INDEPENDENT SUBJECTIVE: Acute pain Pyelonephritis is ♦ After 8 hours ♦ Assess pain, noting ♦ Helps evaluate ♦ After 8 hours related to acute an inflammation of nursing location, degree of of nursing “Tatlong araw ng inflammation of of the kidney and interventions, characteristics, discomfort and interventions, masakit ang pg- renal tissues. upper urinary the patient intensity (0-10 may reveal the patient ihi ko” (I have had tract that usually will verbalize scale). developing was able to painful urination for results from relief or complications. verbalize the past 3 days) as noncontagious control of relief or verbalized by the bacterial infection pain. ♦ Note urine flow and ♦ Decreased flow control of patient. of the bladder characteristics. may reflect pain. (cystitis). It urinary retention OBJECTIVE: presents with with increased dysuria (painful pressure in ♦ Guarding/ voiding of urine), upper urinary distracting abdominal pain tract. behaviors. (radiating to the ♦ Self focusing. back on the ♦ Encourage patient ♦ Reduction of ♦ V/S taken as affected side) and to verbalize anxiety or fear follows: tenderness of the concerns. Active that can promote bladder area and listen these relaxation and T: 37.6 the side of the concerns and comfort. P: 90 involved kidney provide support by R: 19 ("renal angle acceptance, BP: 120/80 tenderness"). In remaining with many cases there patient and giving are systemic appropriate symptoms in the information. form of fever, rigors (violent ♦ Provide comfort ♦ Reduces muscle shivering while measure like back tension, the temperature rub or deep promotes rises), headache breathing exercises. relaxation, and and may enhance coping abilities.
♦ Assist with range of ♦ Reduces muscle
motion exercises or joint stiffness. and encourage Ambulation ambulation. returns organs to normal position and promotes feeling of well being.
♦ Investigate and ♦ Requiring prompt
report abdominal medical muscle rigidity, intervention. involuntary guarding and rebound tenderness.
COLLABORATIVE:
♦ Administer ♦ Relieves pain,
medications as enhances indicated e.g comfort and analgesics and promotes rest. antibiotics.