Nursing Diagnosis for Pyelonephritis : Impaired Urinary Elimination


Pyelonephritis is an ascending urinary tract infection that has reached the pyelum or pelvis of the kidney. It is a form of nephritis that is also referred to as pyelitis.

Pyelonephritis is a potentially serious kidney infection that can spread to the blood, causing severe illness. Fortunately, pyelonephritis is almost always curable with antibiotics.

Pyelonephritis presents with fever, accelerated heart rate, painful urination, abdominal pain radiating to the back, nausea, and tenderness at the costovertebral angle on the affected side.

Most cases of pyelonephritis are complications of common bladder infections. Bacteria enter the body from the skin around the urethra. They then travel up the urethra to the bladder.

Pyelonephritis may start with similar symptoms. However, once the infection has spread to the kidney, signs of more severe illness usually result:
  • Back pain or flank pain
  • Fever (usually present) and/or chills
  • Feeling sick (malaise)
  • Nausea and vomiting
  • Confusion (especially in the elderly)

Pyelonephritis may cause noticeable changes in the urine, such as:
  • Blood in the urine (hematuria)
  • Cloudy or foul-smelling urine
  • Pain when urinating
  • Increased frequency or urgency of urination

Nursing Diagnosis for Pyelonephritis : Impaired Urinary Elimination (dysuria, urge, frequency, and or nocturia) related to a kidney infection.

Goal : elimination pattern either

Expected Outcome : The pattern of elimination clients improved, there was no sign of urinary disorders (urgency, oliguric, dysuria)

Nursing Interventions and Rationale:

1. Measure and record the voiding of urine each time.
R /: To investigate the change of color, and to determine the input / output.

2. Advise to urinate every 2-3 hours.
R /: To prevent the buildup of urine in the urinary vesicles.

3. Palpation of the bladder every 4 hours.
R /: To determine the presence of bladder distension.

4. Help clients use bedpans / urinals.
R /: To facilitate clients in urination.

5. Help clients get a comfortable position to urinate.
R /: So that the client is not difficult to urinate.

6. Encourage increased fluid intake.
R /: Increased hydration rinse bacteria.

7. Observations of changes in mental status:, behavior or level of consciousness.
R /: Accumulated residual uremic and electrolyte imbalance can be toxic to the central nervous system.

Collaboration:

1. Perform laboratory tests; electrolytes, BUN, creatinine.
R /: Monitoring of renal dysfunction.

2. Take action to maintain acidic urine.
R /: Acid urine hinder the growth of germs.

3. Increase input berry juice and give medications to increase uric acid.
R /: Increased input juice can affect the treatment of urinary tract infections.

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Ineffective Tissue Perfusion related to Meningitis

Meningitis is a disease caused by the inflammation of the protective membranes covering the brain and spinal cord known as the meninges. The inflammation is usually caused by an infection of the fluid surrounding the brain and spinal cord.

Anyone can get meningitis, but it is more common in people whose bodies have trouble fighting infections. Meningitis can progress rapidly. You should seek medical care quickly if you have
  • A sudden fever
  • A severe headache
  • A stiff neck

Meningitis can produce mild symptoms — such as headache, low-grade fever and tiredness lasting two to three days — in some patients. In other patients, the symptoms can be severe and begin suddenly with fever, headache and stiff neck accompanied by some combination of other symptoms: decreased appetite, nausea, vomiting, sensitivity to bright light, confusion and sleepiness.

In newborns and infants, the classic findings of fever, headache and stiff neck may or may not be present. An infant may have no other symptoms than being listless, irritable and sleepy, having little interest in feeding and possibly vomiting. A purplish red rash may appear with meningococcal meningitis.

Nursing Diagnosis for Meningitis : Ineffective Tissue Perfusion related to Increased Intracranial Pressure

Goal:
  • The patient returned to the state of the neurological status before the illness.
  • Increased patient awareness and sensory function.

Expected outcomes
  • Vital signs are within normal limits
  • Reduced head pain
  • The increased awareness
  • An increase in cognitive or loss and no signs of increased intracranial pressure.

Intervention and Rational:

1. Patients total bed rest with supine sleeping position without a pillow.
R /: Changes in intracranial pressure can cause the risk of going to the occurrence of brain herniation.

2. Monitor signs of neurological status with the GCS.
R /: to reduce further brain damage.

3. Monitor vital signs such as blood pressure, pulse, temperature, and caution in systolic hypertension.
R \ /: In normal autoregulation to maintain a state of altered systemic blood pressure fluctuations. Autoreguler failure will cause cerebral vascular damage that can be manifested by an increase in systolic and diastolic pressure followed by a decrease. While the increase in temperature can describe the course of infection.

4. Monitor intake and output.
R /: Hyperthermia can lead to increased IWL and increase the risk of dehydration, especially in patients who are not aware, a decrease nausea peroral intake.

5. Help patients to limit vomiting, coughing. Instruct the patient to exhale when moving or turning in bed.
R /: This activity can increase intracranial pressure and intra-abdominal. Exhale while moving or changing positions can protect themselves from the effects of Valsalva.

Collaboration:

1. Give fluids per infusion with strict attention.
R /: Minimize the burden of vascular and fluctuations in intracranial pressure, fluid and fluid vetriksi can reduce cerebral edema.

2. Monitor AGD when needed oxygen delivery.
R /: The possibility of acidosis accompanied by the release of oxygen at the cellular level may lead to ischemic cerebral.

3. Provide appropriate therapy doctors advice.

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Acute Pain related to Menstrual Disorders (Dysmenorrhea)

A menstrual disorder is an irregular condition in a woman's menstrual cycle. There are a number of different menstrual disorders. Problems can range from heavy, painful periods to no period at all. There are many variations in menstrual patterns, but in general women should be concerned when periods come fewer than 21 days or more than 3 months apart, or if they last more than 10 days.

Dysmenorrhea is severe, frequent cramping during menstruation. Pain occurs in the lower abdomen but can spread to the lower back and thighs.

There are two types of dysmenorrhea: "primary" and "secondary".


Nursing Diagnosis and Interventions Menstrual Disorders (Dysmenorrhea) :

Acute Pain

Goal: reduced patient pain

Expected outcomes:
  • Pain is reduced / can be adapted,
  • Can identify activities that increase / decrease pain,
  • Low pain scale.

Interventions and Rationale:

1. Explain and help clients with pain relief measures, nonpharmacological and non-invasive.
R /: Approach using relaxation and other nonpharmacological has demonstrated effectiveness in reducing pain.

2. Teach the use of warm compresses.
R /: Relieves abdominal cramps. Heat works by the increasing vasodilation and muscle relaxation, while decreasing iskemic uterus.

3. Teach Relaxation: Techniques to reduce skeletal muscle tension, which can reduce pain intensity and improve relaxation massage.
R /: Will the blood circulation, so that the oxygen demand will be met by the tissue, which will reduce the pain.

4. Teach methods of distraction for acute pain.
R /: Divert attention pain to the things that make happy.

5. Do massage the lower back.
R /: Reduce pain with vertebral muscle relaxation and increased blood supply. Many women are adapting something positive with yoga, biofeedback, meditation, and relaxation therapy.

6. Give chance a break when it feels pain and provide a comfortable position; eg bedtime, mounted behind a small pillow.
R /: Rest will relax, thereby increasing comfort.

7. Encourage lowering sodium input during the week before menstruation.
R /: Reduce the risk of fluid retention.

8. Increase knowledge of: the causes of pain, and connect how long pain will last.
R /: Knowledge that will help reduce the pain felt. And can help develop client adherence to treatment plans.

9. Observations over the level of pain, and motor response client, 30 minutes after drug administration to assess the analgesic effectiveness. And every 1-2 hours after the maintenance action for 1-2 days.
R /: Assessment of optimal, will provide objective data to prevent possible complications and appropriate interventions.

10. Collaboration with physicians, providing analgesic.
R /: Analgesic block the path of pain, so the pain will be reduced.

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Nursing Intervention of Malaria

Malaria is caused by a type of parasite known as Plasmodium. This is a microscopic parasite that is transmitted by certain species of mosquitoes. Although there are numerous types of Plasmodia parasites, only four cause malaria in humans. These include:
  • Plasmodium falciparum
  • Plasmodium vivax
  • Plasmodium ovale
  • Plasmodium malariae

Features of malaria include high fever over 38C (100.4F) along with chills and sweating. There is intense muscle pain, headache, blurring of vision and dizziness. Some patients may develop diarrhea and vomiting as well. Symptoms develop within seven days after being bitten or may take between 10 to 15 days to appear.

Malaria can sometimes become complicated. Some of the complications include:
  • severe anaemia
  • cerebral malaria
  • malaria during pregnancy
  • spleen rupture
  • acidosis
  • kidney damage
  • multi-organ failure etc.

Nursing Care Plan for Malaria


Nursing Diagnosis 1.

Hyperthermia related to the development of malaria parasites in red blood cells.

Nursing Intervention:

1. · Assess any complaints or signs of increased body temperature changes.
R /: Increased body temperature will exhibit a variety of symptoms such as red eyes and the body feels warm.

2. Observation of vital signs, especially body temperature as indicated.
R /: To determine interventions.

3. Warm water compress on the forehead and both axilla.
R /: stimulates the hypothalamus to the center of the temperature setting.

4. Collaboration of antipyretic drugs.
R /: Controlling fever.


Nursing Diagnosis 2.

Risk for Fluid Volume Deficit related to hyperthermia

Nursing Interventions:

1. Supervise the input and output of fluids. Estimate loss of fluid through sweat.
R /: Provides information about the fluid balance, are guidelines for fluid replacement.

2. Observations of decreased skin turgor.
R /: Indicates excessive fluid loss / dehydration.

3. Give parenteral fluids if needed.
R /: Helping peroral fluid intake.


Nursing Diagnosis 3.

Imbalanced Nutrition, Less Than Body Requirements related to anorexia

Nursing Interventions:

1. Encourage bed rest / or activity restrictions.
R /: Maintaining sufficient energy savings.

2. Provide oral hygiene.
R /: a clean mouth can enhance the flavor of food.

3. Provide food in a well ventilated, pleasant environment, the situation is not in a hurry, accompany.
R /: Pleasant surroundings lower stress and more conducive to eating.

4. Collaboration of antiemetic drugs.
R /: Eliminate the symptoms of nausea and vomiting.


Nursing Diagnosis 4

Knowledge Deficit: about disease

Nursing Interventions:

1. Determine the patient's perception of the disease process.
R /: Creating a knowledge base and provide awareness of individual learning needs.

2. Review the disease process, the cause / effect relationship factors that cause symptoms and identify ways to lose factors. Encourage questions.
R /: Trigger factors / ballast individuals, so the patient needs to be aware of lifestyle factors may trigger symptoms. Accurate knowledge base gives patients the opportunity to make an informed decision / choice about the future and control of chronic diseases. Although many patients know about the disease itself, they can experience that has been left behind or wrong concept.

3. The review: medicine, destination, frequency, dosage, and possible side effects.
R /: Improving understanding and to increase cooperation in the program.

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Nursing Diagnosis for Pulmonary Edema

Pulmonary edema is fluid accumulation in the lungs, which collects in air sacs. Pulmonary edema is an abnormal buildup of fluid in the air sacs of the lungs, which leads to shortness of breath. It leads to impaired gas exchange and may cause respiratory failure. It is due to either failure of the left ventricle of the heart to adequately remove blood from the pulmonary circulation ("cardiogenic pulmonary edema"), or an injury to the lung parenchyma or vasculature of the lung ("noncardiogenic pulmonary edema").

Treatment usually focuses on improving respiratory function and dealing with the source of the problem. It generally includes supplemental oxygen and medications. Acute pulmonary edema - the type that occurs suddenly - if a medical emergency. If treatment is prompt and adequate, pulmonary edema is rarely fatal.

Pulmonary edema may be caused either by direct damage to tissue, or a result of a heart or circulatory system malfunction. If pulmonary blood pressure is above 15 mmHg, pulmonary edema may occur.

Non-cardiogenic (not originating in the heart) causes of pulmonary edema:
  • Acute respiratory distress syndrome
  • Aspirin overdose
  • High altitude
  • Intracranial hemorrhage
  • Kidney failure
  • Methadone/heroin overdose
  • Pleural effusion - too much liquid around the lung is removed, causing it to expand too quickly
  • Pulmonary embolism
  • Severe seizures

Cardiogenic (originating in the heart) causes of pulmonary edema:
  • Congestive heart failure
  • Fluid overload, such as from kidney failure or intravenous therapy
  • Hypertensive crisis
  • Pericardial effusion with tamponade
  • Severe arrhythmias (tachycardia/fast heartbeat or bradycardia/slow heartbeat)
  • Severe heart attack with left ventricular failure

Symptoms of pulmonary edema may include:
  • Coughing up blood or bloody froth
  • Difficulty breathing when lying down (orthopnea) -- you may notice the need to sleep with your head propped up or use extra pillows
  • Feeling of "air hunger" or "drowning" (if this feeling wakes you from sleep and causes you to sit up and try to catch your breath, it's called "paroxysmal nocturnal dyspnea")
  • Grunting, gurgling, or wheezing sounds with breathing
  • Inability to speak in full sentences because of shortness of breath

Other symptoms may include:
  • Anxiety or restlessness
  • Decrease in level of alertness (consciousness)
  • Leg swelling
  • Pale skin
  • Sweating (excessive)

Nursing Diagnosis for Pulmonary Edema

1. Ineffective breathing pattern

related to: fatigue and breathing aids installation.

2. Impaired gas exchange

related to: distention of pulmonary capillaries.

3. Risk for infection

related to: the invasion of microorganisms area secondary to endotracheal tube installation.

4. Ineffective tissue perfusion

related to: decreased cardiac muscle contractility.

5. Risk for Injury / trauma

related to: anxiety secondary to the installation of breathing aids.

6. Anxiety

related to: the threat of biological integrity secondary to the actual installation of breathing aids.

7. Impaired verbal communication

related to: installation of endotracheal tube.

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