that cause an active inflammation within the glomeruli. Some of these diseases are systemic (i.e., other parts of the body are involved at the same time) and some occur solely in the glomeruli. When there is active inflammation within the kidney, scar tissue may replace normal, functional kidney tissue and cause irreversible renal impairment. The severity and extent of glomerular damagefocal (confined) or diffuse (widespread) determines how the disease is manifested. Glomerular damage can appear as subacute renal failure, progressive chronic renal failure (CRF); or simply a urinary abnormality.

A. Current trends about the disease condition

Recent trends in the therapy of urinary tract infections (H. Bucht 2007)

The frequency of chronic renal failure leading to uraemia has steadily decreased in Sweden during the last decade. The two main groups those cases due to phenacetin abuse and those of bacterial origin have both decreased to the same extent. The number of cases of uraemia due to glomerulonephritis and interstitial nephritis are at present equal. Earlier, cases related to pyelonephritis dominated. It was to be expected that the frequency of uraemia due to phenacetin would decrease after the sale of drugs containing phenacetin was restricted in 1962. The decrease of cases due to bacterial infection is more complex. It is obvious that practitioners have prescribed antibiotics more actively during the last 1015 years than previously. Now there seems to be a tendency to dispense with therapy. The main reason for this is the intensive propaganda in the mass media on cases of severe drug-induced accidents. In Sweden there is no tendency towards increased resistance of urinary pathogens. Therefore, the actual need of

new drugs is limited. The frequency of side-effects of drugs for the treatment of UTI is discussed. There seems however, to be a need for a new trimethoprim/sulphonamide combination with a pharmacokinetically better and if possible less toxic sulphonamide. A new treatment policy with short-term treatment periods and more frequent controls is also desirable.

Imaging strategies in pediatric urinary tract infection. Dacher JN, Hitzel A, Avni FE, Vera P. (Eur Radiol. 2005)

This article is focused on the controversial topic of imaging strategies in pediatric urinary tract infection. A review of the recent literature illustrates the complementary roles of ultrasound, diagnostic radiology and nuclear medicine. The authors stress the key role of ultrasound which has recently been debated. The commonly associated vesicoureteric reflux has to be classified as congenital or secondary due to voiding dysfunction. A series of frequently asked questions are addressed in a second section. The proposed answers are not the product of a consensus but should rather be considered as proposals to enrich the ongoing debate concerning the evaluation of urinary tract infection in children.

B. Reason for choosing such case for presentation

Having a disease can greatly affect the functioning of the body but the reason behind why such case happen can create confusion. To motivate and provide continuity of learning in the nursing profession, the student-nurses had chosen this case presentation to enlighten them as to have a single condition which can lead to serious disease and can create complications that prevents the individual from functioning well. The student-nurses chose this case for them to disseminate the appropriate teachings to the significant others to prevent exacerbation, decrease the incidence ad for the student nurses to be effective nurses in preventing the illness. The information that were gathered may also serve as a guide in promoting health to the patients. The student-nurses also wants to understand the reason why Urinary tract infection are still a cause of morbidity despite the advances in modern science and medicine that, by now, should have already armed the public with ample tools to prevent the disease from occuring. With this in mind, the student nurses intend to find out all the necessary data to draw a conclusion on what caused this to happen and to serve as a way to inform the public regarding the disease condition through the presentation of this particular case through a nursing perspective. The student-nurses would like to be of great help to the patient and her family in terms of shedding light with regards to what the patient is suffering from and why. The student-nurses understand that the information that would be shared to the patient and her family would bring clarity to them. Enhancing the student nurses understanding and competence for they to be able to impart the best possible care to their patient is another justification to be considered. The student nurses believed that learning should not only be confined in the four corners of our classrooms, but it should also be derived from the people we bestow our utmost concerns. This will widen their knowledge because new uncommon diseases and how to deal with it. To identify what is the best intervention for a patient who suffers such disease.

c. Objectives

Short-term (Student Centered)

After 2-5 hours of interviewing the significant others of the client the student nurses will be able to:

Established rapport Explained to the clients significant other the purpose of the interview Assessed the clients condition Obtained the following data: o o Personal data of the client Pertinent family history such as: size of the family, mothers previous pregnancies in chronological order and her attitude towards them, mode of deliveries, living condition including housing and economic status o Personal History such as: pre-natal mothers practices/ habits during pregnancy, birth duration and circumstances of labor, home or hospital delivery, type, complication, birth weight, and AOG o Childs growth and development (Assessed) Obtained pertinent data from patients chart

Long-term (Student Centered)

After 2-3 days of Students exposure to the client, the student nurses will be able to:

Know the importance of Case study Applied their theoretical knowledges upon exposure to the client Performed further physical examination and assessed thoroughly the clients condition

Give health teachings to the clients significant others Further monitored the clients progress Done further records review from the clients chart Familiarize themselves in making their case study

Short-term (Client Centered)

After 2-5 hours of Nursing Interventions the client and clients significant others shall have:

Familiarize themselves with the student nurses Know the importance of the case study and the rationale behind the students conducting the interview Gave student nurses pertinent data for their case study Verbalized understanding on the explanations of health teachings given such as importance of medication compliance Demonstrated the proper way to execute the health teachings taught by the student nurses such as: o o o o Chest physiotherapy Proper positioning of the client in semi-fowlers position Proper hand washing before and after handling the child Proper execution of tepid sponge bath

Long-term (Client Centered)

After 2-3 days of Nursing Interventions the client and the clients significant others shall have:

Appreciated concern from the student nurses

Improved ways to care for the client by proper execution of techniques in: o o o o Chest physiotherapy Proper positioning of the client in semi-fowlers position Proper hand washing before and after handling the child Proper execution of tepid sponge bath

Applied health teachings of the student nurses to improve care for the client Further gave student nurses data about the clients history

II.

NURSING ASSESSMENT

1 . PERSONAL DATA

To secure confidentiality with our patient, he will be referred as amber is a six year old boy of Kapampangan descent and was born in Tarlac, Pampanga on January 1 ,2006 .

His parents are Mr .and Mrs. Agustine , the patient was admitted last January 13 2012.

2 . PERTINENT FAMILY HISTORY

A. SIZE OF THE FAMILY The family of the patient is considered as a nuclear family compost of five members including the mother , father , amber (the patient) his older sister and a younger brother.

B. MOTHER S PREVIOUS PREGANCIES AND HER ATTITUDE TOWARDS THEM , MODE OF DEILVERY

Mother had her first baby on full term at ONA last July 17,2004 she delivered the baby via NSD and had no complains of unusual discomforts during and after her pregnancy /because of this she choose to give birth at home with mid-wife attending the delivery of her second child ( Amber ) last January 1 ,2006 baby amber was also a full term baby and has a weight of 6.5 lbs. . the last child( also a full term ) was born also at home via mid-wife last april 10, 2005 .

C. LIVING CONDTION , HOUSING AND ECONOMIC STATUS Ambers parents makes longganisa and sells it to the market for their income they earn around 500 -700 pesos per day . the familys income per month is estimated to be 21000 pesos per month .The breakdown of their expenses is as follows : P4000 is spent on their food, while they spend P500 for their electricity, P500 is also spent for their transportation and P500 for their water bill P3000 is spent on other expenses. But with this amount of income they are still considered poor, because according to NEDA,2004 a family should haveatleast P2768.60 per individual per month.

D. CULTURAL FACTORS AFFECTING THE HEALTH OF THE FAMILY Whenever the family members are sick, they sometimes resort to herbolarios for fever, cough and stomach pains where they are given different herbal plants or helot . They prepare the leaves by boiling them in one or two glasses of water f or f i f t e e n minutes or until one-half of the liquid is left, then they will be drinking it. But most of the time, they purchase over-the-counter (OTC) drugs such as paracetamol for fever, Neozepfor colds and carbocisteine for cough. And there are also some instances that these herbalplants and OTC drugs dont make them feel better, so when this happen, that when they go the nearest public hospital.

3. PERSONAL HISTORY

A. PRE-NATAL-MOTHER PRACTICE/ HABITS DURING PREGNANCIES The patients mother goes to the Public hospital for her free natal check ups every moth or every other week when ever she had a free time to visit the hospital. she eats a lot of fruits and vegetables for she knows that eating notorious food were good for her babies , she takes different supplements as recommended to her by the physician ( iron and folic acid) .

She believes in paglilihi or an old Filipino belief that preganats womans craving for a certain food will influence the physical attributes of her unborn child.

B. BIRTH DURATION AND CIRCUMSTANCES OF LABOR , HOME OR HOSPITAL DELIVERY ,TYPE, COPLICATION, BIRTH WEIGHT AND AGE OF GESTATION

the first child was a born at a public hospital via NSD ( normal spontaneous delivery ) has a weight of 7 lbs a year after that mother give birth at there home to another baby (amber) who has a weigh 6.5 lbs. which was attended by the mid-wife and two years after giving birth to amber another child was atted to the family ( youngest ) weighs 7lbs was at home via mid-wife, all of the children were on full term and had no complications .

C. FEEDING he patient was exclusively breastfed from birth until he was 1 year and 6 moths old . They started supplementary feeding at an age of 7 moths, such as cerelac, smashedsquash, lugaw and formula milks (Alacta and Nestogen ) . they continued to give formula Milk until he was 3 years old .

D. GROWTH AND DEVELOPMENT When Amber was 7 moths old he was able to sit alone , 8 moths later he was able to walk without help and at the age of 2 year old he was able to speak few words .

The Developmental Stages of Erik Erikson 1. Infancy: Birth to 18 Months Ego Development Outcome: Trust vs. Mistrust Basic strength: Drive and Hope Erikson also referred to infancy as the Oral Sensory Stage (as anyone might who watches a baby put everything in her mouth) where the major emphasis is on the mother's positive and loving care for the child, with a big emphasis on visual contact and touch. If we pass successfully through this period of life, we will learn to trust that life is basically okay and have basic confidence in the future. If we fail to experience trust and are constantly frustrated because our needs are not met, we may end up with a deep-seated feeling of worthlessness and a mistrust of the world in general. Incidentally, many studies of suicides and suicide attempts point to the importance of the early years in developing the basic belief that the world is trustworthy and that every individual has a right to be here. Not surprisingly, the most significant relationship is with the maternal parent, or whoever is our most significant and constant caregiver. 2. Early Childhood: 18 Months to 3 Years Ego Development Outcome: Autonomy vs. Shame Basic Strengths: Self-control, Courage, and Will During this stage we learn to master skills for ourselves. Not only do we learn to walk, talk and feed ourselves, we are learning finer motor development as well as the much appreciated toilet training. Here we have the opportunity to build self-esteem and autonomy as we gain more control over our bodies and acquire new skills, learning right from wrong. And one of our skills during the "Terrible Two's" is our ability to use the powerful word "NO!" It may be pain for parents, but it develops important skills of the will. It is also during this stage, however, that we can be very vulnerable. If we're shamed in the process of toilet training or in learning other important skills, we may feel greatshame and doubt of our capabilities and suffer low self-esteem as a result. The most significant relationships are with parents. 3. Play Age: 3 to 5 Years Ego Development Outcome: Initiative vs. Guilt Basic Strength: Purpose During this period we experience a desire to copy the adults around us and take initiative in creating play situations. We make up stories with Barbie's and Ken's, toy phones and miniature cars, playing out roles in a trial universe, experimenting with the blueprint for what we believe it

means to be an adult. We also begin to use that wonderful word for exploring the world "WHY?" While Erikson was influenced by Freud, he downplays biological sexuality in favor of the psychosocial features of conflict between child and parents. Nevertheless, he said that at this stage we usually become involved in the classic "Oedipal struggle" and resolve this struggle through "social role identification." If we're frustrated over natural desires and goals, we may easily experience guilt. The most significant relationship is with the basic family. 4. School Age: 6 to 12 Years Ego Development Outcome: Industry vs. Inferiority Basic Strengths: Method and Competence During this stage, often called the Latency, we are capable of learning, creating and accomplishing numerous new skills and knowledge, thus developing a sense of industry. This is also a very social stage of development and if we experience unresolved feelings of inadequacy andinferiority among our peers, we can have serious problems in terms of competence and selfesteem. As the world expands a bit, our most significant relationship is with the school and neighborhood. Parents are no longer the complete authorities they once were, although they are still important. 5. Adolescence: 12 to 18 Years Ego Development Outcome: Identity vs. Role Confusion Basic Strengths: Devotion and Fidelity Up to this stage, according to Erikson, development mostly depends upon what is done to us. From here on out, development depends primarily upon what we do. And while adolescence is a stage at which we are neither a child nor an adult, life is definitely getting more complex as we attempt to find our own identity, struggle with social interactions, and grapple with moral issues. Our task is to discover who we are as individuals separate from our family of origin and as members of a wider society. Unfortunately for those around us, in this process many of us go into a period of withdrawing from responsibilities, which Erikson called a "moratorium." And if we are unsuccessful in navigating this stage, we will experience role confusion and upheaval. A significant task for us is to establish a philosophy of life and in this process we tend to think in terms of ideals, which are conflict free, rather than reality, which is not. The problem is that we don't have much experience and find it easy to substitute ideals for experience. However, we can also develop strong devotion to friends and causes. It is no surprise that our most significant relationships are with peer groups. 6. Young adulthood: 18 to 35 Ego Development Outcome: Intimacy and Solidarity vs. Isolation Basic Strengths: Affiliation and Love In the initial stage of being an adult we seek one or more companions and love. As we try to find mutually satisfying relationships, primarily through marriage and friends, we generally also begin to start a family, though this age has been pushed back for many couples who today don't start their families until their late thirties. If negotiating this stage is successful, we can experience intimacy on a deep level.

If we're not successful, isolation and distance from others may occur. And when we don't find it easy to create satisfying relationships, our world can begin to shrink as, in defense, we can feel superior to others. Our significant relationships are with marital partners and friends. 7. Middle Adulthood: 35 to 55 or 65 Ego Development Outcome: Generativity vs. Self absorption or Stagnation Basic Strengths: Production and Care Now work is most crucial. Erikson observed that middle-age is when we tend to be occupied with creative and meaningful work and with issues surrounding our family. Also, middle adulthood is when we can expect to "be in charge," the role we've longer envied. The significant task is to perpetuate culture and transmit values of the culture through the family (taming the kids) and working to establish a stable environment. Strength comes through care of others and production of something that contributes to the betterment of society, which Erikson calls generativity, so when we're in this stage we often fear inactivity and meaninglessness. As our children leave home, or our relationships or goals change, we may be faced with major life changesthe mid-life crisisand struggle with finding new meanings and purposes. If we don't get through this stage successfully, we can become self-absorbed and stagnate. Significant relationships are within the workplace, the community and the family. 8. Late Adulthood: 55 or 65 to Death Ego Development Outcome: Integrity vs. Despair Basic Strengths: Wisdom Erikson felt that much of life is preparing for the middle adulthood stage and the last stage is recovering from it. Perhaps that is because as older adults we can often look back on our lives with happiness and are content, feeling fulfilled with a deep sense that life has meaning and we've made a contribution to life, a feeling Erikson call sintegrity. Our strengt h comes from a wisdom that the world is very large and we now have a detached concern for the whole of life, accepting death as the completion of life. On the other hand, some adults may reach this stage and despair at their experiences and perceived failures. They may fear death as they struggle to find a purpose to their lives, wondering "Was the trip worth it?" Alternatively, they may feel they have all the answers (not unlike going back to adolescence) and end with a strong dogmatism that only their view has been correct.

Jean Piaget Stages of Cognitive Development Stage Sensori-motor (Birth-2 yrs) Characterised by Differentiates self from objects Recognises self as agent of action and begins to act intentionally:

e.g. pulls a string to set mobile in motion or shakes a rattle to make a noise Achieves object permanence: realises that things continue to exist even when no longer present to the sense (pace Bishop Berkeley) Pre-operational (2-7 years) Learns to use language and to represent objects by images and words Thinking is still egocentric: has difficulty taking the viewpoint of others Classifies objects by a single feature: e.g. groups together all the red blocks regardless of shape or all the square blocks regardless of colour Concrete operational (7-11 years) Can think logically about objects and events Achieves conservation of number (age 6), mass (age 7), and weight (age 9) Classifies objects according to several features and can order them in series along a single dimension such as size. Formal operational (11 years and up) Can think logically about abstract propositions and test hypotheses systemtically Becomes concerned with the hypothetical, the future, and ideological problems

Freud's Psychosexual Stages of Development Freud advanced a theory of personality development that centered on the effects of the sexual pleasure drive on the individual psyche. At particular points in the developmental process, he claimed, a single body part is particularly sensitive to sexual, erotic stimulation. These erogenous zones are the mouth, the anus, and the genital region. The child's libidocenters on behavior affecting the primary erogenous zone of his age; he cannot focus on the primary erogenous zone of the next stage without resolving the developmental conflict of the immediate one. A child at a given stage of development has certain needs and demands, such as the need of the infant to nurse. Frustration occurs when these needs are not met; Overindulgence stems from such an ample meeting of these needs that the child is reluctant to progress beyond the stage. Both frustration and overindulgence lock some amount of the child's libido permanently into the stage in which they occur; both result in a fixation. If a child progresses normally through the stages, resolving each conflict and moving on, then little libido remains invested in

each stage of development. But if he fixates at a particular stage, the method of obtaining satisfaction which characterized the stage will dominate and affect his adult personality

The Oral Stage The oral stage begins at birth, when the oral cavity is the primary focus of libidal energy. The child, of course, preoccupies himself with nursing, with the pleasure of sucking and accepting things into the mouth. The oral characterwho is frustrated at this stage, whose mother refused to nurse him on demand or who truncated nursing sessions early, is characterized by pessimism, envy, suspicion and sarcasm. The overindulged oral character, whose nursing urges were always and often excessively satisfied, is optimistic, gullible, and is full of admiration for others around him. The stage culminates in the primary conflict of weaning, which both deprives the child of the sensory pleasures of nursing and of the psychological pleasure of being cared for, mothered, and held. The stage lasts approximately one and one-half years. The Anal Stage At one and one-half years, the child enters the anal stage. With the advent of toilet training comes the child's obsession with the erogenous zone of the anus and with the retention or expulsion of the feces. This represents a classic conflict between the id, which derives pleasure from expulsion of bodily wastes, and the ego and superego, which represent the practical and societal pressures to control the bodily functions. The child meets the conflict between the parent's demands and the child's desires and physical capabilities in one of two ways: Either he puts up a fight or he simply refuses to go. The child who wants to fight takes pleasure in excreting maliciously, perhaps just before or just after being placed on the toilet. If the parents are too lenient and the child manages to derive pleasure and success from this expulsion, it will result in the formation of an anal expulsive character. This character is generally messy, disorganized, reckless, careless, and defiant. Conversely, a child may opt to retain feces, thereby spiting his parents while enjoying the pleasurable pressure of the built-up feces on his intestine. If this tactic succeeds and the child is overindulged, he will develop into an anal retentive character. This character is neat, precise, orderly, careful, stingy, withholding, obstinate, meticulous, and passive-aggressive. The resolution of the anal stage, proper toilet training, permanently affects the individual propensities to possession and attitudes towards authority. This stage lasts from one and one-half to two years. The Phallic Stage The phallic stage is the setting for the greatest, most crucial sexual conflict in Freud's model of development. In this stage, the child's erogenous zone is the genital region. As the child becomes more interested in his genitals, and in the genitals of others, conflict arises. The conflict, labeled the Oedipus complex (The Electra complex in women), involves the child's unconscious desire to possess the opposite-sexed parent and to eliminate the same-sexed one. In the young male, the Oedipus conflict stems from his natural love for his mother, a love which becomes sexual as his libidal energy transfers from the anal region to his genitals. Unfortunately for the boy, his father stands in the way of this love. The boy therefore feels aggression and envy towards this rival, his father, and also feels fear that the father will strike

back at him. As the boy has noticed that women, his mother in particular, have no penises, he is struck by a great fear that his father will remove his penis, too. The anxiety is aggravated by the threats and discipline he incurs when caught masturbating by his parents. This castration anxiety outstrips his desire for his mother, so he represses the desire. Moreover, although the boy sees that though he cannot posses his mother, because his father does, he can posses her vicariously by identifying with his father and becoming as much like him as possible: this identification indoctrinates the boy into his appropriate sexual role in life. A lasting trace of the Oedipal conflict is the superego, the voice of the father within the boy. By thus resolving his incestuous conundrum, the boy passes into the latency period, a period of libidal dormancy. On the Electra complex, Freud was more vague. The complex has its roots in the little girl's discovery that she, along with her mother and all other women, lack the penis which her father and other men posses. Her love for her father then becomes both erotic and envious, as she yearns for a penis of her own. She comes to blame her mother for her perceived castration, and is struck by penis envy, the apparent counterpart to the boy's castration anxiety. The resolution of the Electra complex is far less clear-cut than the resolution of the Oedipus complex is in males; Freud stated that the resolution comes much later and is never truly complete. Just as the boy learned his sexual role by identifying with his father, so the girl learns her role by identifying with her mother in an attempt to posses her father vicariously. At the eventual resolution of the conflict, the girl passes into the latency period, though Freud implies that she always remains slightly fixated at the phallic stage. Fixation at the phallic stage develops a phallic character, who is reckless, resolute, selfassured, and narcissistic--excessively vain and proud. The failure to resolve the conflict can also cause a person to be afraid or incapable of close love; Freud also postulated that fixation could be a root cause of homosexuality. Latency Period The resolution of the phallic stage leads to the latency period, which is not a psychosexual stage of development, but a period in which the sexual drive lies dormant. Freud saw latency as a period of unparalleled repression of sexual desires and erogenous impulses. During the latency period, children pour this repressed libidal energy into asexual pursuits such as school, athletics, and same-sex friendships. But soon puberty strikes, and the genitals once again become a central focus of libidal energy. The Genital Stage In the genital stage, as the child's energy once again focuses on his genitals, interest turns to heterosexual relationships. The less energy the child has left invested in unresolved psychosexual developments, the greater his capacity will be to develop normal relationships with the opposite sex. If, however, he remains fixated, particularly on the phallic stage, his development will be troubled as he struggles with further repression and defenses.

Anna Freud Developmental lines Anna Freud initially distinguished six developmental lines. The line considered most 'basic' is one which describes the progression from dependency to emotional self-reliance and adult object relationship. It describes the changes at the level of observable mother-child relationships alongside the evolution of internal representations of objects that create templates for later relationships. Along this developmental line, the following stages are identified: 1. Biological unity between the mother-infant couple. The infant is under the assumption that the mother is a part of itself and is under its control, and the mother experiences the baby as psychologically part of her. Separation from the mother in this stage is thought to give rise to 'separation anxiety proper'. This first stage ends with the first year of life. 2. There is a need-fulfilling anaclitic relationship between the child and its object, which is based on the child's imperative body needs. It has a naturally fluctuating character as the need for the object increases with the arousal of drives, but the importance of the object for the child is reduced when satisfaction has been reached. The extent to which the child's needs are satisfied is thought to determine the images of a good and a bad mother. This stage of the developmental line starts at the second half of the first year of life. 3. The stage of object constancy: the child achieves a consistent representation of the mother, which can be maintained irrespective of the satisfaction of drives: thus, the representation of the mother is more stable. The child becomes able to form reciprocal relationships that can survive disappointments and frustrations. 4. The toddler's positive and negative feelings are focused on the same person and become visible (known as the 'terrible twos'). The child is in conflict: wishing both to be independent and to retain the complete devotion of the mother. In this stage, ambivalence is considered to be normal. 5. The so-called phallic-oedipal phase: this stage is object-centred, characterized by possessiveness of the parent of the opposite sex and jealousy and rivalry with the same sex parent. The child becomes aware that there are aspects of the relationship between the parents from which he is excluded. 6. The latency period: the urgency of the child's drives is reduced and there is a transfer of libido from parents to peers and others in the child's social environment and the community.

7. The preadolescent prelude to the 'adolescent revolt'. A regression from the reasonableness of latency children to a demanding, contrary, inconsiderate attitude characteristic of earlier stages, especially the part-object, need-fulfilling and ambivalent attitudes en behaviour. This strengthens oral, anal and phallic drive components, reviving infantile fantasies and intensifying intra-psychic conflict. 8. Adolescence: representing the ego's struggle to master the upsurge of sexuality and aggression during this period. Two new defence mechanisms (intellectualization and asceticism) emerge in adolescence to defend the individual from the instinctual demands of the body. The adolescent is preoccupied with its internal struggle to transfer emotional investment from parents to new objects. sources: http://www.learningandteaching.info/learning/piaget.htm http://www.victorianweb.org/science/freud/develop.html http://www.learningplaceonline.com/stages/organize/Erikson.htm http://en.wikipedia.org/wiki/Developmental_lines

E. IMMUNIZATION STATUS All of the children were immunized but the mother doesnt remember the dates she told the student nurses that she uses a certain immunization card that was checked or marked every time her child was immunized . but she was able to state some vaccines that was administered to her children like measles vaccine 9 moths old and hepa B vaccine.

4. History of past illness There were no known past diseases or illnesses prior to urinary tract infection, acute glomerulonephritis were Ambers was admitted.

5. History of present illness Amber experienced edema and difficulty of breathing when he was admitted on the hospital.

6. PHYSICAL EXAMINATION

Physical Assessment Amber was seen lying on bed, looks weak, with an IVF ofD5 0.3 NaCl, at 500 cc level infusing well on the left hand. He was wearing a sleeveless shirt and a short . He was unkempt because his hair was wet because of sweat and it was uncombed. His fingernails were dirty and untrimmed as well . Mental status:

Vital signs:

PR:

94 bpm

T: 36.2 C

RR: 24

SKIN: Upon inspection, there was swelling or edema on his face , floppy eye lids no discoloration, , lesions and nodules were present. Skin color was even with the other parts of the body. Palpation revealed no signs of masses, nodules or lesions. Skin felt warm and dry. Upon assessment of skin turgor, the skin sprung back to its previous state for less than a second. There was no more edema present in upper and lower extremities but there were some scars present in lower extremities.

HAIR: Hair appeared to black and short. It was well distributed throughout the scalp Amber hair was wet and uncombed. There was no infection and no flaking, sores, lice, nits, and ringworms were present.

NAILS: Ambers nails were cut clean and intact the angle of the nail plates curvature was approximately 160 and convex in shape which was negative of any clubbing and produced a diamond shape when asked to perform Shamroths test. The nail beds were highly vascular as evidenced by

having pinkish nails no factors of cyanosis or pallor were noted. Capillary refill was less than 4 seconds. Nails were smooth no terrys nails or beaus lines were present as well as discoloration of any sort. Tissues surrounding the nails were intact and absent of infections and sores.

SKULL AND FACE The skull was normocephalic. No nodules, masses, depressions were palpated in the sides of the head. Related muscles of the face were functioning properly and symmetry of facial movements were noted as Amber was asked to smile, blow, frown, and pout. There was no cracking or locking of the temporo-mandibular joint when he was asked to open the mouth. Eyebrows were aligned and had equal movement as well as the eyelashes which were well and equally distributed, curled slightly outward. Eyes were symmetrical and even though there is the presence of edema . Pupils were responsive to light and accommodation. The irises were black which the normal color was generally. There was no discoloration of sclera and remained to be transparent. The palpebral conjunctiva appeared to be shiny, smooth, and red. The cornea also appeared to be transparent, shiny and smooth; the details of the irises were also visible. Amber blinked when the cornea was touched. Both eyes move in unison, with parallel alignment when instructed to follow the movement of the penlight. No unstable movement and jerking of eyes were noted. Lacrimal gland appeared to be intact and absent of any edema or infection. Lacrimal gland and nasolacrimal duct were absent of any tenderness or tearing.

EARS AND HEARING Ears appeared to have the same color with the rest of the facial skin and were aligned with the outer cantus of the eyes. No lesions or flakes and scales were noted. No inflammation and tenderness was noted upon palpation. Pinna recoils after it is folded. The distal thirds of the ear canal contained hair follicles there were no discharges. There was dry cerumen but absent of any excessive cerumen obstructing ear canal. Amber had no difficulty hearing normal voices and responded immediately upon hearing the tick of the watch in both ears.

NOSE AND SINUS The nose appeared to be straight and aligned, color was similar to facial skin. No lesions discharges or flaring. No tenderness, masses, or displacement of cartilages or bones were palpated. Air moved freely as the client breathed through the nares. The mucosa of the nose

was pink, no lesions. Nasal septum was intact and in midline. Facial sinuses were not tender upon palpation.

MOUTH AND OROPHARYNX Outer lips were uniform pink color. Soft, moist, smooth texture. There was symmetry of contour.. Inner lips appeared to be pink as well, moist, smooth, soft, glistening, and elastic texture Amber had teeth (10 up, 10 down), and presence of visible dental caries was noted . He had pink and moist gums. There were no retraction of gums. The buccal mucosa had no lesions or signs of infections. It was smooth, pink, and intact. The tongue was in the center of the mouth and pink in color. It moved freely and frenulum was attached to the floor of the mouth. The soft palate was light pink and smooth. The hard palate appeared to be lighter pink and had a more irregular texture. The uvula was positioned in midline of soft palate. The oropharynx appeared to have a smooth posterior wall. The tonsils were absent of any signs of infections and appeared to be pink and smooth as well.

NECK Neck had no edema, lesions or masses and when inspected and palpated. Amber had no discomfort when moved the chin to chest and when instructed to turn the head from left to right against the applied force of the student nurse. Supraclavicular lymph nodes were not palpable. Trachea was midline of the neck, thyroid gland was neither visible upon inspection nor palpable.

THORAX AND LUNGS Anteroposterior to transverse diameter of the thorax was in 1:1.Amber had no barrel chest or pigeon chest. Spine curved vertically. Spinal column is straight, right and left shoulders and hips are at same height. Upon palpation, the thorax had uniform temperature. Chest wall was intact, no tenderness; no masses. Full and symmetric chest expansion when he took a deep breath. No adventitious breath sounds were heard. Breathing patterns were quiet, rhythmic, and effortless respirations. Costal angle was at 90. Percussion notes resonated except at the scapula. Lowest point of resonance was at the diaphragm. Percussion of the ribs elicited flatness.

ABDOMEN Amber abdomen was round and symmetric contour. No tenderness upon light palpation. Bowel sounds were active in all four quadrants, aortic pulsations were not visibly present. There were no friction rubs as well. No signs of enlargement of liver or spleen were present.

Cranial Nerve

Type and Function

Assessment Procedure

Expected Result

Actual Result

I.

Olfactory

Sensory Sense of smell

Ask client to close eyes and identify differed aromas

Client is expected to identify the different odors presented like alcohol and hydrogen peroxide ,perfume .

Amber was able to identify the aroma asked without difficulty

II. Ooptic

Sensory Sense of vision

Ask client to read fine prints at a distance of 14 inches Check visual fields by confrontation

Client will be able to read fine prints (ABCD) Able to see objects in the periphery when looking straight ahead

Amber was able to see without difficulty. He was also able to see objects within the peripheral while looking straight ahead

III. Oculomotor

Motor Extraocular eye movement

Assess the six oculomotor movements of the eyes and

Client is expected to move eyes from left to

Amber was able to follow the movement of the penlight

of sphincter of pupili movement of ciliary muscles of lens IV. Trochlear Motor EOM; specificall y moves eyeball downward and laterally V. Trigeminal Sensory (opthalmic branch) Sensation of cornea, skin of face and nasal mucosa

pupil reaction

right, upward laterally and downward laterally

without head movement (+PERRLA)

Assess superior oblique muscle by downward lateral movement of each eye

Client will be able to move eyes downward and laterally

Amber was able to move eyes downward and laterally

Test light sensation by having client close eyes and wiping a wisp of cotton over clients forehead, cheek and chin To test deep sensation, use

Client is expected to identify the sensation felt and the location where the cotton or safety pin was placed

Amber was able to identify the sensation felt and the location where the cotton or safety pin touched. Client was also able to chew without difficulty

Sensory (maxillary branch) Sense of the face and anterior oral cavity

alternating blunt and sharp ends of safety pin over the same area Assess the muscles of mastication while chewing food

and anterior oral cavity Motor and sensory (mandibul ar branch) Jaw movement - chewing and masticatio n VI. Abducens Motor EOM; Lateral movement of the eye VII. Facial Sensory Sense of taste on the anterior two thirds of the tongue Motor Movement of the muscles of the face Ask client to do different facial expressions and identify various taste on the tip and sides of the tongue Client is expected to raise eyebrows, frown, smile, puff out cheeks, close eyes tightly and be able to identify various taste on the tip and sides of tongue like sweet candy Amber was able to show, frown and raise eyebrows without exerting effort. he was able to identify tastes placed on the tip and sides of his tongue. Assess lateral rectus muscle by the movement of each eye Client will be able to move eyes laterally Amber was able to follow the movement of the penlight

and salt VIII. Vestibuloco chlear Sensory (vestibular branch) Equilibriu m Sensory (cochlear branch) Sense of hearing IX. Glossophary ngeal Sensory Sense of taste on the posterior one third of the tongue Motor Pharynge al movement and swallowin g
X. Vagus Motor and sensory Sensation of pharynx and larynx The student nurse asked the client to state name and determines hoarseness of voice Client must be able to state his/her name without hoarseness of voice Amber was able to verbally state his name without hoarseness of voice

Allow the client to listen to the ticking of a watch on each ear while she has both eyes closed. Instruct client to walk in a straight line Assess swallowing, gag reflex and posterior tongue

Client must be able to identify and hear the ticking sound of the wristwatch on each ear

Amber was able to hear and identify the ticking sound of the wristwatch on each ear and also maintain balance

The client is expected to elicit gag reflex and identify bitter taste

Amber was able to identify different flavours placed on the posterior portion of the tongue and he was able to move his tongue; side to side and up and down

XI. Accessory

Motor Movement of shoulders muscle

Assess shrugging of shoulders and movement of head from side to side against resistance

The client must be able to shrug shoulders and move head from side to side against applied resistance

Amber was able to shrug his shoulder against applied resistance

XII. Hypoglossal

Motor Movement of the tongue or strength of the tongue

Ask client to protrude tongue and move it from side to side

The client is expected to protrude tongue and move it from side to side

Amber was able to protrude his tongue and move it from side to side and in and out

7. DIAGNOSTIC AND LABORATORY PROCEDURES a) URINALYSIS

Diagnostic/ Laboratory Procedures

Date Ordered and Date Results IN DO: 01-1712 DR: 01-1712

Indication or Purpose

Results

Normal Values

Analysis and Interpretation of Results

URINALYSIS (UA)

Urinalysis is COLOR: rusty done to brown check for early signs of glomerulo nephritis. It may also be used to further evaluate the condition of Ambers kidney. TRANSPARENCY: Slightly turbid

Amber yellow

Ambers urine color is rusty brown because of the presence of red blood cells.

Clear

The result is abnormal which signifies presence of pus, RBC, and protein in Ambers urine

SPECIFIC GRAVITY: 1.030

1.0101.030

The specific gravity is within the normal range, which indicates normal concentration of urine particles.

PROTEIN: (+) 3

The result is abnormally elevated which shows (-) Negative an injury in the glomerular membrane which increases in size and allows the passage of large molecules like proteins.

The result shows abnormality. (-) SUGAR/GLUCOSE Negative This indicates that Ambers kidney could not reabsorb the glucose in the proximal renal tubule.

The result shows

EPITHELIAL CELLS: many

Few

abnormality, which indicates presence of tubule cell injuries.

PUS CELLS: 20-25

The result shows (-) abnormally Negative increase in pus cells in the urine which may indicates presence of infection

RBC/HPF: more than 50

<2

The result shows abnormally increase in pus cells in the urine which may indicates presence of infection

NU RSI

NG RESPONSIBILITIES FOR URINALYSIS:

Prior to procedure:

Check doctors order. Explain to the patient/SO the purpose and importance of the procedure. Explain to the patients SO that the procedure is non-invasive; no pain will be felt. During the procedure: Provide comfort to the patient. Assist patient in going to bathroom or comfort room. Collect fresh urine specimen in a urine container Instruct the patient and SO to get a clean-catch or midstream urine specimen. Clean or wipe first the external urethral orifice. Disregard the first flow of urine so as to wash out the distal part of the urethra. Position a sterile container and have the patient void 3 to 4 ounces of urine. Cap the container. Allow the patient to finish voiding. Then, clean it again.

After the procedure: Transport the urine specimen to the laboratory promptly. If the specimen cannot be processed immediately, refrigerate it. Chart the time of collection of urine specimen. Attach the result to the chart as soon as they are available

b.)COMPLETE BLOOD COUNT

Diagnostics/ Laboratory Procedures

Date Ordered and Date Results IN

Indication/ Purpose

Result

Normal Values

Analysis and Interpretation of Results

HEMOGLOBIN

DO: 01-14-12 DR: 01-14-12

It measures the total amount of hemoglobin in the blood to determine the extent of Ambers hematuria

100

120-160 g/l

Ambers hemoglobin level indicates that there is a low concentration of RBC within the blood volume

because of hematuria It measures the percentage of RBC s in the total blood volume. It may also provide idea on Ambers fluid status

HEMATOCRIT

0.36

0.37-0.52 g/L

Ambers Hematocrit level is below the normal range which indicates a low concentration of redblood cells within the blood volume and due to retention of fluid, thus,causing dilutional anemia

WHITE BLOOD CELL COUNT

It is used to determine presence of infection

3.3 x 109/L

5-10 x 109/L

Ambers WBC count of 13.3 x109/L is above the normal range which indicates the presence of bacterial infection or inflammation from post streptococcal infection

LYMPHOCYTES

Used to confirm Ambers infection whether bacterial or viral in origin

0.11

0.20-0.25

Mr. Kidneys lymphocyte count is below the normal range which indicates the presence of bacterial infection from post streptococcal infection

This test is done to rule out acute bacterial infection in Ambers condition

Ambers result indicates bacterial infection caused by post streptococcal

infection.

NEUTROPHILS

This is to determine acute infection since they act on bacteria, dead cells and debri.

0.87

0.45-0.65 The result is within the normal limits which indicates presence of acute infection

MONOCYTES

It is used to determine the number of platelets in the blood in order to prevent and detect thrombocytopenia

0.02

0.02-0.06

Ambers platelet count is within the normal range but still a low finding,

PLATELET

199 x 109L

150400x109

NURSING RESPONSIBILITIES FOR COMPLETE BLOOD COUNT:

Prior to procedure: Check Doctors order Explain to the patient the purpose of the procedure Notify the patient that he may feel pain while puncturing the needle Prepare material necessary for the test Use aseptic technique by cleaning the area of puncture with alcohol in a circular motion

During the procedure: Provide comfort to the patient Do not leave the patient while the procedure is ongoing Collect 5 to 7 ml of venous blood in a tube To avoid hemodiluted sample, draw the sample from an extremity that does not have IV line. Dont leave the tourniquet for more than 60 seconds. Invert and gently rotate the tubes thoroughly to mix with the anticoagulant.

After the procedure: Apply pressure on the site of puncture to prevent bleeding. Handle the blood sample carefully to prevent hemolysis. Check the venipuncture site for bleeding. Fill-out the laboratory form properly and send it to the laboratory technician during the collection of the sample or specimen. Document the procedure

III.

ANATOMY AND PHYSIOLOGY

The ureters are tubes made of smooth muscle fibers that propel urinefrom the kidneys to the urinary bladder. In the adult, the ureters are usually 2530 cm (1012 in) long and ~3-4 mm in diameter. In humans, the ureters arise from the renal pelvis on the medial aspect of each kidney before descending towards the bladder on the front of the psoas major muscle. The ureters cross the pelvic brim near the bifurcation of the iliac arteries (which they cross anteriorly). This is a common site for the impaction ofkidney stones (the others being theureterovesical valve, where the ureter meets the bladder, and the pelvouteric junction, where the renal pelvis meets the ureter in the renal hilum). The ureters run posteroinferiorly on the lateral walls of the pelvis and then curve anteriormedially to enter the bladder through the back, at the vesicoureteric junction, running within the wall of the bladder for a few centimetres. The backflow of urine is prevented by valves known as ureterovesical valves.

The urinary bladder is the organ that collects urine excreted by thekidneys before disposal by urination. A hollow muscular, and distensible (or elastic) organ, the bladder sits on the pelvic floor. Urine enters the bladder via the ureters and exits via the urethra. Bladders occur throughout much of the animal kingdom, but are very diverse in form and in some cases are not homologous with the urinary bladder in humans. The human urinary bladder is derived in embryo from the urogenital sinusand, it is initially continuous with theallantois. In males, the base of the bladder lies between the rectum and the pubic symphysis. It is superior to the prostate, and separated from therectum by the rectovesical excavation. In females, the bladder sits inferior to the uterus and anterior to the vagina; thus, its maximum capacity is lower than in males. It is separated from the uterus by thevesicouterine excavation. In infantsand young children, the urinary bladder is in the abdomen even when empty.

The urethra (from Greek - ourethra) is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine. In females, the urethra is shorter and emerges above the vaginal opening. The external urethral sphincter is a striated muscle that allows voluntary control overurination.

Micrograph of urethral cancer(urothelial cell carcinoma), a rare problem of the urethra.

Hypospadias and epispadias are forms of abnormal development of the urethra in the male, where the meatus is not located at thedistal end of the penis (it occurs lower than normal with hypospadias, and higher with epispadias). In a severe chordee, the urethra can develop between the penis and thescrotum.

Infection of the urethra is urethritis, said to be more common in females than males. Urethritis is a common cause of dysuria (pain when urinating).

Related to urethritis is so called urethral syndrome

Passage of kidney stones through the urethra can be painful, which can lead to urethral strictures.

Cancer of the urethra. Foreign bodies in the urethra are uncommon, but there have been medical case reports of self-inflicted injuries, a result of insertion of foreign bodies into the urethra such as an electrical wire.

The kidneys, organs with several functions, serve essential regulatory roles in mostanimals, including vertebrates and someinvertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acidbase balance, and regulation of blood pressure (via maintaining salt and water balance). They serve the body as a natural filter of the blood, and remove wastes which are diverted to the urinary bladder. In producing urine, the kidneys excrete wastes such as urea and ammonium, and they are also responsible for the reabsorption of water, glucose, and amino acids. The kidneys also produce hormonesincluding calcitriol, erythropoietin, and the enzyme renin. Located at the rear of theabdominal cavity in theretroperitoneum, the kidneys receive blood from the paired renal arteries, and drain into the paired renal veins. Each kidney excretes urine into a ureter, itself a paired structure that empties into the urinary bladder. Renal physiology is the study of kidney function, while nephrology is the medical specialty concerned with kidney diseases. Diseases of the kidney are diverse, but individuals with kidney disease frequently display characteristic clinical features. Common clinical conditions involving the kidney include the nephriticand nephrotic syndromes,renal cysts, acute kidney injury, chronic kidney disease, urinary tract infection, nephrolithiasis, andurinary tract obstruction.[1]Various cancers of the kidney exist; the most common adult renal cancer is renal cell carcinoma. Cancers, cysts, and some other renal conditions can be managed with removal of the kidney, or nephrectomy. When renal function, measured by glomerular filtration rate, is persistently poor, dialysis and kidney transplantation may be treatment options. Although they are not severely harmful, kidney stones can be a pain and a nuisance. The removal of kidney stones includes sound wave treatment to break up the stones into smaller pieces, which are then passed through the urinary tract. One common symptom of kidney stones is a sharp pain in the medial/lateral segments of the lower back.

IV.

THE PATIENTS ILLNESS

1. Definition of the disease A urinary tract infection (UTI) is a bacterialinfection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a simple cystitis (a bladder infection) and when it affect the upper urinary tract it is known as pyelonephritis (a kidney infection). Symptoms from a lower urinary tract include painful urination and either frequent urination or urge to urinate (or both), while those of pyelonephritis include fever andflank pain in addition to the symptoms of a lower UTI. In the elderly and the very young, symptoms may be vague. The main causal agent of both types is Escherichia coli, however other bacteria, viruses or fungusmay rarely be the cause. Urinary tract infections occur more commonly in women than men, with half of women having an infection at some point in their life. Recurrences are common. Risk factors include sexual intercourse as well as family history. Pyelonephritis usually follows a bladder infection but may also occur from a blood borne infection. Diagnosis in young healthy women can be based on symptoms alone. In those with vague symptoms, diagnosis can be difficult because bacteria may be present without there being an infection. In complicated cases or if treatment has failed, a urine culturemay be useful. In those with frequent infections, low dose antibiotics may be taken as a preventative measure. In uncomplicated cases, urinary tract infections are easily treated with a short course of antibiotics, although resistance to many of the antibiotics used to treat this condition is increasing. In complicated cases, longer course or intravenous antibiotics may be needed, and if symptoms have not improved in two or three days, further diagnostic testing is needed. In women, urinary tract infections are the most common form of bacterial infection with 10% developing urinary tract infections yearly.

The urinary tract is comprised of the kidneys, ureters, bladder, and urethra. A urinary tract infection (UTI) is an infection caused by pathogenic organisms (for example, bacteria, fungi, or parasites) in any of the structures that comprise the urinary tract. However, this is the broad definition of urinary tract infections; many authors prefer to use more specific terms that localize the urinary tract infection to the major structural segment involved such as urethritis (urethral infection), cystitis (bladder infection), ureter infection, and pyelonephritis (kidney infection).

Other structures that eventually connect to or share close anatomic proximity to the urinary tract (for example, prostate, epididymis, and vagina) are sometimes included in the discussion of UTIs because they may either cause or be caused by UTIs. Technically, they are not UTIs and will be only briefly mentioned in this article.

UTIs are common, more common in women than men, leading to approximately 8.3 million doctor visits per year. Although some infections go unnoticed, UTIs can cause problems that range from dysuria (pain and/or burning when urinating) to organ damage and even death. The kidneys are the active organs that, during their average production of about 1.5 quarts of urine per day, function to help keep electrolytes and fluids (for example, potassium, sodium, water) in balance, assist removal of waste products (urea), and produce a hormone that aids to form red blood cells. If kidneys are injured or destroyed by infection, these vital functions can be damaged or lost. While some investigators state that UTIs are not transmitted from person to person, other investigators dispute this and say UTIs may be contagious and recommend that sex partners avoid relations until the UTI has cleared. There is no dispute about UTIs caused by sexually transmitted disease (STD) organisms; these infections (gonorrhea, chlamydia) are easily transmitted between sex partners and are very contagious.

2. Predisposing / Precipitating factors

Having urinary tract abnormalities. Babies born with urinary tract abnormalities that don't allow urine to leave the body or cause urine to back up in the urethra have an increased risk of urinary tract infections. Having blockages in the urinary tract. Kidney stones or an enlarged prostate can trap urine in the bladder and increase the risk of urinary tract infection. Having a suppressed immune system. Diabetes and other diseases that impair the immune system the body's defense against germs can increase the risk of urinary tract infections. Using a catheter to urinate. People who can't urinate on their own and use a tube (catheter) to urinate have an increased risk of urinary tract infections. This may include

people who are hospitalized, people with neurological problems that make it difficult to control their ability to urinate and people who are paralyzed.

Being female. Urinary tract infections are very common in women, and many women will experience more than one. A key reason is their anatomy. Women have a shorter urethra, which cuts down on the distance bacteria must travel to reach the bladder. Being sexually active. Women who are sexually active tend to have more urinary tract infections than women who aren't sexually active. Using certain types of birth control. Women who use diaphragms for birth control also may be at higher risk, as may women who use spermicidal agents. Undergoing menopause. After menopause, urinary tract infections may become more common because the lack of estrogen causes changes in the urinary tract that make it more vulnerable to infection.

3. Signs and symptoms Urine may contain pus (a condition known as pyuria) as seen from a person with sepsis due to a urinary tract infection. Lower urinary tract infection is also referred to as a bladder infection. The most common symptoms are burning with urination and having to urinate frequently (or an urge to urinate) in the absence ofvaginal discharge and significant pain.[1] These symptoms may vary from mild to severe[2] and in healthy women last an average of six days.[3]Some pain above the pubic bone or in the lower back may be present. People experiencing an upper urinary tract infection, or pyelonephritis, may experience flank pain, fever, or nausea and vomiting in addition to the classic symptoms of a lower urinary tract infection.[2] Rarely the urine may appear bloody[4] or contain visible pyuria (pus in the urine).[5] In children In young children, the only symptom of a urinary tract infection (UTI) may be a fever. Because of the lack of more obvious symptoms, when females under the age of two or uncircumcised

males less than a year exhibit a fever, a culture of the urine is recommended by many medical associations. Infants may feed poorly, vomit, sleep more, or show signs of jaundice. In older children, new onset urinary incontinence (loss of bladder control) may occur. In the elderly Urinary tract symptoms are frequently lacking in the elderly. The presentations may be vague with incontinence, a change in mental status, or fatigue as the only symptoms. While some present to a health care provider with sepsis, an infection of the blood, as the first symptoms. Diagnosis can be complicated by the fact that many elderly people have preexisting incontinence or dementia.

4. Health promotion and preventive aspects of disease

Antibiotics (medications that kill bacteria) are the usual treatment for bladder infections and other urinary tract infections. Seven to ten 10 of antibiotics is usually required, although some infections may require only a single dose of antibiotics. It's important that all antibiotics are taken as prescribed. Antibiotics should not be discontinued before the full course of antibiotic treatment is complete. Symptoms may disappear soon after beginning antibiotic treatment. However, if antibiotics are stopped early, the infection may still be present and recur. An additional urine test may be ordered about a week after completing treatment to be sure the infection is cured. Tips for Preventing Urinary Tract Infections

The most important tip to prevent urinary tract infections, bladder infections, and kidney infections is to practice good personal hygiene. Always wipe from front to back after a bowel movement or urination, and wash the skin around and between the rectum and vagina daily. Washing before and after sexual intercourse also may decrease a woman's risk of UTI. Drinking plenty of fluids (water) each day will help flush bacterium out of the urinary system. Emptying the bladder as soon as the urge to urinate occurs also may help decrease the risk of bladder infection or UTI. Urinating before and after sex can flush out any bacteria that may enter the urethra during sexual intercourse.

Vitamin C makes the urine acidic and helps to reduce the number of potentially harmful bacteria in the urinary tract system. Wear only panties with a cotton crotch, which allows moisture to escape. Other materials can trap moisture and create a potential breeding ground for bacteria. Avoid thongs. Cranberry juice is often said to reduce frequency of bladder infections, though it should not be considered an actual treatment. Cranberry supplements are available over-the-counter and many women find they work when an UTI has occurred; however, a physician's diagnosis is still necessary even if cranberry juice or related herbalsreduce pain or symptoms. If you experience frequent urinary tract infections changing sexual positions that cause less friction on the urethra may help. Some physicians prescribe an antibiotic to be taken immediately following sex for women who tend to have frequent UTIs.

Things to Remember... Although urinary tract infections are common and distinctly painful, they usually are easy to treat once properly diagnosed and only last a few days. When treated promptly and properly, UTIs are rarely serious.

1. Definition of the disease

Glomerulonephritis, also known asglomerular nephritis, abbreviated GN, is arenal disease (usually of both kidneys) characterized by inflammation of the glomeruli, or small blood vessels in the kidneys.[1] It may present with isolated hematuria and/orproteinuria (blood or protein in the urine); or as a nephrotic syndrome, a nephritic syndrome, acute renal failure, or chronic renal failure. They are categorised into several different pathological patterns, which are broadly grouped into non-proliferative or proliferative types. Diagnosing the pattern of GN is important because the outcome and treatment differs in different types. Primary causes are ones which are intrinsic to the kidney, whilst secondary causes are associated with certain infections (bacterial, viral or parasitic pathogens), drugs, systemic disorders (SLE, vasculitis) or diabetes. Acute glomerulonephritis (AGN) is active inflammation in the glomeruli. Each kidney is composed of about 1 million microscopic filtering "screens" known as glomeruli that selectively remove uremic waste products.The inflammatory process usually begins with an infection or injury (e.g., burn, trauma), then the protective immune system fights off the infection, scar tissue forms, and the process is complete. There are many diseases that cause an active inflammation within the glomeruli. Some of these diseases are systemic (i.e., other parts of the body are involved at the same time) and some occur solely in the glomeruli. When there is active inflammation within the kidney, scar tissue may replace normal, functional kidney tissue and cause irreversible renal impairment.

The severity and extent of glomerular damagefocal (confined) or diffuse (widespread) determines how the disease is manifested. Glomerular damage can appear as subacute renal failure, progressive chronic renal failure (CRF); or simply a urinary abnormality.

2. Predisposing factors Age: 5-10 years old Gender: Male Precipitating factors B-hemolytic Streptococci Post infection Poor intake of rich vitamin food

Post-streptococcal glomerulonephritis - strep infections of the throat and impetigo (a skin infection) may cause glomerulonephritis. Impetigo is a much less common cause than throat infection. As treatment for most streptococcal infections improve, this cause is becoming much less common.

TB (tuberculosis) - glomerulonephritis can develop as a complication of tuberculosis. Syphilis - glomerulonephritis can develop as a complication of syphilis. Injecting illegal drugs - people who inject illegal drugs are at a much higher risk of developing glomerulonephritis.

Bacterial endocarditis - this is an infection in at least one of the heart valves. Patients with a heart defect have a higher risk of developing bacterial endocarditis and eventually glomerulonephritis.

Some viral infections - people infected with the HIV, hepatitis B and C viruses are more likely to develop glomerulonephritis compared to others.

Lupus - this is a chronic inflammatory condition caused by an autoimmune disease (the body's immune system attacks itself, its own tissues). People with lupus are more likely to develop compared to people without it.

Goodpasture's syndrome - this is also an autoimmune disease which causes lung and kidney disease. The patient may bleed in the lungs and develop glomerulonephritis.

IgA nephropathy - immunoglobulin A (IgA) deposits appear in the glomeruli, eventually causing glomerulonephritis.

Polyarteritis - this is an autoimmune disease in which the arteries become inflamed (arteritis). As the arteries are involved it can affect any organ in the body, including the kidneys.

Wegener's granulomatosis - a rare kind of inflammation of the small arteries and veins

(vasculitis) that typically involves the vessels that supply lung, sinus and kidney tissue. The following conditions may cause scarring of the glomeruli:

Hypertension (high blood pressure) - hypertension can damage the kidneys and subsequently their normal functioning. Glomerulonephritis itself can cause hypertension because kidney function is undermined - the kidneys play a vital role in regulating our blood pressure.

Diabetic nephropathy (diabetic kidney disease) - any patient with diabetes has the potential to develop diabetic nephropathy. Kidney damage may be prevented, or at least significantly slowed down with good diabetes control.

Focal segmental glomerulosclerosis - segmental collapse of glomerular capillaries (small vessels). There may be scattered scarring of some of the glomeruli.

Acute glomerulonephritis - an attack of acute glomerulonephritis may develop into chronic (long-term) glomerulonephritis. If the patient has no history of kidney disease, the first indication of chronic glomerulonephritis will be chronic kidney failure.

Genetic factors - there is a certain type of glomerulonephritis that runs in families. However, most people with glomerulonephritis do not have a family member who has/had the condition.

Long-term medications - some medications, if taken over the long-term, may increase a patient's likelihood of developing glomerulonephritis. Examples include:
o o o o

NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen and aspirin. Gold injections, for the treatment of rheumatoid arthritis. Lithium, for the treatment of depression. Penicillamine, for the treatment of arthritis.

Hodgkin's disease - this is a type of cancer which can result in glomeruli being damaged. Sickle cell disease - a genetic blood disease in which there is an abnormal form of hemoglobin.

3. Signs and symptoms

A symptom is something the patient feels or reports, while a sign is something other people, including the doctor may detect. For example, a headache may be a symptom while a rash may be a sign. Some patients may not show any clear symptoms. The type of signs and symptoms will usually depend on whether it is the acute or chronic form, and its cause. For some people, their first indication that something is not right is when the results of a urine or blood sample test come back.

Urine - if the glomeruli are damaged there will be a small amount of blood and/or protein in the urine, which may be visible or will show up in a urine test. If symptoms are more severe the individual's urine will turn visibly red - sometimes it may be Coca-cola colored. If the urine is cloudy or frothy it means that excess protein is present (proterinuria). A healthy adult urinates between 1 to 1.5 liters per day. People with severe glomerulonephritis may spend two or three days without being able to urinate; and when they do, there may be blood and/or protein in the urine.

Kidney damage - in the initial stage the inflammation of the kidneys may not be evident. Symptoms may suddenly appear, or come on about three weeks after infection. Patients with glomerulonephritis caused by kidney damage may have the following signs or symptoms:
o o o o o o o o

An elevated body temperature (typically about 38C, 100.4F) Breathing difficulties Edema (swelling), especially in the hands, face, feet, ankles or abdomen Loss of appetite Nausea Pallor Vision problems Vomiting

The following signs or symptoms are also possible:


o o

Hypertension (high blood pressure) Fatigue

Kidney pain - although pain in the kidneys is possible, it is unusual. When pain is felt, it is usually in the upper back, behind the ribs. Sometimes the pain may be intense. Kidney pain might be a symptom of kidney stones or a kidney infection, instead of glomerulonephritis.

4. Health promotion and preventive aspects of disease

Diet and fluid intake - the patient will likely be advised to reduce fluid intake and refrain from consuming alcoholic drinks or those with a high salt or potassium content. The patient may be referred to a dietician who will give advice on potassium and salt intake, among other things. Blood chemistry will need to be checked regularly to make sure levels of potassium, sodium, and chloride are right. Hypertension - in order to treat the hypertension and halt or slow down kidney function decline, the doctor may prescribe diuretics, Angiotensin-converting enzyme (ACE) inhibitors, and Angiotensin-converting enzyme (ACE) inhibitors, which help to relax the blood vessels, reducing the workload of the heart. Hypertension can cause further kidney decline and other health problems and needs to be controlled.

The following medications may also be prescribed to treat possible underlying causes: Bacterial infections - a targeted antibiotic. Lupus or vasculitis - corticosteroids and immunosuppressants. IgA - possibly fish oil supplements. Goodpasture's syndrome - plasmapheresis is a procedure designed to reduce blood plasma levels without depleting the body of its blood cells. Antibodies are removed and donated plasma replaces the depleted plasma.

V.

THE PATIENT AND HIS CARE A. MEDICAL MANAGEMENT a. IVF

MEDICAL MANAGEMENT/TREAT MENT

DATE ORDERED DATE TAKEN/GIVEN DATE CHANGED

GENRAL DESCRIPTION

INDICATION/S PURPOSE/S

CLIENTS RESPONSE TO TREATMENT

D5 0.3 NaCl 500cc

DO: DG:

.A

hypotonic Purpose

of There

good

solution that has hypotonic solution hydration status greater concentration free is to give up their was of water to a maintained. and of

water dehydrated cell so Sign

molecules that are it can return to symptoms found inside the isotonic cell rather than on equilibrium its surrounding

decreased fluid volumes reduced intravenous medication were given. were and

NURSING RESPONSIBILITIES FOR INTRAVENOUS THERAPY: Preparing the Client / Patient:

Explain to the client or the S.O. the procedure that is to be done Elicit the patients cooperation on the said activity Verify the IV ordered by the physician Gather the necessary equipment Prepare the IV solution

Performing the Procedure:

Regulate IV as ordered by the physician

After Insertion:

Examine the IV site for complications Inspect the patient for generalized reaction Monitor laboratory reports for electrolyte imbalance

Reminders: Be cautious to the proper drop factor ordered by the physician Always check if the IV tube is patent and identify if it composed of micro drop or drop IV

b. Drugs

NAME OF DRUGS: Generic and Brand Name

Generic Name: Cefuroxime

Date Ordered Date Given Date Changed D/C Date Ordered: 01-15-12

Route or Administration Dosage and Frequency of Administration Route: IV

General Action Functional Classification Mechanism of Action General Action: Antibiotic Mechanisms of Action: Binds to cell membranes, inhibits cell wall synthesis

Indication or Purpose

Brand Name: Ceftin

Date Given: 01-15-12 To 01-19-12

Dosage: 550 mg Frequency: q6

Cefuroxime was given to Amber to fight for streptococcal infection

Clients Response to the Medication with Actual Side Effect Amber respond to drug accordingly as evidenced by reduced temperature from 38.5 C to 36.4 C

Date Changed: n/a

Prior to administration:

Perform Skin test prior to administration. Check for the results of culture and sensitivity. Assess for any allergy to the drug component

During the administration:

Observe for any negative effect of the drug during the administration. Administer the drug at the right route Administer the drug with the right dosage Assess for the possible side effects that may occur

After the administration: Instruct patient to take medication as directed for full course of therapy, even if feeling better. Take missed doses as soon as remembered but not if almost time for next dose. Do not double doses. Inform patient that increased fluid and fiber intake and may take with food and milk Be alert for Super infection such as severe genital/anal pruritus, abdominal pain, severe mouth soreness,moderate diarrhea.

NAME OF DRUGS: Generic and Brand Name

Generic Name: Penicillin G sodium

Date Ordered Date Given Date Changed D/C Date Ordered: 01-15-12

Route or Administration Dosage and Frequency of Administration Route: IV

General Action Functional Classification Mechanism of Action General Action: Antibiotic Mechanisms of Action: Binds to cell membranes, inhibits cell wall synthesis

Indication or Purpose

Brand Name: Pfizerpen

Date Given: 01-15-12 To 01-19-12

Dosage: 550 mg Frequency: OD

It was given to Amber to treat streptococcal infection

Clients Response to the Medication with Actual Side Effect Amber respond to drug accordingly as evidenced by reduced temperature from 38.5 C to 36.4 C

Date Changed: n/a

Nursing Responsibilities: Prior to administration:

Check for the doctors order Check for allergy. Perform culture and sensitivity. Check for the right drug to be administered. Inform the patient about the drug to be given

During Administration:

Observe for any negative effect of the drug during the administration. Administer the drug at the right route Administer the drug with the right dosage Assess for the possible side effects that may occur.

After the administration: Observe the patient for any adverse reaction. Monitor serum electrolytes imbalance especially sodium and potassium. Instruct patient to eat small frequent feeding if nausea or vomiting occurs. Chart the medication administered. Instruct patient to report any unusual bleeding, sore throat severe diarrhea, difficulty of breathing to the healthcare provider.

NAME OF DRUGS: Generic and Brand Name

Generic Name: Prednisone

Date Ordered Date Given Date Changed D/C Date Ordered: 01-15-12

Route or Administration Dosage and Frequency of Administration Route: IV

General Action Functional Classification Mechanism of Action General Action: Antiimflammatory Mechanisms of Action:
Decreases or prevents tissues from responding to inflammation and also modifies the body's response to certain immune stimulation.

Indication or Purpose

Brand Name: Delatson

Date Given: 01-15-12 To 01-19-12

Dosage: 10 mg/5 ml Frequency: OD

It was given to Amber because he is having a slight asthma attack.

Clients Response to the Medication with Actual Side Effect After taking the medication Amber manifested relief in breathing

Date Changed: n/a

Nursing Responsibilities: Prior to administration: Identify the patient and assess for any allergy to the drug component Inform patient about the drug to be received. Assess for vital signs.

During the administration:

Check for the right drug to be given Check for the right route. Assess for any possible reaction side effects of the drugs

After Administration:

Monitor vital signs Observe patient in any adverse reaction Chart the medication administered

NAME OF DRUGS: Generic and Brand Name

Generic Name: Acetaminophen

Date Ordered Date Given Date Changed D/C Date Ordered: 01-14-12

Route or Administration Dosage and Frequency of Administration Route: IV

General Action Functional Classification Mechanism of Action General Action: Antipyretic Mechanisms of Action:
May produce analgesic effect by blocking pain impulses by inhibiting prostaglandin or pain receptor synthesizer. May relief fever by acting in hypothalamic heat-regulating center

Indication or Purpose

Brand Name: Paracetamol

Date Given: 01-14-12

Dosage: 10 mg/5 ml Frequency: Q4 PRN T > 37.8 C

Paracetamol is given to Amber because upon admission the patient manifested hyperthermia

Clients Response to the Medication with Actual Side Effect Ambers temperature decreased from 38.5C to 37.4C on 01-14-12

Date Changed: n/a

Nursing Responsibilities:

Prior to administration:

Check the doctors order. Assess for any allergy to the medication Assess for VS especially temperature. Inform the client about the drug to be administered

During the administration:

Check the right drug to be given. Check for the right dosage to be given. Monitor for any possible reactions.

After the administration:

Monitor for VS especially temperature. Advise patient not to take any OTC drug because it may cause possible reaction to the medication. Advise patient to report any rash, urticaria or discoloration of the skin because this may indicate adverse reaction.

c. Diet

TYPE OF DATE DIET

GENERAL

INDICATIONS

SPECIFIC

CLIENTS

ORDERED DESCRIPTION OR AND DATE PERFORM ED DATE CHANGED AND PURPOSES

FOODS TAKEN RESPONSE AND/OR REACTION THE DIET TO

Nothing per Orem

DO:

Without

food For further

Nothing

The seems irritated

patient to be most

and liquid intake observation and DP: for 1 to with to avoid 2 hours medications complication of unless otherwise prescribed by aspiration.

probably due to hunger.

the physician to resume fluid and food intake. Dry DO: Low DP: protein, L o w s a l t t o prevent manage fluid further i n c r ease in Yakult crackers,

overload Low Protein, Low salt and avoid occurrence of edema.

lipid and to c h o l e s t e r o l level in the blood and reduced f o r fluid retention t o reduce edema

T h e c l i e n t respond to as by had the diet

evidenced the patient a

r e d u c t i o n o f edema both and

from upper

lower extrem ities admission upon

Nursing Responsibilities for the DIET

Explained the importance of the diet Instruct the pt SO about the foods and the fluids Emphasized strict compliance of the diet regimen Instruct the pt SO to comply with the diet Instruct SO to position the pt in semi-fowlers position to avoid aspiration.

D. Activity/Exercise

Type of Exercise

Date ordered Date Performed Date changed

General Description

Indication, Initial Reaction, Purpose

Client response to activity exercise

Ambulation

Ma y sit on side of bed a n d walk around t h e room

T o p r o m o t e g o o d circulation

The patient w a s a b l e to resum e activities of daily living gradually

Nursing Responsibilities: Prior to: During: After:

Check for the doctors order Assess patients condition Assess for Vital signs. Explain the benefit that the patient may get from this activity.

Assist patient in the activity Advise the patient to have rest periods to avoid fatigue. Instruct the patient to gradually increase activities as tolerated.

Monitor patients vital signs. Advise patient to report to the physician any unusual fatigability to the physician because this may indicate activity intolerance. Monitor for vital signs to assess for tolerance to activity. Provide health teaching regarding the proper food to be taken to provide adequate supply of energy.

VII. CONCLUSION AND RECOMMENDATION

Urinary tract infection is a bacterial infection that affects part of the urinary tract. It affects the upper urinary tract it is known as pyelonephritis (a kidney infection) which can lead to a condition called Glomerulonephritis, also known as glomerular nephritis. It is a renal disease (usually of both kidneys) characterized by inflammation of the glomeruli, or small blood vessels in the kidneys. It is the active inflammation in the glomeruli. The inflammatory process usually begins with a U.T.I infection then the protective immune system fights off the infection, scar tissue forms, and the process is complete. This case is then called Urinary Tract Infection, Acute Glomerulonephritis.

Through this case study, the group should be able to learn and understand the disease condition U.T.I r/t Acute Glomerulonephritis, therefore will give knowledge in proper management, prevention and treatment. As a student nurse, it is very important to know many things including the said disease condition. This study is recommended to the following: This study is recommended to different hospitals in the Philippines for them to be able to make protocols to prevent further severity of their patients with this condition. This study is recommended to parents for them to be aware and be able to prevent occurrences of this condition within their family.

This is a disease that when given prompt treatment and proper attention could give a good prognosis. But when neglected, it could lead you to a more severe condition just like other disease.

This disease can be prevented to different ways. The researcher of this case study stated many ways to prevent from having them and the following are practically recommended for everyone: Proper hygiene in genital areas, this is to prevent cases of Urinary Tract infection.

Drink lots of water Low sodium diet to prevent water retention which may lead to infection.\ Use condom if ever you are engaging in sexual activities with different partners to prevent S.T.D. Proper Hand washing especially for children that are fond of touching and exploring their genital areas.

Learning Derived:

Even young people can have very serous illness like AGN and UTI so its very important that even young people are aware on how to take care of their selves so health education is very important in all walks of life which is one of our major responsibilities us student nurses to provide . Alvarez, Beatriz

At first, I and my groupmates dont actually know how and where to start in our case study because it is our first time to do a case study. This case study definitely gave me a broader view of the disease condition about Urinary Tract Infection, Acute Glomerulonephritis. Upon doing the case study, Ive learned a lot of things about the disease condition. Ive found this case interesting in terms of the interventions done and because I myself before, had Urinary Tract Infection, were I had my urine with blood and it feels so painful. In this case study I learned how to prevent this condition by means of having a healthy lifestyle. As a student nurse it is a great sense of fulfillment to me that I have participated with my group mates doing and making this case study possible. Creating awareness to us and being knowledgeable on the disease itself. Our efforts and sacrifices came to the hard copy of the case study itself. The care nourished by love and compassion somehow relieved the burden of the pt.s illness.

Guanzon, Clarrize Joyce C.

A UTI is an infection in the urinary tract. Infections are caused by microbesorganisms too small to be seen without a microscopeincluding fungi, viruses, and bacteria. Bacteria are the most common cause of UTIs. Normally, bacteria that enter the urinary tract are rapidly removed by the body before they cause symptoms. However, sometimes bacteria overcome the bodys natural defenses and cause infection. An infection in the urethra is called urethritis. A bladder infection is called cystitis. Bacteria may travel up the ureters to multiply and infect the kidneys. A kidney infection is called pyelonephritis. And knowing that, doing a case study would require a lot of patience with cooperation to each member of our group, doing this case study made us more collaborative to each other, cooperating and lending each others hand whenever in need and respecting one another made us to be more understanding to every member of the group and it strengthens our team work. I also learned that you have to give the best nursing care that you could provide to your patient for them to be properly cared and feel better. Furthermore, this case study made me realize that though there are things that hinders us to do what we need to we need to find a way to do it or else we might fail to do them, as a group you need to work as one and have a brain of more than one for you to be able to achieve and meet your goals. Tantenco, Abigail

VIII. Bibliography

A. Book Based:

Maternal and Child Health Nursing Vol. 2 Essentials of Anatomy and Physiology 6th Edition Nurses Pocket Guide (Diagnoses, Prioritized Interventions and Rationales 12th Edition Nursing Care Plans (Thomson Asian Edition: Delmar)

B. Internet Based: http://en.wikipedia.org/wiki/Urinary_tract_infection http://www.springerlink.com/content/k01x348378r3x8p5/ http://www.ncbi.nlm.nih.gov/pubmed/15789210 http://www.healthcommunities.com/acute-glomerulonephritis-agn/index.shtml http://www.medicinenet.com/urine_infection/article.htm#what http://www.learningandteaching.info/learning/piaget.htm http://www.victorianweb.org/science/freud/develop.html http://www.learningplaceonline.com/stages/organize/Erikson.htm http://en.wikipedia.org/wiki/Developmental_lines

2. Actual SOAPIERs

S> O> Received patient sitting on bed, conscious, with an IVF of D5 0.3 NaCl 500cc x KVO @ 260cc level, infusing well at right cephalic vein, with no signs of infiltration and phlebitis, with mild facial edema at the lower eyes, with rales heard upon auscultation , with pale palpebral conjunctiva, skin is warm to touch, clear nasal discharge, productive cough, no bipedal edema, tea-colored urine 3x during shift. VS as follows; T: 37 PR: 132 bpm RR: 34 bpm BP: 110/80 A: Excess fluid volume R/T compromised regulatory mechanism AEB facial edema secondary to AGN P: After 1-2 hrs of nursing interventions the patients SO will be able to verbalize understanding of individual dietary and sodium restrictions I: Established rapport Monitored and documented vital signs Provided comfort and safety measures Encouraged adequate rest periods Encouraged proper hygiene Kept back dry Encouraged adequate oral fluid intake Regulate IVF as ordered Health teachings Assess presence of edema in periorbital tissue or dependent areas Weigh (specify: daily BID or as needed) on same scale, at same time, and with same clothing. Assess for pleural effusion by presence of dysnea, tachypnea, crackles, orthopnea, acites Limit sodium intake as ordered by removing salt shaker, foods high in salt. Maintain bed rest and position and support edematous body parts; change position (q 2h).

E: Goal met AEB SOs verbalization of understanding of individual dietary of sodium and restrictions.

S> O> Received patient on bed, conscious with an intact heplock on his right hand ,negative for facial edema , has light tea colored urine , negative stool , presence of rales was hared on both lung fileds during auscultation with fital sings as follows :

T: 36.2 PR:94 RR :24

A> Ineffective airway clearance related to retained secretions as evidence by presence of rales. P> After 2-3 hours of nursing intervention the patient will matain airway patency as evidence by absence of respiratory distress .

I> E>

Established rapport. monitored VS. observed mucous and skin integrity. Monitored intake and out put of the client. Evaluated for signs of edema .. Evaluated for signs of infection. Evaluated clients respiration breath sounds. Elevated patients head. Monitored sings of DOB. Reinforced Diet (low salt and low fat) Encouraged adequate fluid intake. Advised to keep heplock clean. Encourage adequate rest periods. Encouraged proper hand hygiene .

Goal met after 2-3 hours of nursing interventions the pt. was able to maintain airway patency.