Acute

Pyeloneph
GROUP-C
 OBJECTIVES 

GENERAL OBJECTIVES:
 This case study aims to assess and gather information about Acute Pyelonephritis
 
SPECIFIC OBJECTIVES:
Knowledge:
 To be able to define Acute Pyelonephritis
 To be able to enhance the understanding about Acute Pyelonephritis
 To be able to discuss the anatomy and physiology of Acute Pyelonephritis
 OBJECTIVES 
Skills:
 To be able to deal and handle patient who had Acute Pyelonephritis
 To be able to monitor effectiveness of nursing interventions
 To be able to promote safety, comfort and patient’s privacy
 To be able to develop a SMART (specific, measurable, attainable, realistic and time
bound) nursing care plan.
 
Attitude:
 To be able to maintain therapeutic relationship with the patient
 To be able to promote holistic nursing care
 INTRODUCTION

Urinary Tract Infections (UTIs) are caused by the pathogenic microorganism in the
urinary tract. UTIs are classified according to location: either the upper urinary tract
(which includes the kidneys and ureters) and lower urinary tract (which includes the
bladder and structures below the bladder). Pyelonephritis is classified as an upper urinary
tract infection. It is an inflammation of the renal pelvis.
Acute pyelonephritis is one of the most common serious bacterial infections in young
adult women.
Can be divided into:
Uncomplicated acute pyelonephritis- Typically occurs in healthy, young women structural
or functional urinary tract abnormalities.
Complicated acute pyelonephritis- Occurs in patients with a structurally or functionally
abnormal genitourinary tract, or a predisposing medical condition.
 INTRODUCTION

CAUSES / ETIOLOGY

The infection usually starts in the lower urinary tract as a urinary tract
infection (UTI). Bacteria enter the body through the urethra and begin to
multiply and spread up to the bladder. From there, the bacteria travel through
the ureters to the kidneys.
Bacteria such as Escherichia coli often cause this infection. However, any
serious infection in the bloodstream can also spread to the kidneys and cause
acute pyelonephritis.
 INTRODUCTION

RISK FACTORS

Any problem that interrupts the normal flow of urine causes a greater risk
of acute pyelonephritis. For example, a urinary tract that's an unusual size or
shape in more likely to lead to acute pyelonephritis. Also, women's urethras
are much shorter than men, so it's easier for bacteria to enter their bodies.
That makes women more prone to kidney infections and puts them at a
higher risk of acute pyelonephritis.
 INTRODUCTION

Other people who at increased risk include:

• Anyone with chronic kidney stones or other kidney or bladder conditions

• Older adults
• People with suppressed immune systems, such as people with diabetes,
HIV/AIDS or cancer
• People with an enlarged prostate
 INTRODUCTION

SIGNS & SYMPTOMS

First symptoms:
1. High Fever
2. Chills
3. Pain in the abdomen, back, side or groin
In some cases, this infection causes nausea and vomiting
Urinary symptoms are also common, including:
• Urinary frequency­­‑ Or the need to urinate often
• Urinary urgency- Or the need to urinate immediately
• Dysuria- Painful urination
• Hematuria- Or blood in the urine
 INTRODUCTION

DIAGNOSTIC & CONFIRMATORY TESTS

Urine tests- This helps to check for bacteria, concentration, blood, and pus in the urine.
Imaging tests:
1. Ultrasound- To look for cysts, tumors, or other obstructions in the urinary
tract.
2. CT-Scan- (with or without injectable dye) can also detect obstructions
within the urinary tract.
Radioactive Imaging:
3. Dimercaptosuccinic acid (DMSA) test- May ordered if suspects scarring as a
result of pyelonephritis. This is an imaging technique that tracks an injection
of radioactive material.
 INTRODUCTION

MANAGEMENT
1. Antibiotics are the first course of action against acute pyelonephritis. However, the
type of antibiotic your doctor chooses depends on whether or not the bacteria can be
identified. If not, a broad-spectrum antibiotic is used.
2. Hospital admission depends on the severity of your condition and how well you
respond to treatment. Treatment includes intravenous hydration and antibiotics for 24
to 48 hours. Doctors, will monitor your blood and urine to track the infection. You’ll
likely receive 10 to 14 days’ worth of oral antibiotics to take after you’re released from
the hospital.
3. Surgery may be required to remove any obstructions or to correct any structural
problems in the kidneys. It may also be necessary to drain an abscess that doesn’t
respond antibiotics.
 INTRODUCTION

COMPLICATIONS

• Proper treatment of pyelonephritis may prevent serious problems. If

untreated, it can lead to a bacterial infection in the bloodstream called
sepsis. This can then spread to other parts of the body and cause serious
conditions requiring emergency treatment.
• Untreated pyelonephritis can also result in acute respiratory distress as
fluid accumulates in the lungs.
• Pyelonephritis during pregnancy is a leading cause of preterm labor, which
puts the baby at high risk for serious complications and even death.
 INTRODUCTION

PREVENTION

Pyelonephritis can be a serious condition. This condition requires prompt

medical attention, so the earlier you start treatment, the better.
1. Drink plenty of fluid to increase urination and remove bacteria from the
urethra
2. Wipe from front to back
3. Avoid using products that can irritate the urethra, such as douches or
feminine sprays.
 INTRODUCTION

EPIDEMIOLOGY

• Urinary tract infections remain among the most common medical

complications during pregnancy. It is estimated that the prevalence of ASB
varies between 2% and 10–13%, similar to nonpregnant women. There is a
scarcity of data concerning acute cystitis in pregnancy; according to the
available studies it is observed in 1–4%. The prevalence of acute
pyelonephritis in most reports ranges from 0.5% to 2% of pregnancies.
 INTRODUCTION
EPIDEMIOLOGY

• Many women acquire bacteriuria before pregnancy. A large retrospective

analysis with logistic regression modeling, embracing 8037 women from
North Carolina, revealed that the two strongest predictors of bacteriuria at
prenatal care at prenatal care initiation were: UTI prior to prenatal care
initiation (OR = 2.5, 95% CI: 0.6–9.8 for whites, and OR = 8.8, 95% CI: 3.8–
20.3 for blacks) and a pre-pregnancy history of UTI (OR = 2.1, 95% CI: 1.4–
3.2). In a second analysis, prior antenatal UTI was found to be the strongest
predictor of pyelonephritis after 20 weeks’ gestation (OR = 5.3, 95% CI: 2.6–
11.0).
 INTRODUCTION

PROGNOSIS
• Overall the majority of cases of pyelonephritis are managed in an outpatient
setting with most patients improving with oral antibiotics. Usually, young women
are among those most likely to be treated as outpatients.

• Despite pyelonephritis improving in most cases, there is still significant morbidity

and mortality that can be associated with severe cases of this disease. Overall
mortality has been reported around 10% to 20% in some studies with a recent
study from Hong Kong finding a mortality rate closer to 7.4%.
 INTRODUCTION

PROGNOSIS
• More importantly, this study found that old age (older than 65 years), male
gender, impaired renal function, or presence of disseminated intravascular
coagulation were associated with increased mortality. With the proper
recognition of the underlying etiology and prompt intervention with adequate
treatment, even patients with severe pyelonephritis generally have a good
outcome.
 PATIENT’S PROFILE
Name: Patient L.T
Age: 23 years old
Gender: Female
Address: Dodan, Aparri, Cagayan
Birth Date: May 19, 1996
Place of Birth: Paddaya Aparri, Cagayan
Civil Status: Married
Religion: Roman Catholic
Nationality/Ethnicity:Filipino
Occupation: Student
 PATIENT’S PROFILE
 
ADMISSION PROFILE
Date and time of admission: 12 – 6 – 19 @ 7:00 pm
Chief complaint/s: Back pain
Admitting diagnosis: Acute Pyelonephritis G3P2 (2002) PU 7 3/7 weeks
Admitting physician: Dr. S
 PATIENT’S PROFILE
 
ADMITTING VITAL SIGNS
Blood Pressure: 90/60 mmHg LMP: 10/22/19
Temperature: 38.2°C AOG: 7 3/7 weeks
Pulse rate: 134 bpm
Respiratory rate: 25 cpm

Date and time handled: 12 – 9 – 19 @ 10:00 AM

Source of information: Patient and Patient’s chart
 
 NURSING HEALTH HISTORY
 
PRESENT HEALTH HISTORY

1 hour prior to admission, the patient experienced pain on her abdomen,

both sides of the lower back and accompanied by fever. Her husband and
mother took her immediately to the hospital and was hence admitted at
Toran Provincial Hospital for further medical management. The patient
underwent abdominal ultrasound on July 9, 2019 at 7:00 pm and was
diagnosed Acute Pyelonephritis G3P2 (2002) PU 7 3/7 weeks.
 
 NURSING HEALTH HISTORY
 
PAST HEALTH HISTORY

During her childhood she experienced illnesses such as fever, common colds
and cough. She uses OTC drugs such as carbocistene and paracetamol. The
patient completed her immunizations and has no allergies to food and
medicines. This is her third time of hospitalization.
 NURSING HEALTH HISTORY
 
FAMILY HEALTH HISTORY

(+) Hypertension (father side)

(-) Diabetes mellitus
(+) Heart disease (mother side)
(-) Cancer
(+) Allergy (both side)
(-) Kidney disease
 NURSING HEALTH HISTORY
 
SOCIAL HEALTH HISTORY

She is married and lives at Dodan Aparri, Cagayan. Patient is currently

studying major in Mathematics at CSU. She is a busy type person because of
school requirements and at the same time a responsible and supportive
mother to his husband and 2 children. The patient is a Roman Catholic by
religion. She said that her family always attends the holy mass on most
Sunday and always pray for their good health and guidance.
 NURSING HEALTH HISTORY
 
OBSTETRIC HISTORY

On 2012, she had a full term normal pregnancy and delivered a baby boy via
spontaneous vaginal delivery (NSD) at Toran Aparri, Cagayan and the weight
of the baby was 3 kg and is alive and well. She had her check-up every month
of pregnancy.
 
On 2018, she had a full term pregnancy and delivered a baby girl via cesarean
section at Christian Hospital and the weight of the baby was 3 kg and is alive
and well.
 NURSING HEALTH HISTORY
 
GYNECOLOGY HISTORY

She attained her menarche at the age of 12 years old with 28 days regular
cycle with 1 week of duration. Consumed 5 pasador in the morning and 2
pads at night and used pH care for cleaning with regular shave. Her LMP was
October 22, 2019 and the AOG is 7 3/7 weeks.
 
Whenever she experienced dysmenorrhea she drinks warm water to relieve
the pain. As for contraception, she was then an oral contraceptive pills.
 GORDON’S FUNCTIONAL PATTERN
  PATTERN BEFORE HOSPITALIZATION DURING HOSPITALIZATION
1. HEALTH According to pt. L.T she defined “Ang hirap ma-hospital,
PERCEPTION/ HEALTH health as “Dapat laging kumain kailangan dapat sundin yung
MANAGEMENT ng masusustansiyang gulay para mga bilin ng nurses at doctors”
PATTERN hindi maging sakitin” she also as verbalized by the patient.
stated that, to manage her
diseases she immediately took
over the counter drugs such as
carbocistene and paracetamol.
 GORDON’S FUNCTIONAL PATTERN
  PATTERN BEFORE HOSPITALIZATION
DURING
HOSPITALIZATION
2.NUTRITIONAL The patient weight 60 kg. According to “Kanin, karne at lugaw
METABOLLIC PATTERN the pt. She ate 3 times a day with the lang yung madalas kong
snack in between. Typically, her meal is kainin ma’am” as
composed of rice, meat and vegetable verbalized by the patient.
dishes. She approximately drinks 2 Moreover she already
glasses of water a day. She is fond of consumed 500 ml of
eating junk foods and drinks 2 bottles water during the shift. Her
of coke per day. Furthermore, the current IVF is PNSS.
patient stated that she has no allergies
on foods and medications.
 GORDON’S FUNCTIONAL PATTERN
  PATTERN BEFORE HOSPITALIZATION
DURING
HOSPITALIZATION
3. ELIMINATION According to the pt. She doesn’t have “Sa tingin ko wala
PATTERN any problem in urinating and namang problema sa pag-
defecating. She urinates 2 times a day ihi at pagbawas ko
with yellow in color. She defecates once ma’am, limang beses na
with semi-form and brown stool. akong umihi at isang
beses namang tumae
pero matigas ito at kulay
green ” as verbalized by
the patient.
 GORDON’S FUNCTIONAL PATTERN
  PATTERN BEFORE HOSPITALIZATION
DURING
HOSPITALIZATION
4. ACTIVITY EXERCISE According to the pt. she considered “Naglalakad lang ako
PATTERN household chores as her exercise every ditto sa hospital ma’am
day. tapos bed rest” as
“Bago po ako maospital, ang sakit po verbalized by the patient.
ng tiyan at balakang ko ma’am” as
verbalized by the patient.
 GORDON’S FUNCTIONAL PATTERN
  PATTERN BEFORE HOSPITALIZATION
5. SLEEP – REST According to the pt. she
PATTERN usually sleeps for 7-8 hours.
Her earliest time to sleep is
9:00 pm and wakes up at
4:00 am. Moreover, she
doesn’t experience any sleep
onset difficulties and only
wakes up at night to urinate.
DURING HOSPITALIZATION
According to the patient, most of
the time, she only stays on her bed
to rest. But usually disturbed
because of interruptions like
routine monitoring. “Maayos
naman yung pag-tulog ko dito
ma’am, matutulog ako ng alas-
syete ng gabi at magigising ng alas
singko ng umaga”, she added.
 GORDON’S FUNCTIONAL PATTERN
  PATTERN BEFORE HOSPITALIZATION
6. COGNITIVE According to the pt. she
PERCEPTUAL PATTERN doesn’t have any problem to
her 5 senses, she listen
attentively and answer
question coherently.
DURING HOSPITALIZATION
Patient T.L is cooperative during the
assessment and interview. She is
oriented to person, time and place.
“Mapait yung panlasa ko ma’am
kaya minsan wala akong gana” as
verbalized by the patient.
 GORDON’S FUNCTIONAL PATTERN
  PATTERN BEFORE HOSPITALIZATION DURING HOSPITALIZATION

7. SELF – PERCEPTION According to the pt. she is a Patient T.L has a scar on her
PATTERN very supportive and abdomen and stretch marks (striae
responsible mother to her gravidarum).
husband.
“Ang hirap po maging isang
batang Ina, ang dami mong
obligasyon lalo na’t nag-
aaral ka pa at ang hirap
pag-sabayin” she added.
 GORDON’S FUNCTIONAL PATTERN
  PATTERN BEFORE HOSPITALIZATION DURING HOSPITALIZATION

8. ROLE – The patient has a nuclear The patient said that she wants to
RELATIONSHIP PATTERN type of family, and live just go home because she missed her
beside her parents. She is the family, especially her 1 year old
one who’s responsible in baby.
maintaining cleanliness and
order at home. She is able to
state a good relation to her
families and friends.
 GORDON’S FUNCTIONAL PATTERN
  PATTERN BEFORE HOSPITALIZATION DURING HOSPITALIZATION

9. SEXUALITY – The patient reports of This is her 3rd pregnancy with 4th
REPRODUCTIVE satisfactory sexual week of gestation.
PATTERN relationship with her Her first child is a boy who is now 7
husband. She is newlywed years old
and been contented to have Her second child is a girl who is now
her simple family. 1 year old.
 
 GORDON’S FUNCTIONAL PATTERN
  PATTERN BEFORE HOSPITALIZATION DURING HOSPITALIZATION

10. COPING STRESS According to the pt. she used The patient stated that, her
PATTERN to pray and stay positive as stressed reliever is to watch Korean
she faced problems and movies.
difficulties in her daily life.
 GORDON’S FUNCTIONAL PATTERN
  PATTERN BEFORE HOSPITALIZATION
11. VALUE – BELIEF According to the pt. she is a
PATTERN Roman Catholic by religion.
She said that her family
always attends the holy mass
during Sundays and serve it
as their family day.
DURING HOSPITALIZATION
She believes that having faith in
God will help her to overcome
problems.
“Lagi ko pong pinag-darasal ang
kaligtasan ng buong pamilya ko” as
verbalized by the patient.
 COURSE IN THE WARD
NURSING
DATE / TIME DOCTOR’S ORDER RATIONALE
RESPONSIBILITY
12 – 6 – 19  Please admit to Ward  For observation and  Admit patient as
7:00 pm monitoring ordered
 Prepare and fill out all
necessary documents
 Obtain initial V/S

   Secure consent for  For documentation  Serve as witness in

admission and records keeping consent signing
   Secure consent on
chart
 COURSE IN THE WARD
NURSING
DATE / TIME DOCTOR’S ORDER RATIONALE
RESPONSIBILITY
   TPR q shift and  To monitor patient’s  Obtain VS as ordered
record condition  Refer relevant
findings accordingly

   CBC U/A-NOW  For diagnostic and  Facilitate lab request

determination of any
abnormalities in the
blood
 COURSE IN THE WARD
DATE / TIME DOCTOR’S ORDER RATIONALE NURSING RESPONSIBILITY
   PNSS x 1L  For hydration and  Ensure proper regulation
balance fluid and  Monitor IV site for
electrolytes swelling or signs of
infection
 Check patency

   Tramadol 50 mg  For pain relief and  Obtain correct orders

IV q8 threat severe pain    Refer for any allergic
reactions
 COURSE IN THE WARD
NURSING
DATE / TIME DOCTOR’S ORDER RATIONALE
RESPONSIBILITY
   Paracetamol 300 mg  To treat fever and for  Monitor VS
IV q4 pain reliever  Obtain correct orders
 Refer for any allergic
reactions

   Cefuroxime 750 mg  Treatment for  Obtain correct orders

IV q4 urinary tract infection  Refer for any allergic
reactions
 COURSE IN THE WARD
NURSING
DATE / TIME DOCTOR’S ORDER RATIONALE
RESPONSIBILITY
   Refer  For continuous  Refer accordingly
monitoring

12-8-19  For abdomino-pelvic  To detect diseases of the  Facilitate request

  CT internal organs and used
to determine the cause
of unexplained pain
 COURSE IN THE WARD
NURSING
DATE / TIME DOCTOR’S ORDER RATIONALE
RESPONSIBILITY
 Incorporate 2  To treat or prevent  Obtain correct orders
 

ampules B complex vitamin deficiency

to abuse IVF
 PHYSICAL ASSESSMENT
 
GENERAL SURVEY:

The patient was assessed on December 9, 2019 @ 10:00 am in her bed, with
ongoing IVF PNSS 800 ml X 20 gtts/min via left metacarpal vein patent and
infusing well. She has a body temperature of 36.4 degree Celsius which is
normal, a respiration of 22 cycles per minute, and her pulse rate was assessed
to be 82 beats per minute. She is 5’ in height and with a body weight of 60 kg.
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMAL FINDINGS ACTUAL ANALYSIS
FINDINGS
THE SKIN
Color Inspection Varies from light to Brown Normal physiologic
deep brown; from change during
ruddy pink to light pregnancy due to
pink; from yellow increased production
overtunes to olive. of Melanin s/t
increased estrogen
level
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMAL FINDINGS ACTUAL ANALYSIS
FINDINGS
THE SKIN
Uniformity of Inspection Generally uniform Uniform Normal physiologic
color except in areas except on change during
exposed to the sun; upper pregnancy due to
areas of lighter extremities increased production
pigmentation in dark (under arm, of Melanin s/t
skinned people leg) increased estrogen
(palms, lips, nail level
beds)
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMAL FINDINGS ACTUAL ANALYSIS
FINDINGS
THE SKIN
Skin turgor Inspection When pinched, skin Skin springs Normal physiologic
springs back to back to change during
previous state previous pregnancy due to
(elastic); maybe state (elastic) increased fluid
slower in older except on retention
adults. lower
extremities
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMAL FINDINGS ACTUAL ANALYSIS
FINDINGS
THE SKIN
Presence of Inspection/ No edema (+) Edema on Normal physiologic
Edema Palpation   both feet change during
pregnancy due to
increased fluid
retention
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMAL FINDINGS ACTUAL ANALYSIS
FINDINGS
THE SKIN
Skin lesions Inspection/ Freckles, some Scar on the Due to surgical
  palpation birthmark, some flat abdomen incision
raised nevi,
no abrasions or
other lesions
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMAL FINDINGS ACTUAL ANALYSIS
FINDINGS
THE SKIN
Skin moisture Inspection/palp Moisture in skin folds Skin Normal
ation and the axillae moisture
(varies with
environmental
temperature and
humidity, body
temperature and
activity)
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMAL FINDINGS ACTUAL ANALYSIS
FINDINGS
THE SKIN
Skin Palpation Uniform within Temp: 36.4˚C Normal
temperature normal range
(depending on the
route)
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMAL FINDINGS ACTUAL ANALYSIS
FINDINGS
HAIR
Color Inspection Varies depending on Black Normal
race

Distribution Inspection Evenly distributed Evenly Normal

(evenness of hair distributed
growth over hair
the scalp)
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMAL FINDINGS ACTUAL ANALYSIS
FINDINGS
HAIR
Thickness Inspection Thick hair Thick hair Normal

Texture and Inspection/ Silky, resilient hair Silky, Normal

oiliness Palpation resilient hair
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMAL FINDINGS ACTUAL ANALYSIS
FINDINGS
NOSE
Color Inspection Uniform in color with Uniform in Normal
other facial features color with
other facial
features

Shape and size Inspection Symmetric and Symmetric Normal

straight and straight
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMAL FINDINGS ACTUAL ANALYSIS
FINDINGS
Outer Lip        
Color Inspection Uniform pink color Brown Normal
(darker, bluish hue in
Mediterranean
groups and dark
skinned client)

Symmetry of Inspection Symmetry of contour Uniform pink Normal

contour color
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMAL FINDINGS ACTUAL ANALYSIS
FINDINGS

Outer Lip        

Texture Inspection/ Soft, moist, smooth Normal Normal

palpation texture
 PHYSICAL ASSESSMENT
 BODY PART METHOD NORMAL FINDINGS ACTUAL ANALYSIS
USE FINDINGS
INNER LIPS AND BUCCAL MUCOSA
Color Inspection Uniform pink color (freckled Uniform pink Normal
brown pigmentation in dark color
skinned clients)
Moisture and Inspection/ Moist, smooth, soft. Moist, Normal
texture Palpation Glistening and elastic smooth, soft.
texture (drier oral mucosa in Glistening
elderly due to decreased and elastic
salivation) texture
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMAL FINDINGS ACTUAL ANALYSIS
FINDINGS
INNER LIPS AND BUCCAL MUCOSA
Number of Inspection 32 adult teeth 29 teeth Normal
teeth

Color and Inspection/ Smooth, white, shiny Smooth, Normal

texture palpation tooth enamel white, shiny
  tooth
enamel
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMAL FINDINGS ACTUAL ANALYSIS
FINDINGS

HEART

Apical pulse/ Auscultation Regular heart sounds Regular Normal

Heart sounds and rhythm (within heart sounds
(aortic, normal range in rate) and rhythm
pulmonic,  
tricuspid, S1: Usually heart at
mitral) all sites, louder at
the apical area
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMAL FINDINGS ACTUAL ANALYSIS
FINDINGS

HEART
S2: Usually heard at
all sites, usually
louder at base of the
heart
S3: Present in
children and young
adults
S4: Present in many
older adults
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMAL FINDINGS ACTUAL ANALYSIS
FINDINGS
HEART
Apical pulse/ Auscultation Systole: silent 82 bpm Normal
Heart sounds interval, slightly
(aortic, shorter duration
pulmonic, than diastole at
tricuspid, normal heart rate
mitral) (60-90 bpm)
 
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMAL FINDINGS ACTUAL ANALYSIS
FINDINGS
HEART
Diastole: silent
interval, slightly
longer duration than
systole at normal
heart rates.
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMAL FINDINGS ACTUAL ANALYSIS
FINDINGS
BREAST
Size symmetry, Inspection Females: Rounded Engorgement Normal physiologic
contour/shape( shape”; slightly of the breast change during
sitting position) unequal in size, pregnancy d/t breast
generally symmetric milk production
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMAL FINDINGS ACTUAL ANALYSIS
FINDINGS
BREAST
Localized Inspection Skin uniform in color Skin uniform Normal
discoloration or (same in appearance in color
hyperpigment as skin of abdomen (same in
action, or back) appearance
retraction or as skin of
dimpling abdomen or
back)
 
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMALFINDINGS ACTUAL ANALYSIS
FINDINGS
BREAST
Skin smooth and  Skin smooth
intact and intact

Diffuse symmetric  
horizontal or vertical 
 
 PHYSICAL ASSESSMENT
 BODY PART METHOD NORMALFINDINGS ACTUAL ANALYSIS
USE FINDINGS
BREAST
Areola area Inspection Round or oval and Round and Normal physiologic
(size,shape, bilateral the same bilateral the change during
symmetric,colo Color varies widely, from same pregnancy
r, surface light pink to dark brown Color dark
characteristics, Irregular placement of brown
masses/lesion) sebaceous glands on the  
surface of the areola
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMALFINDINGS ACTUAL ANALYSIS
FINDINGS
BREAST
Nipples for Inspection Rounded, everted and Rounded, Normal
size, shape, equal in size, similar in everted and
position, color, color, soft and smooth, equal in size,
discharge and both nipples point in the similar in color,
lesions same direction slightly dry, both
Inversion of one or both nipples point in
nipples may be present the same
from puberty direction
 
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMALFINDINGS ACTUAL ANALYSIS
FINDINGS
BREAST
Axillary, Palpation No tenderness, No Normal
subclavicular masses or nodules tenderness,
and lymph masses or
nodes nodules
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMALFINDINGS ACTUAL ANALYSIS
FINDINGS
BREAST
Masses, Palpation No tenderness, Tender, Normal physiologic
tenderness and masses, nodules. No nipple change during
discharge from nipple discharge discharge pregnancy d/t breast
the areola and except from milk production
nipples pregnant or breast-
feeding females
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMALFINDINGS ACTUAL ANALYSIS
FINDINGS
ABDOMEN
Skin Integrity Inspection Unblemished skin, Presence of Normal physiologic
  uniform in color stretch change during
Silver-white marks pregnancy due to
striae(Stretch marks rupture and atrophy
or surgical scars) of small segments of
the connective layer
of the skin
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMALFINDINGS ACTUAL ANALYSIS
FINDINGS
ABDOMEN
Scar on the Due to surgical
abdomen incision
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMALFINDINGS ACTUAL ANALYSIS
FINDINGS
ABDOMEN
Contour and Inspection Flat rounded(convex Flat Normal
symmetry or scaphoid rounded(con
(concave) vex or
scaphoid
(concave)
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMALFINDINGS ACTUAL ANALYSIS
FINDINGS
ABDOMEN
Abdominal Inspection Symmetric Symmetric Normal
movements movements caused movements
by respirations caused by
Visible peristalsis in respirations
very lean people Visible
peristalsis in
very lean
people
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMALFINDINGS ACTUAL ANALYSIS
FINDINGS
ABDOMEN
Aortic pulsations in Aortic
thin persons at pulsations in
epigastric area thin persons
at epigastric
area
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMALFINDINGS ACTUAL ANALYSIS
FINDINGS
ABDOMEN
Vascular Inspection No visible vascular No visible Normal
patterns problem vascular
problem
 PHYSICAL ASSESSMENT
 BODY PART METHOD USE NORMALFINDINGS ACTUAL ANALYSIS
FINDINGS
ABDOMEN
Level of Inspection Glasgow coma score Glasgow Normal
consciousness of 15 indicates coma score
alertness and of 15
complete orientation indicates
alertness and
complete
orientation
 ANATOMY AND PHYSIOLOGY
 
Overview of the Urinary System
The urinary system maintains blood homeostasis by filtering out excess
fluid and other substances from the bloodstream and secreting waste.
 
The Renal System
It is also called the urinary system, is a group of organs in the body that
filters out excess fluid and other substances from the bloodstream.
The purpose of the renal system is to eliminate wastes from the body,
regulate blood volume and pressure, control levels of electrolytes and
metabolites, and regulate blood pH.
 ANATOMY AND PHYSIOLOGY

The renal system organs include the: kidney, ureters, bladder, and urethra.
Metabolic wastes and excess ions are filtered out of the blood, along with
water, and leave the body in the form of urine.

Figure 1: Components and major organs of the renal system

 ANATOMY AND PHYSIOLOGY
Renal System Functions:

Many of these functions are interrelated with the physiological mechanisms

in the cardiovascular and respiratory systems.
1. Removal of metabolic waste products from the body
(mainly urea and uric acid)
2. Regulation of electrolyte balance (e.g., sodium,
potassium, and calcium)
3. Osmoregulation controls the blood volume and body
water contents.
 ANATOMY AND PHYSIOLOGY

4. Blood pressure homeostasis: The renal system alters

water retention and thirst to slowly change blood volume
and keep blood pressure in a normal range.
5. Regulation of acid-base homeostasis and blood pH, a
function shared with the respiratory system.

Many of these functions are related to one another as well. For example, water
follows ions via an osmotic gradient, so mechanisms that alter sodium levels or
sodium retention in the renal system will alter water retention levels as well.
 ANATOMY AND PHYSIOLOGY

Organs of the Renal System

 
Kidneys- Are the most complex and critical part of the urinary system. The
primary function of the kidneys is to maintain a stable internal environment
(homeostasis) for optimal cell and tissue metabolism. The kidneys have an
extensive blood supply from the renal arteries that leave the kidneys via the
renal vein.
 ANATOMY AND PHYSIOLOGY
Nephrons- Are the main functional component inside the parenchyma of
the kidneys, which filter blood to remove urea, a waste product formed by the
oxidation of proteins, as well as ions like potassium and sodium. The nephrons
are made up of a capsule capillaries (the glomerulus) and a small renal tube.

The renal tube of the nephron consists of a network of tubules and loops that
are selectively permeable to water and ions.

Many hormones involved in homeostasis will alter the permeability of these

tubules to change the amount of water that is retained by the body
 ANATOMY AND PHYSIOLOGY
Ureter
Urine passes from the renal tube through tubes called ureters and into the
bladder.
Bladder
It is flexible and is used as storage until the urine is allowed to pass through
the urethra and out of the body.
Human Osmoregulation
The kidneys play a very large role in human osmoregulation by regulating
the amount of water reabsorb from the glomerular filtrate in kidney tubules,
which is controlled by hormones such as antidiuretic hormone (ADH), renin,
aldosterone, and angiotensin I and II.
 ANATOMY AND PHYSIOLOGY
 
A basic example is that a decrease in water concentration of blood is
detected by osmoreceptors in the hypothalamus, which stimulates ADH release
from the pituitary gland to increase the permeability of the wall of the
collecting ducts and tubules in the nephrons.
Therefore, a large proportion of water is reabsorbed from fluid to prevent a fair
proportion of water from being excreted.
The extent of blood volume and blood pressure regulation facilitated by the
kidneys is a complex process. Besides, ADH secretion, the renin-angiotensin
feedback system is critically important to maintain blood volume and blood
pressure homeostasis.
 ANATOMY AND PHYSIOLOGY

 
Figure 2. The Kidney
 Renal Cortex- The cortex is the outer part of the kidney. This is where blood
is filtered.
 Renal Medulla- Where the amount of salt and water in your urine is
controlled.
Renal Capsule- Smooth, transparent sheet of irregular connective tissue that is
continuous with the outer coat of the ureter.

Minor Calyx- Portion of the urinary collecting system within the kidney that
drains one renal papilla.

 Major calyx- Portion of the urinary collecting system within the kidney that
drains several minor calyces.

Renal Columns- Are lines of the kidney matrix which support the cortex of the
kidney. They are composed of lines of blood vessels and urinary tubes and a
fibrous, cortical material.
 ANATOMY AND PHYSIOLOGY
Renal Pyramid- Are conical segments within the internal medulla of the kidney.
The pyramids contain the secreting apparatus and tubules.

Renal Pelvis- This is the region of the kidney where urine collects.
 
Renal Papilla- Tip of renal pyramid projecting into minor calyx.

Ureter- Muscular tube that serves as the duct of the kidney to carry urine to
the bladder.
ANATOMY AND PHYSIOLOGY
URINE FORMATION

Glomerular Filtration

Tubular Reabsorption

Tubular Secretion
 ANATOMY AND PHYSIOLOGY
URINE ELIMINATION
Increased bladder pressure

Transmit nerve impulse

Propagate to micturition Center

Trigger micturition reflex

Contraction of the detrusor muscle and Relaxation of the internal

urethral sphincter

Urination
PATHOPHYSIOLOGY
Acute kidney
injury

Pyelonephritis

Ascension

Uroepithelium
penetration

Colonization
 LABORATORY RESULT
COMPLETE BLOOD COUNT
DATE/TIME: 12/6/19@8:00 PM
TEST DONE NORMAL VALUES ACTUAL VALUES ANALYSIS
WBC 5.00- 10.00 6.73 10^9/L Normal
RBC 3.50- 5.50 4.36 10^12/L Normal
HGB 12.0- 16.0 13.0 g/dL Normal
HCT 0.37- 0.47 0.38 % Normal
Platelet count 150- 450 234 10^9/L Normal
Neutrophil 0.50 – 0.70 0.84 % Elevated; due to
infection
 LABORATORY RESULT
COMPLETE BLOOD COUNT
DATE/TIME: 12/6/19@8:00 PM
TEST DONE NORMAL VALUES ACTUAL VALUES ANALYSIS
Lymphocyte 0.20 – 0. 40 0.05 % Lower value; due to
intense exercise,
severe stress or
malnutrition

Monocyte 0.03 – 0. 12 0.07 % Normal

Eosinophil 0.00 – 0.05 0.04 % Normal
Basophil 0.00 – 0.01 0.00 % Normal
MCV 80.00- 100.0 86.0 fL Normal
MCH 27.0 - 34.0 29.4 pg Normal
 URINALYSIS
DATE/TIME: 12/6/19@8:30 PM
TEST DONE NORMAL VALUES ACTUAL VALUES ANALYSIS
Physical      
examination:      
Color   Yellow Normal

Transparency Clear Hazy Due to presence of

blood

Reaction ------ 5.0 Normal

Specific gravity 1.001-1.035 1.020 Normal
 MICROSCOPIC
Pus cells/ Leukocytes 0-4 4-6 Elevated; due to
infection

Red blood cell   0.2 Normal

Amorphous urates   Few  

Squamous   Moderate Normal

Bacteria   Few Normal

 DRUG STUDY
DOCTOR’S ORDER: Tramadol 30 mg IV q8
GENERIC NAME: Tramadol hydrochloride
BRAND NAME: Tramal Solution
CLASSIFICATION: Opiate (narcotic) analgesics
PREGNANCY CLASSIFICATION: C
 
MECHANISM OF ACTION:
It is known to act on the mu opioid receptors to produce pain relief. When a person
takes Tramadol, it acts on the mu opioid receptor, blocking the neuron from communicating
pain to the brain.
 
INDICATIONS:
Is indicated for the management of moderate to moderately severe pain in adults.
CONTRAINDICATIONS AND CAUTIONS:
• Use of tramadol is contraindicated in patients who are receiving or who have received
MAOI therapy within the past 14 days. Additive CNS depression, drowsiness, dizziness,
or hypotension may occur. Concomitant use may also increase the risk for serotonin
syndrome.

ADVERSE EFFECTS:
• Pruritus, agitation, anxiety, constipation, diarrhea, hallucination, nausea, tremor,
vomiting, and diaphoresis.
• Other side effects include: Insomnia, sweating, dizziness, nausea, vomiting, dry mouth,
fatigue, asthenia, somnolence, confusion, constipation, flushing, headache, vertigo,
tachycardia, palpitations, miosis, insomnia, orthostatic hypotension, seizures, CNS
stimulation e.g. hallucinations.
• Potentially Fatal: Respiratory depression
 
 
NURSING RESPONSIBILITIES:
• Control environment (temperature, lighting) if sweating or CNS effects occur.
• WARNING: Limit use in patients with past or present history of addiction to or
dependence on opioids.
 
 
 
 
 
DOCTOR’S ORDER: Paracetamol 300 mg IV q4
GENERIC NAME: Paracetamol
BRAND NAME: Ifimol IV
CLASSIFICATION: Aniline Analgesics
PREGNANCY CLASSIFICATION: A
 
MECHANISM OF ACTION:
• Paracetamol exhibits analgesic action by peripheral blockage of pain impulse generation.
It produces antipyretics by inhibiting the hypothalamic heat-regulating centre. Its weak
anti-inflammatory activity is related to inhibition of prostaglandin synthesis in the CNS.
 
INDICATIONS:
• For mild to moderate pain and to treat fever.
CONTRAINDICATIONS AND CAUTIONS:
• Hypersensitivity. Severe hepatic impairment or active liver disease (IV).

ADVERSE EFFECTS:
• Significant: Thrombocytopenia, leucopenia, neutropenia, pancytopenia,
methaemoglobinaemia, agranulocytosis, angioedema, pain and burning sensation at
injection site. Rarely hypotension and tachycardia.
• Gastrointestinal disorders: Nausea, vomiting, constipation.
• Nervous system disorders: Headache.
• Psychiatric disorders: Insomnia.
• Skin and subcutaneous tissue disorders: Erythema, flushing, pruritus.
• NURSING RESPONSIBILITIES
• Check that the patient is not taking any other medication containing paracetamol.
• For children who may refuse medicine off a spoon try using a medicine syringe to squirt
liquid slowly into the side of the child’s mouth or use soluble paracetamol mixed with a
drink.
• Some children may be happy to take one paracetamol product but dislike the taste of
another.
• There are no known harmful effects when used during pregnancy.
• Small amounts may pass into breast milk. However, there are no known harmful effects
when used by breastfeeding mothers.
• Alcohol increases the risk of liver damage that can occur if an overdose of paracetamol is
taken. The hazards of paracetamol overdose are greater in persistent heavy drinkers and
in people with alcoholic liver disease.
DOCTOR’S ORDER: Cefuroxime 750 mg IV q8
GENERIC NAME: Cefuroxime
BRAND NAME: Ceftin, Zinacef
CLASSIFICATION: Ceftin
PREGNANCY CLASSIFICATION: B
 
MECHANISM OF ACTION:
• Cephalosporins exert bactericidal activity by interfering with bacterial cell wall synthesis
and inhibiting cross-linking of the peptidoglycan. The cephalosporins are also thought to
play a role in the activation of bactericidal cell autolysins which may contribute to
bacterial cell lysis.
INDICATIONS:
• Susceptible mild to moderate infections including pharyngitis/tonsillitis, acute maxillary
sinusitis, chronic bronchitis, acute otitis media, uncomplicated skin and skin structure,
UTIs, gonorrhea, early Lyme disease. Treatment of the following infections caused by
susceptible organisms: Respiratory tract infections, Skin and skin structure infections,
Bone and joint infections (not cefaclor or cefprozil), Urinary tract infections (not cefprozil).
Meningitis, gynecologic infections, and Lyme disease.
 
CONTRAINDICATIONS AND CAUTIONS:
• Contraindicated in: Hypersensitivity to cephalosporins; Serious hypersensitivity to
penicillins.
• Use Cautiously in: Renal impairment (dose adjustments necessary); History of GI disease,
especially colitis; Geri: Dosage adjustment due to age-related decrease in renal function
may be necessary; may also be at increase risk for bleeding with cefotetan or cefoxitin;
OB: Pregnancy and lactation (have been used safely).
ADVERSE EFFECTS:
• CNS: seizures (high doses)
• GI: Pseudomembranous colitis, diarrhea, cramps, nausea, vomiting
• Derm: rashes, urticaria. Hemat agranulocytosis, bleeding (increase with cefotetan and
cefoxitin), eosinophilia, hemolytic anemia, neutropenia, hrombocytopenia.
• Local: pain at IM site, phlebitis at IV site.
• Misc: allergic reactions including anaphylaxis and serum sickness, superinfection.

NURSING RESPONSIBILITIES:
• Assess patient for signs and symptoms of infection prior to and throughout therapy.
• Before initiating therapy, obtain a history to determine previous use of and reactions to
penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may
still have an allergic response.
• Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema,
wheezing). Discontinue the drug and notify physician or other health care professional
immediately if these symptoms occur. Keep thromepinephrine, an antihistamine, and
resuscitation equipment close by in the event of an anaphylactic reaction.
• Instruct patient to report signs of hypersensitivity.
DOCTOR’S ORDER: Incorporate 2 amp B-Complex
GENERIC NAME: B-Complex
BRAND NAME: Aduvit
CLASSIFICATION: Antianemics, Food supplements
PREGNANCY CLASSIFICATION: C
 
MECHANISM OF ACTION:
• This product is a combination of B vitamins used to treat or prevent vitamin deficiency
due to poor diet, certain illnesses, alcoholism, or during pregnancy. Vitamins are
important building blocks of the body and help keep you in good health. B vitamins
include thiamine, riboflavin, niacin/niacinamide, vitamin B6, vitamin B12, folic acid, and
pantothenic acid.
INDICATIONS:
• Vitamin B complex helps prevent infections and helps support or promote: cell health,
growth of red blood cells, energy levels, good eyesight, healthy brain function, good
digestion, healthy appetite, proper nerve function.
 
CONTRAINDICATIONS AND CAUTIONS:
• The following conditions are contraindicated with this drug. Check with your physician if
you have any of the following:
Conditions:
• A high amount of oxalic acid in urine
• Iron metabolism disorder causing increased iron storage
• Sickle cell anemia
• Anemia from Pyruvate Kinase and G6PD Deficiencies
• An overload of iron in the blood
• A type of blood disorder where the red blood cells burst
• An ulcer from too much stomach acid
• A type of stomach irritation called gastritis
• Ulcerative colitis
• An inflammatory condition of the intestines
• Diverticular Disease
• Excess iron due to repeated blood transfusions
• Decreased blood-clotting from low vitamin K
• Increased risk of bleeding due to clotting disorder
• Allergies:Vitamin B
• Iron Complex
• Iron Analogues
• Ascorbic Acid (Vitamin C)
NURSING RESPONSIBILITIES:
• Obtain a sensitivity test history before administration. An intradermal test dose is
recommended in patients with possible sensitivity.
 
• Protect solution from light, and refrigerate ampules.
• Don’t mix parenteral preparations in same syringe with other drugs.
• Monitor patient for hypokalemia for first 48 hours, as anemia corrects itself. Give
potassium supplement, as needed.
• Stress proper nutritional habits to prevent recurrence of deficiency.
• Warn patient that there may be burning at the injection site.
• Folic Acid Containing Drugs
• Vitamin E Analogues
• Potential Side Effects
• However, taking supplements that contain excessively high and unnecessary quantities of
B-complex vitamins could lead to serious side effects. High doses of supplemental B3
(niacin) may lead to vomiting, high blood sugar levels, skin flushing and even liver damage
 ADVERSE EFFECTS:
• CNS: Drowsiness, insomnia, dizziness, nervousness, confusion, headache.
• GI: Severe diarrhea, ulceration, and bleeding; nausea, vomiting, abdominal cramps, flatus,
constipation, hepatic toxicity.
 NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Subjective: Acute pain r/t: After 1 hour of • Monitor Vital • To obtain GOAL MET:
“Ang sakit po traumatize nursing Signs baseline as evidenced
ng tiyan at tissue as interventions   data for by the pain
balakang ko manifested by the pt. will be   comparison scale reduced
ma’am” as able to attain from 7/10 to
verbalized by facial grimace pain scale of 2/10.
the patient. from 7/10 to • Provide • To aid
2/10 therapeutic alleviation
• Pain scale= environment of pain
7/10
 NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Objective: • Evaluate pain • Pain is subject

• Facial characteristics experience must
Grimace and intensity be described by
• Irritability (scale 0 – 10) the client in order
• Guarding   to plan effective
behaviour treatment
Vital Signs: • Ascertain client’s • Provide baseline
• Temp: knowledge of for interventions
38.2◦C and and teaching,
• BP: 90/60 expectations provides
mmHg about pain opportunity to
• PR: 134 management allay common
bpm fears and
• RR: 25 cpm misconception
 NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

• Observed •  Observations may

nonverbal cues not be congruent
and pain with verbal
behaviors reports

• Position the • To promote

client to where circulation and
he is prevent tissue
comfortable pressure.
 NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

• Instruct patient • Cognitive

of deep behavioral
breathing interventions may
reduce reliance on
pharmacological
therapy and
enhance pt. sense
of control.

• Encourage • To manage or
adequate rest cope with pain
periods  

• Administered • To relieved pain

paracetamol as
prescribed
 NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION
Subjective: • Hyperther • After 30 • Monitor body • For GOAL MET;
“Sobrang mia r/t minutes of temperature monitoring The patient
sakit po ng increase nursing were able to
ulo ko ma’am pyrogens in interventio • Performed • To reduce decrease
tapos and init the body ns, the Tepid Sponge heat loss by temperature
po ng patient will Bath (TSB) evaporation from 38.5◦C to
katawan ko” be able to     37◦C
as verbalized decrease • Promotes • To reduce
by the temperatur surface cooling body
patient. e from by means of temperature
  38.5◦C undressing by means of
Objective: within 36.5- conduction
• Skin warm 37◦C
to touch
 
 NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Vital Signs: • Encourage • To prevent

• Temp: adequate fluid dehydration
38.2◦C intake  
• BP: 90/60
mmHg • Encourage to • To reduce
• PR: 134 maintain bed metabolic
bpm rest demands and
• RR: 25 cpm   oxygen
  consumption
• Provide cool • To promote
environment heat loss by
convection
• Administer • To treat fever
medication as
prescribed
 NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION
Subjective: Discharge After 1 hour of • Take all • Not GOAL
planning teaching and medicine you finishing PARTIALLY
“Hilig kong related to giving were prescribe, the MET: as
kumain ng mga patient with knowledge, even if you feel medicine evidenced by
junkfoods, at acute the patient better can make improving
softdrinks lalo pyelonephritis will be able to the good
na kapag ako’y attain and infection elimination
nasa school.” as improve good come back pattern
verbalized by elimination • Drink 8 to 10 • Clear fluids
pattern glasses of fluid such as
the patient. everyday water are
Objective: best
• Keep your • For proper
Vital Signs: genital area hygiene
clean. Used
 Temp: 38.2◦C mild soap.
  Rinse water
 NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION
• Urinate • Do not full
• BP: 90/60 frequently your
mmHg bladder
• PR: 134 bpm • Always urinate • To avoid
• RR: 25 cpm after sexual infection
intercourse