Professional Documents
Culture Documents
General Objectives
At the end of my duty in GABMMC, I, Lyndon L. Santos 3rd year Bachelor of Science in
Nursing student of San Beda College, Mendiola, will be to impart my knowledge and skills
towards the patient, through promoting and maintaining, physiologic and psychologic stability,
Specific Objectives
• To gain new information about the patient’s disease and its etiology, pathophysiology,
clinical manifestations as well as the standard medical and nursing management so that
we may apply this newly acquired to our patient as well as similar situations in the future.
• To learn new clinical skills as well as sharpen our current clinical skills required in the
• To develop our sense of unselfish love and empathy in rendering nursing care to our
patient so that we may be able to serve future clients with a higher level of holistic
• Formulate an effective nursing care plan for the client regarding UTI.
• Acquire necessary skills in assessing the signs and symptoms of patient with UTI.
• Educate the family in the prevention, promotion, and maintenance of healthy lifestyle as
A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary tract.
The main cause agent is Escherichia coli. Although urine contains a variety of fluids, salts, and
waste products, it does not usually have bacteria in it. When bacteria get into the bladder or
The most common type of UTI is acute cystitis often referred to as a bladder infection. An
infection of the upper urinary tract or kidney is known as pyelonephritis, and is potentially more
serious. Although they cause discomfort, urinary tract infections can usually be easily treated
with a short course of antibiotics. Symptoms include frequent feeling and/or need to urinate, pain
Risk Factors
Gender
Women are more prone to UTIs than men because in females, the urethra is much shorter
and closer to the anus than in males, and they lack the bacteriostatic properties of
prostatic secretions. Among the elderly, UTI frequency is roughly equal proportions in
women and men. This is due, in part, to an enlarged prostate in older men. An enlarged
prostate means the gland has grown bigger. Prostate enlargement happens to almost all
men as they get older. As the gland grows, it can press on the urethra and cause urination
and bladder problems. As the gland grows, it obstructs the urethra, leading to increased
difficulty in micturition. Because there is less urine flushing the urethra, there is a higher
In young sexually active women sex is the cause of 75—90 % of bladder infections, with
the risk of infection related to the frequency of sex. The term "honeymoon cystitis" has
been applied to this phenomenon of frequent UTIs during early marriage. In post
menopausal women sexual activity does not affect the risk of developing a UTI.
Urinary catheters
catherterization rather than an indwelling catherter may decrease these associated risks.
Genetics
Others
Other risk factors include diabetics sickle-cell disease or anatomical malformations of the
While ascending infections are generally the rule for lower urinary tract infections and
cystitis, the same is not necessarily true for upper urinary tract infections like
Recurrent Infections
Many women suffer from frequent UTIs. Nearly 20 percent of women who have a UTI
will have another and 30 percent of those will have yet another. Of the last group, 80
the infection before it, indicating a separate infection. Even when several UTIs in a row
are due to E. coli, slight differences in the bacteria indicate distinct infections.
Research funded by the National Institutes of Health (NIH) suggests that one factor
behind recurrent UTIs may be the ability of bacteria to attach to cells lining the urinary
tract. A recent NIH-funded study found that bacteria formed a protective film on the
inner lining of the bladder in mice. If a similar process can be demonstrated in humans,
the discovery may lead to new treatments to prevent recurrent UTIs. Another line of
research has indicated that women who are "non-secretors" of certain blood group
antigens may be more prone to recurrent UTIs because the cells lining the vagina and
urethra may allow bacteria to attach more easily. Further research will show whether this
association is sound and proves useful in identifying women at high risk for UTIs.
Infections in Pregnancy
Pregnant women seem no more prone to UTIs than other women. However, when a UTI
does occur in a pregnant woman, it is more likely to travel to the kidneys. According to
Scientists think that hormonal changes and shifts in the position of the urinary tract
during pregnancy make it easier for bacteria to travel up the ureters to the kidneys. For
this reason, many doctors recommend periodic testing of urine during pregnancy.
Epidemiology
Mortality/Morbidity
• The mortality associated with acute uncomplicated cystitis among women aged 20-60
higher mortality among women with a history of UTI compared with age-matched
women without this history (37% versus 28% in 10 y, P <0.001).1 These cohorts were not
matched for other mortality-related factors, making it difficult to attribute the increased
mortality to UTIs.
tremendous. Each episode of UTI in a young woman results in an average of 6.1 days of
symptoms, 1.2 days of decreased class/work attendance, and 0.4 days in bed.
• Groups at risk for UTIs associated with calculi include those with dysfunctional voiding,
I chose this case study out of curiosity as it was my first time to encounter such case and because
of that, I was interested in it. I was willing to undergo new experiences which would bring new
learnings for me. Another reason was that it was one of the suggestions of our clinical instructor
Birthplace: Cavite
Status: Single
Nationality: Filipino
Patient X works in a casino. She earns roughly up to 10,000-20,000 pesos every month.
But since she was diagnosed with UTI, she works less and naturally earns less.
• Place of residence:
• Cultural/Ethnicity:
Environmental Factor
No data
o Patient X has no previous confinement. This was the first time the patient was
confined.
she also experienced suprapubic pain and discomfort. She also reported that she
frequently feel urinated and experiencing pain in urination. She also noticed an unusual
She took paracetamol to relive her fever and pain. After a week of taking medications she
decided to consult the doctor because she still experienced fever and pain. She then was
Sibling Sibling 6
1 Sibling Patien
tX Sibling Sibling 7 Sibling 8
2
4
Sibling 5
Legend:
Female – Alcoholic -
Male – Hypertensive-
Diabetic - Asthma -
Smoker - Deceased -
UTI -
Gordon’s Health Pattern of Functioning
Health Perception and Management
Before: During/After:
• Health is given a high priority; • Patient’s hemoglobin, hematocrit count
• If possible, patient visits the doctor for is below normal; causing the patient to
check-up if experiencing illnesses. be weak and pale
• Usual illnesses: cough, colds, • The patient’s V/S is monitored every 2
fever(seldom) hrs.
• Treatment/management: paracetamol • Patient’s intake and output is being
for fever; takes vitamins measured accurately
• The patient is being checked by the
physician during rounds
• The patient responds well and
cooperates with interventions
Analysis: Patient X cannot function normally like before because of her
confinement and her hospital condition.
Interpretation: UTI refers to the infection of the urinary tract of a person. Due to this infection.
The patient experiences pain which inhibits her to move normally.
Nutritional/Metabolic Pattern
Before: During/After: 3 meal/3 day recall
• Likes to eat fried chicken, porkchop,Day 1: Breakfast-Sandwich Lunch-rice,
sinigang dinner-vegetables
hotdogs, sinigang(these are the typical
meal/seldomely eats vegetables) Day2: Breakfast-Soup Lunch- Chopsuey
• Eats mostly at home; sometimes clientDinner- nilaga and banana
eats at fast foods when at work Day3: hotcake/champorado Lunch- sandwich
dinner-Tinola
Analysis: Patient X’s nutritional and metabolic status has been changed due to
her confinement and her medical health condition. Her preconfinement
status is totally affected.
Analysis: Patient X’s bowel and urination pattern is altered; her bowel comes irregularly. She is
also required to increase her oral fluid intake which results to much more frequent urination.
Interpretation:
Sleep/Rest Pattern
Before: During/After:
• Hrs. of sleep- 6-7 hours • Patient X complains difficulty in
• Client has no sleeping habits; does not sleeping
take afternoon naps • The patient usually is able to sleep for a
• Texting and watching TV is his/her short period of time
form of relaxation • The patient doesn’t feel rested from
time to time
Analysis: Patient X is not used to the hospital environment. She is not used to the hot
temperature of her room which makes it difficult for her to sleep.
Interpretation: the patient is having a hard to rest and sleep because of the environment.
Self-Perception and Cognitive Pattern
Before: During/After:
• Professional at work • The patient experiences on and off
• Has a strong personality fever
• Gives self high respect and confidence • Patient X feels a little scared and
disappointed about her recurrent fever
• She fears that she might have a longer
confinement
Analysis: Because of her present health status, her self concept had changed. She is very
disappointed that she isn’t able to work and not able to contribute to the family’s needs.
Interpretation: “Events or situations may change the level of self concept over time. Illness and
trauma can also affect self concept.” (Fundamentals of Nursing 7th edition by Barbara Kozier
p.959 & 962)
Cognitive Perception
Before: sensory During/After:
Analysis:
Interpretation:
Before: During/After:
Analysis:
Interpretation:
Physical Assessment
AREA TECHNIQUE NORMAL ACTUAL ANALYSIS
FINDINGS FINDINGS
• Observe the
client’s posture
and gait, Observation Relaxed, erect Relaxed; Normal
standing, posture; erect/proper
sitting, and coordinated posture; walks
walking. movement without any
difficulty
• Observe the
over all
hygiene and
grooming. Observation Clean, neat Clean, hygiene- normal
Relate these to conscious
the person’s
activities prior
to the
assessment.
• Note for color Inspection Varies from light Skin is pale- Hemoglobin count
and uniformity to deep brown; looking; generally is low
Best assessed from ruddy pink to uniform
under natural light light; from yellow
and on areas not over tones to olive.
exposed to sun. Generally uniform
expect in areas
exposed to sun;
area of lither
pigmentation
(palm, lips, nail
beds in dark
skinned people)
No edema
No edema
• Assess presence
Normal
of edema
Moisture in the
• Assess skin skin folds and in Normal
moisture. Inspection/ the axillae, perspiration Normal
• Note skin Palpation freckles, some
lesions birthmarks, some No lesions
according to flat and raised nevi Normal
location, (moles); no
distribution, abrasion or any
color, other lesion.
configuration,
size, shape,
type or
structure Uniform, within
normal range.
Fine. fine
• Palpate for Palpation
texture. Normal
NAILS
Intact epidermis
Intact epidermis Normal
• Note tissue Prompt return of
surrounding pink or usual Prompt return of normal
nails. color. (Generally pinkish color; 1-2
• Perform less than four secs
blanch test of seconds.)
capillary refill.
BODY PART TO TECHNIQUE NORMAL ACTUAL ANALYSIS
BE ASSESSED FINDINGS FINDINGS
Skull
Size and symmetry INSPECTION Normocephalic, Symmetrical Normal symmetry
and shape symmetrical
Hearing Acuity
Inspect the nasal Inspection Nasal septum intact Nasal septum normal
septum between and aligned in the intact; aligned in
the nasal chambers midline the midline
Bone and cartilage Palpation There should be no none
displacements,
masses and
tenderness
Palpate the Inspection and There should be no none
maxillary and Palpation inflammation and
frontal sinuses for tenderness
tenderness
Mouth and Oropharynx
Inspect the outer Inspection Uniform pink color Soft, pinkish in normal
lips for symmetry Soft, moist, smooth color, dry texture,
of contour, color texture symmetry has the ability to
and texture of contour, ability purse lips
to purse lips
Location: Should
occupy only one
interspace, the 4th
or 5th, and be at
or medial to the
midclavicular;
Size:Normally
1cm x 2cm;
Amplitude:
Normally a short,
gentle tap;
Duration: short,
normally
occupies only 1st
half of systole.
No lift or heave
Auscultate the Heart in all
four anatomic sites: aortic, Aortic pulsation
pulmonic, tricuspid, and
apical (mitral). Auscultation S1: usually at all S1 heard heard at Normal
sites all sites
Usually louder at
apical area S2 heard at all
S2: usually heard sites normal
at all sites
Usually louder at
case of heart
Systole: silent
interval; slightly
shorter duration
than diastole at
normal heart rate
(60-90 beats per
minute)
Diastole: silent
interval; slightly
longer duration
than systole at
normal heart
rates.
S3 in children
and young adults
S4 in many older
adults
Assess the peripheral legs Inspection Limbs not tender. Limbs are not normal
veins for signs of phlebitis Symmetric in tender
size. symmetric
Inspect the skin of the Inspection Skin color pink. Skin is pinkish in normal
hands and feet for color, color; temp is
temperature, edema, and within normal
skin changes. range; no edema
Assess the adequacy of Inspection Buerger’s test:
arterial flow if arterial original color
insufficiency is suspected. returns in 10
secs.; veins in
feet or hands fill
in about 15 secs. 1-2 secs capillary normal
Capillary refill refill
test: immediate
return of color.
Palpate the liver to detect Palpation May not be Slightly palpable normal
enlargement and palpable.
tenderness. Border feels
smooth
Palpate the ares above the Palpation Distended and None palpable normal
pubic symphisis if the palpable as
clients history indicates smooth, round,
possible urinary retention. tense mass
(indicates urinary
retention)
BODY PART TO BE TECHNIQUE NORMAL ACTUAL ANALYSIS
ASSESSED FINDINGS FINDINGS
Muscles:
Inspect the muscles for Inspection Equal size on Equal on both Normal
size and compare both both sides of the sides
sides body
Equal strength on
each body side
Inspection Right muscle is Normal
stronger
Bones:
1.)Shoulder movement
Inspection The client lifts Able to lift Normal
Stand facing your patient. shoulder despite shoulder
Place your hands on his or your downward
her shoulders. Ask him or pressure.
her to lift his or her
shoulders as you apply
moderate downward
pressure.
Tongue Movement
1.) Reflexes
a.) Biceps
reflex
Present
Inspection Presence of Normal
normal slight
flexion of the
elbow, and
biceps
contraction
b.) triceps reflex
Inspection Present
c.) Patellar reflexes Presence of Normal
normal slight
extension of the
elbow.
Inspection Present
Presence of Normal
d.) Achilles reflex normal
extension or
kicking out of
the leg as the
quadriceps
Inspection muscle
contracts.
e.) Plantar Reflex Present
Presence of Normal
normal plantar
flexion
Inspection (downward jerk)
of the foot)
2.) Motor function Negative Babinski
All five toes Normal
a.) Walking gait bend downward
– normal
negative
babinski reflex
Inspection
Can alternately
d) Fingers to supinate and
fingers Inspection pronate hands at Normal
rapid pace.
Moves smoothly
13.) Pain sensation
The client
Inspection demonstrates
bilateral equal Normal
coordination
14.)Temperature sensation Light touch
sensation
Inspection Moves
smoothly, with
coordination Able to determine Normal
15.)Position of Kinesthetic
sensation Inspection
Light tickling or Able to determine Normal
touch sensation
16.) Tactile discrimination
For all tests, the client’s
eyes needs to be closed. Inspection The client is
able to Normal
a.) Stereo gnosis(Ability discriminate
to recognize objects “sharp” and
“dull”
by touching them)
sensations
The client is
b.)Extinction Inspection able to
Phenomenon discriminate Normal
between “hot”
and “cold”
sensations
Readily
determines
Can readily
determine the
position of the
fingers and toes.
Inspection
Able to recognize Normal
The client
recognize
Inspection common objects Both points felt
normal
Both points of
stimulus are felt
White blood White blood cell count or leukocyte count 4.6-10.0 Increased An elevated number of white
cell count is the number of white blood cells in the 11.6 /L blood cells (leukocytosis) can
blood. The doctor will usually measure /L result from bacterial infections,
WBC as part of the CBC, or complete inflammation, leukemia, trauma,
blood count. White blood cells are the or stress.
infection-fighting cells in the blood, and
are distinct from the red oxygen-carrying
blood cells, known as erythrocytes. All the
types of white blood cells are reflected in
the white blood cell count. A low white
blood cell count is termed leucopenia, and
a high white blood cell count is termed
leukocytosis.
Eosinophils An absolute eosinophil count is a blood No data 0-0.05 --- ---
test that measures the number of white
blood cells called eosinophils. Eosinophils
become active when you have certain
allergic diseases, infections, and other
medical conditions.
This test is done if the results of another
blood test, called a blood differential, are
abnormal. This test may also be done if the
doctor thinks you may have a specific
disease.
Lymphocytes Lymphocytes are responsible for immune 0.23 0.20-0.40 Normal
responses. There are two main types of
lymphocytes: B cells and T cells. The B
cells make antibodies that attack bacteria
and toxins while the T cells attack body
cells themselves when they have been
taken over by viruses or have become
cancerous. Lymphocytes secrete products
(lymphokines) that modulate the functional
activities of many other types of cells and
are often present at sites of chronic
inflammation.
Neutrophils 0.02 0-0.05 Normal
band
Monocytes White blood cells are evaluated by a Decreased A low number of monocytes in
differential count, which reports 0.01 /L 4.6-10 the blood (monocytopenia) can
percentages of the types of WBCs present. /L occur in response to the release
These are neutrophils which fight infection of toxins into the blood by
(also known as polys and bands, certain types of bacteria
polymorphonuclear leukocytes, PMN’s, (endotoxemia), as well as in
grans, segs and nonsegs), lymphocytes people receiving chemotherapy
which produce antibodies and other or corticosteroids. Low
immune system activities (lymphs, ly), monocyte count means that you
monocytes which also fight infection are more susceptible to infections
(mono’s), eosinophils (eos) and basophils since you don't have enough anti
(basos) which are involved with allergies. bodies that will defend you from
The red cells are also evaluated for size, viruses, bacteria and other
shape, color and the presence of any unwelcome organisms.
Segmenter abnormalities 0.74 0.60-0.70 Increased
Potassium Serum or plasma tests for potassium levels 3.18 mmol/L 3.4-4.0 Normal
are routinely performed in most patients mmol/L
when they are investigated for any type of
serious illness. Also, because potassium is
so important to heart function, it is usually
ordered (along with other electrolytes)
during all complete routine evaluations,
especially in those who take diuretics or
blood pressure or heart medications.
Potassium is ordered when a doctor is
diagnosing and evaluating high blood
pressure (hypertension) and kidney disease
and when monitoring a patient receiving
dialysis, diuretic therapy, or intravenous
therapy
Chloride Blood chloride testing is often ordered, No data 98-106
along with other electrolytes, as part of a mmol/L
regular physical to screen for a variety of
conditions. These tests may also be ordered
to help diagnose the cause of signs and
symptoms such as prolonged vomiting,
diarrhea, weakness, and respiratory
distress. If an electrolyte imbalance is
detected, the doctor will look for and
address the disease, condition, or
medication causing the imbalance and may
order electrolyte testing at regular intervals
to monitor the effectiveness of treatment. If
an acid-base imbalance is suspected, the
doctor may also order blood gas tests to
further evaluate the severity and cause of
the imbalance.
Calcium Blood calcium is tested to screen for, No data 2.15-2.57
diagnose, and monitor a range of mmol/L
conditions relating to the bones, heart,
nerves, kidneys, and teeth. Blood calcium
levels do not directly tell how much
calcium is in the bones, but rather, how
much calcium is circulating in the blood.
4/26/10
• started at 4pm
4/27/10
• The patient’s IV fluid is shifted to D5LR 1 liter (bottle #1) started at 5am
• During the 2-10 shift, the patient’s IVF of D5LR 1L is at 600cc level
4/28/10
4/29/10
• The patient’s IV fluid is shifted to D5NM 1 liter, bottle #3; to run for 8° reg. @ 30-31
gtts/min
• Started @ 10:45am
• Started @ 10pm
4/30/10
• Started @ 6am
Medications Taken:
• Ranitidine 50 mg IV q8°
STAT Medications:
• NONE
PRN Medications:
• Paracetamol
Diet:
>S/E by Dr. Abioq with orders made and >with IVF D5LR 1L @ 900mL level on
carried out left hand
>ambulatory
4/27/10 2-10 >on DAT
>received back from DR accompanied by >with good capillary refill as evidenced by
DR NOD 1-2 secs. Refill
>seen by OB with orders made
>with good skin turgir as evidenced by 1-2 >monitor v/s every 2 hours
secs. Return
>monitor I/O
>with pain on neck
>Encouraged divertional activities
>no pain upon urination
>provide quiet and relaxed environment
>light yellow urine color
>Health teachings done
>supportive care done
>morning care done
>seen @ intervals
>follow-up cross-matching
>after the shift, showed signs comfort and relaxation; responding well and attentively
>endorsed to the next duty nurse with IV fluid of D5NM 1L regulated @ 30-31 drops/min; @
550 cc level
Doctor’s Order
4/27/10
>defer FeSO4
>Ranitidine 50 mg q8°
4/29/10
Nursing Responsibilities
• One of the most important nursing roles involved in the urinary system is keeping I & O,
• The fluid intake and output must be accurately measured for all patients with any urinary
related issues. Unless a patient is on fluid restrictions they should be offered fluids
frequently and have them fresh and readily available at their bedside. Fluids should
include a variety of juices, tea, soups and most of all water. Adequate hydration keeps the
urinary system clean and prevents urine from becoming concentrated. The fluid intake
should be no less than 2500 cc every day. Unless fluids are being lost through excessive
intake was 2500cc). There is always loss with breathing and normal body function. If the
patient is dehydrated and not receiving enough fluids these body functions cannot be
performed correctly.
• The intake part of I & O consists of any fluid taken in by the patient. This can be orally or
IV. A fluid is anything that is liquid or turns back into liquid at room temperature. Ice
cream, Jell-O, Soups. The output part of I & O is anything out of the body in liquid form.
This can be from any part of the body. Vomiting, severe perspiration, diarrhea, and of
course urine. All of these must be written down and documented as soon as it occurs.
Trying to remember what your patient drank all day or when and how much they urinated
is not OK. Many patient are too confused or just to tired or confused to remember what
• If you have a mobile patient it is best to have a hat in the commode to catch the urine. For
a man have him use a urinal. For things like excessive sweating this is more difficult to
measure, you may say a chux soaked two times this shift. This can also be used if the
patient is incontinent and uses some sort of attends (adult diaper). Some people are on
very strict I & O and the attends would have to be weighed. When doing I & O remember
to notice the color and odor and any sentiment you may see.
• Another nursing responsibility is collecting specimens related to the urinary system "A
Urinalysis". There are several different kinds of urine samples that may be needed:
1.) Clean catch, all urine specimens should be clean catch, if a urine specimen states:
2.) Routine, this means there is no special procedures for collection but bacteria collects
around the urinary meatus all the time, so if we do not clean the area prior to collection of
the specimen you are going to end up with a contaminated specimen. So be it routine or
3.) Sterile urine specimen needs to come from a catheter. It is not OK to collect a
specimen directly from a catheter bag!!! You must clamp the catheter off for
approximately 20 - 30 minutes prior to collection and then clean the catheter tip with
alcohol and then drip the urine into a sterile cup. If it is a patient who does not already
have a catheter in place then you, (the license. nurse) must do a sterile straight catheter
specimen.
4.) A 24 hour urine specimen is just that. You MUST save all urine for 24 hours to find
out if there is protein being spilled into the urine. If any of the urine is not added to the
• All urine specimens must be labeled with the patient’s name, time and date; they must
URINARY SYSTEM
The Urinary System is a group of organs in the body concerned with filtering out excess fluid
and other substances from the bloodstream. The substances are filtered out from the body in the
form of urine. Urine is a liquid produced by the kidneys, collected in the bladder and excreted
through the urethra. Urine is used to extract excess minerals or vitamins as well as blood
corpuscles from the body. The Urinary organs include the kidneys, ureters, bladder, and urethra.
The Urinary system works with the other systems of the body to help maintain homeostasis. The
kidneys are the main organs of homeostasis because they maintain the acid base balance and the
One of the major functions of the Urinary system is the process of excretion. Excretion is the
process of eliminating, from an organism, waste products of metabolism and other materials that
are of no use. The urinary system maintains an appropriate fluid volume by regulating the
amount of water that is excreted in the urine. Other aspects of its function include regulating the
concentrations of various electrolytes in the body fluids and maintaining normal pH of the blood.
Several body organs carry out excretion, but the kidneys are the most important excretory organ.
The primary function of the kidneys is to maintain a stable internal environment (homeostasis)
for optimal cell and tissue metabolism. They do this by separating urea, mineral salts, toxins, and
other waste products from the blood. They also do the job of conserving water, salts, and
electrolytes. At least one kidney must function properly for life to be maintained. Six important
Regulation of plasma ionic composition. Ions such as sodium, potassium, calcium, magnesium,
chloride, bicarbonate, and phosphates are regulated by the amount that the kidney excretes.
Regulation of plasma osmolarity. The kidneys regulate osmolarity because they have direct
control over how many ions and how much water a person excretes.
Regulation of plasma volume. Your kidneys are so important they even have an effect on your
blood pressure. The kidneys control plasma volume by controlling how much water a person
excretes. The plasma volume has a direct effect on the total blood volume, which has a direct
effect on your blood pressure. Salt(NaCl)will cause osmosis to happen; the diffusion of water
Regulation of plasma hydrogen ion concentration (pH). The kidneys partner up with the lungs
and they together control the pH. The kidneys have a major role because they control the amount
of bicarbonate excreted or held onto. The kidneys help maintain the blood Ph mainly by
Removal of metabolic waste products and foreign substances from the plasma. One of the most
important things the kidneys excrete is nitrogenous waste. As the liver breaks down amino acids
it also releases ammonia. The liver then quickly combines that ammonia with carbon dioxide,
creating urea which is the primary nitrogenous end product of metabolism in humans. The liver
turns the ammonia into urea because it is much less toxic. We can also excrete some ammonia,
creatinine and uric acid. The creatinine comes from the metabolic breakdown of creatine
phospate (a high-energy phosphate in muscles). Uric acid comes from the breakdown of
nucleotides. Uric acid is insoluble and too much uric acid in the blood will build up and form
Secretion of Hormones The endocrine system has assistance from the kidney's when releasing
hormones. Renin is released by the kidneys. Renin leads to the secretion of aldosterone which is
released from the adrenal cortex. Aldosterone promotes the kidneys to reabsorb the sodium
(Na+) ions. The kidneys also secrete erythropoietin when the blood doesn't have the capacity to
carry oxygen. Erythropoietin stimulates red blood cell production. The Vitamin D from the skin
is also activated with help from the kidneys. Calcium (Ca+) absorption from the digestive tract is
promoted by vitamin D.
The kidneys are large, bean-shaped organs towards the back of the abdomen (belly). They lie
behind a protective sheet of tissue within the abdomen. The kidneys perform many vital
functions which are important in everyday life. For example, they help us get rid of waste
products by making urine and excreting it from the body. A special system of tubes within the
The kidneys regulate the amount of water in the body. Humans produce about 1.5 litres of urine
a day. However, if we drink more water, we may produce more urine. On hot days, if we get
dehydrated and sweat more, we may produce less urine. This is why it's very important to drink
The kidneys also produce renin (a hormone important in regulating blood pressure) and
Located in the lower part of our bellies, the right kidney is slightly lower in position than the left,
allowing room for the liver. The kidneys are reddish brown in colour and measure about 10 cm
in length, 5 cm width and 2.5 cm thick. On the side of the kidney with the smaller curve is an
opening called the hilum, where blood vessels, nerves, and the ureters enter the kidney. On one
end of the ureters is a funnel-shaped expansion, called the renal pelvis, where urine collects. The
ureters carry urine to the bladder; they are 25–30 cm long tubes lined with smooth muscle. The
muscular tissue helps force urine downwards. The ureters enter the bladder at an angle, so urine
doesn't flow up the wrong way. The ureters are two tubes that drain urine from the kidneys to the
bladder. Each ureter is a muscular tube about 10 inches (25 cm) long. Muscles in the walls of the
ureters send the urine in small spurts into the bladder, (a collapsible sac found on the forward
part of the cavity of the bony pelvis that allows temporary storage of urine). After the urine
enters the bladder from the ureters, small folds in the bladder mucosa act like valves preventing
backward flow of the urine. The outlet of the bladder is controlled by a sphincter muscle. A full
bladder stimulates sensory nerves in the bladder wall that relax the sphincter and allow release of
the urine. However, relaxation of the sphincter is also in part a learned response under voluntary
Urinary Bladder
The bladder is a pyramid-shaped organ which sits in the pelvis (the bony structure which helps form the
hips). The main function of the bladder is to store urine and, under the appropriate signals, release it into a
tube which carries the urine out of the body. Normally, the bladder can hold up to 500 mL of urine. The
bladder has three openings: two for the ureters and one for the urethra (tube carrying urine out of the
body).
The bladder consists of smooth muscles. The main muscle of the bladder is called the detrusor muscle.
Muscle fibres around the opening of the urethra forms a ring-like muscle that controls the passage of
urine. When we want to urinate, stretch receptors in the bladder are activated, which send signals to our
brain and tell us that the bladder is full. The ring-like muscle relaxes and the detrusor muscle contracts,
The blood supply of the bladder is from many blood vessels. Some of these blood vessels are named: the
vesical arteries, the obturator, uterine, gluteal and vaginal arteries. In females, a venous network drains
blood from the bladder arteries into the internal iliac vein. Nervous control of the bladder involves centres
The urethra is a muscular tube that connects the bladder with the outside of the body. The
function of the urethra is to remove urine from the body. It measures about 1.5 inches (3.8 cm) in
a woman but up to 8 inches (20 cm) in a man. Because the urethra is so much shorter in a woman
it makes it much easier for a woman to get harmful bacteria in her bladder this is commonly
called a bladder infection or a UTI. The most common bacteria of a UTI is E-coli from the large
The male urethra is 18–20 cm long, running from the bladder to the tip of the penis. The male
urethra is supplied by the inferior vesical and middle rectal arteries. The veins follow these blood
The female urethra is 4–6 cm long and 6 mm wide. It is a tube running from the bladder neck
and opening into an external hole located at the top of the vaginal opening. As the female urethra
is shorter than the male urethra, it is more likely to get infections from bacteria in the vagina. The
A nephron is the basic structural and functional unit of the kidney. The name nephron comes
from the Greek word (nephros) meaning kidney. Its chief function is to regulate water and
soluble substances by filtering the blood, reabsorbing what is needed and excreting the rest as
urine. Nephrons eliminate wastes from the body, regulate blood volume and pressure, control
levels of electrolytes and metabolites, and regulate blood pH. Its functions are vital to life and are
regulated by the endocrine system by hormones such as antidiuretic hormone, aldosterone, and
parathyroid hormone.
Each nephron has its own supply of blood from two capillary regions from the renal artery. Each
nephron is composed of an initial filtering component (the renal corpuscle) and a tubule
specialized for reabsorption and secretion (the renal tubule). The renal corpuscle filters out large
solutes from the blood, delivering water and small solutes to the renal tubule for modification.
Glomerulus
The glomerulus is a capillary tuft that receives its blood supply from an afferent arteriole of the
renal circulation. The glomerular blood pressure provides the driving force for fluid and solutes
to be filtered out of the blood and into the space made by Bowman's capsule. The remainder of
the blood not filtered into the glomerulus passes into the narrower efferent arteriole. It then
moves into the vasa recta, which are collecting capillaries intertwined with the convoluted
tubules through the interstitial space, where the reabsorbed substances will also enter. This then
combines with efferent venules from other nephrons into the renal vein, and rejoins with the
main bloodstream.
Afferent/Efferent Arterioles
The afferent arteriole supplies blood to the glomerulus. A group of specialized cells known as
juxtaglomerular cells are located around the afferent arteriole where it enters the renal corpuscle.
The efferent arteriole drains the glomerulus. Between the two arterioles lies specialized cells
called the macula densa. The juxtaglomerular cells and the macula densa collectively form the
juxtaglomerular apparatus. It is in the juxtaglomerular apparatus cells that the enzyme renin is
formed and stored. Renin is released in response to decreased blood pressure in the afferent
arterioles, decreased sodium chloride in the distal convoluted tubule and sympathetic nerve
Angiotensin I and Angiotensin II which stimulate the secretion of aldosterone by the adrenal
cortex.
Glomerular Capsule or Bowman's Capsule
Bowman's capsule (also called the glomerular capsule) surrounds the glomerulus and is
composed of visceral (simple squamous epithelial cells) (inner) and parietal (simple squamous
epithelial cells) (outer) layers. The visceral layer lies just beneath the thickened glomerular
basement membrane and is made of podocytes which send foot processes over the length of the
glomerulus. Foot processes interdigitate with one another forming filtration slits that, in contrast
to those in the glomeruluar endothelium, are spanned by diaphragms. The size of the filtration
slits restricts the passage of large molecules (eg, albumin) and cells (eg, red blood cells and
platelets). In addition, foot processes have a negatively-charged coat (glycocalyx) that limits the
repulsion.
The parietal layer of Bowman's capsule is lined by a single layer of squamous epithelium.
Between the visceral and parietal layers is Bowman's space, into which the filtrate enters after
passing through the podocytes' filtration slits. It is here that smooth muscle cells and
macrophages lie between the capillaries and provide support for them. Unlike the visceral layer,
the parietal layer does not function in filtration. Rather, the filtration barrier is formed by three
components: the diaphragms of the filtration slits, the thick glomerular basement membrane, and
the glycocalyx secreted by podocytes. 99% of glomerular filtrate will ultimately be reabsorbed.
The process of filtration of the blood in the Bowman's capsule is ultrafiltration (or glomerular
filtration), and the normal rate of filtration is 125 ml/min, equivalent to ten times the blood
volume daily. Measuring the glomerular filtration rate (GFR) is a diagnostic test of kidney
function. A decreased GFR may be a sign of renal failure. Conditions that can effect GFR
include: arterial pressure, afferent arteriole constriction, efferent arteriole constriction, plasma
Any proteins that are roughly 30 kilodaltons or under can pass freely through the membrane.
Although, there is some extra hindrance for negatively charged molecules due to the negative
charge of the basement membrane and the podocytes. Any small molecules such as water,
glucose, salt (NaCl), amino acids, and urea pass freely into Bowman's space, but cells, platelets
and large proteins do not. As a result, the filtrate leaving the Bowman's capsule is very similar to
blood plasma in composition as it passes into the proximal convoluted tubule. Together, the
The proximal tubule can be anatomically divided into two segments: the proximal convoluted
tubule and the proximal straight tubule. The proximal convoluted tubule can be divided further
into S1 and S2 segments based on the histological appearance of it's cells. Following this naming
convention, the proximal straight tubule is commonly called the S3 segment. The proximal
convoluted tubule has one layer of cuboidal cells in the lumen. This is the only place in the
nephron that contains cuboidal cells. These cells are covered with millions of microvilli. The
Fluid in the filtrate entering the proximal convoluted tubule is reabsorbed into the peritubular
capillaries, including approximately two-thirds of the filtered salt and water and all filtered
organic solutes (primarily glucose and amino acids). This is driven by sodium transport from the
lumen into the blood by the Na+/K+ ATPase in the basolateral membrane of the epithelial cells.
Much of the mass movement of water and solutes occurs in between the cells through the tight
The solutes are absorbed isotonically, in that the osmotic potential of the fluid leaving the
proximal tubule is the same as that of the initial glomerular filtrate. However, glucose, amino
acids, inorganic phosphate, and some other solutes are reabsorbed via secondary active transport
through cotransport channels driven by the sodium gradient out of the nephron.
The loop of Henle (sometimes known as the nephron loop) is a U-shaped tube that consists of a
descending limb and ascending limb. It begins in the cortex, receiving filtrate from the proximal
convoluted tubule, extends into the medulla, and then returns to the cortex to empty into the
distal convoluted tubule. Its primary role is to concentrate the salt in the interstitium, the tissue
Descending limb
Its descending limb is permeable to water but completely impermeable to salt, and thus
descends deeper into the hypertonic interstitium of the renal medulla, water flows freely
out of the descending limb by osmosis until the tonicity of the filtrate and interstitium
equilibrate. Longer descending limbs allow more time for water to flow out of the filtrate,
so longer limbs make the filtrate more hypertonic than shorter limbs.
Ascending limb
Unlike the descending limb, the ascending limb of Henle's loop is impermeable to water,
a critical feature of the countercurrent exchange mechanism employed by the loop. The
ascending limb actively pumps sodium out of the filtrate, generating the hypertonic
interstitium that drives countercurrent exchange. In passing through the ascending limb,
the filtrate grows hypotonic since it has lost much of its sodium content. This hypotonic
The distal convoluted tubule is similar to the proximal convoluted tubule in structure and
function. Cells lining the tubule have numerous mitochondria, enabling active transport to take
place by the energy supplied by ATP. Much of the ion transport taking place in the distal
convoluted tubule is regulated by the endocrine system. In the presence of parathyroid hormone,
the distal convoluted tubule reabsorbs more calcium and excretes more phosphate. When
aldosterone is present, more sodium is reabsorbed and more potassium excreted. Atrial
natriuretic peptide causes the distal convoluted tubule to excrete more sodium. In addition, the
tubule also secretes hydrogen and ammonium to regulate pH. After traveling the length of the
distal convoluted tubule, only 3% of water remains, and the remaining salt content is negligible.
97.9% of the water in the glomerular filtrate enters the convoluted tubules and collecting ducts
by osmosis.
The Urinary system is a very important component inside our body. It plays a very
important role in our everyday life. The urinary system, with groups of organs like the kidneys,
which filters excess fluid and other substances in the bloodstream, And this fluids and other
The urinary is composed of different organs which work together to accomplish different
important tasks. The Urinary organs include the kidneys, ureters, bladder, and urethra. The
kidneys are the main organs of homeostasis because they maintain the acid base balance and the
water salt balance of the blood. A nephron is the basic structural and functional unit of the
kidney. The name nephron comes from the Greek word (nephros) meaning kidney. Its chief
function is to regulate water and soluble substances by filtering the blood, reabsorbing what is
needed and excreting the rest as urine. Nephrons eliminate wastes from the body, regulate blood
volume and pressure, control levels of electrolytes and metabolites, and regulate blood pH.
and other materials that are of no use; this is one of the major functions of the system. The
urinary system maintains an appropriate fluid volume by regulating the amount of water that is
excreted in the urine. Several body organs carry out excretion, but the kidneys are the most
important excretory organ. There are also the six important functions of this system; the
The human body is composed of different body systems which help keep the balance and
fights harmful substances in and out of our body, but even so, we still have to do our share of
epithelium of the urinary tract to avoid being washed out with voiding, evade host defense
mechanisms, and initiate inflammation. Most UTIs result from fecal organisms that ascend from
the perineum to the urethra and the bladder and then adhere to the mucosal surfaces.
By increasing the normal slow shedding of bladder epithelial cells (resulting in bacteria
removal), the bladder can clear itself of even large numbers of bacteria. Glycosaminoglycan
(GAG), a hydrophilic protein, normally exerts a nonadherent protective effect against various
bacteria. The GAG molecule attracts water molecules, forming water barrier that serves as
defensive layer between the bladder and the urine. GAG may be impaired by certain agents
(cyclamate, saccharin, aspartame, and trytophan metabolites). The normal bacterial flora of the
vagina and urethral area also interfere with adherence of Escherichia coli (the most common
microorganisms causing UTI). Urinary immunoglobulin A (IgA) in the urethra may also provide
a barrier to bacteria.
Reflux
reflux (backward flow) of urine from the urethra into the bladder. With coughing, sneezing, or
straining, the bladder pressure rises, which may force urine from the bladder into the urethra.
When the pressure returns to normal, the urine flows back into the bladder, bringing into the
bladder bacteria from the anterior portions of the urethra. urethrovesical reflux is also caused by
dysfunction of the bladder neck or urethra. The urethrovesical angle and urethral closure pressure
may be altered with menopause, increasing the incidence of infection in postmenopausal women.
Reflux is most often noted, however, in young children. Treatment is based on its severity.
Ureterovesical or vesicoureteral reflux refers to the backflow of urine from the bladder
into one or both ureters. Normally, the ureteroveical junction prevents urine from traveling back
into the urether. The ureters tunnel into the bladder wall so that the bladder musculature
compresses a small portion of the ureter during normal voiding. When the ureterovesical valve is
impaired by congenital causes or ureteral abnormalities, the bacteria may reach and eventually
Loss of integrity of the mucosal lining (caused by in indwelling catheter, tumor, parasites, or
calculus)
⇓
Scarring of the kidney parenchyma (occurs in chronic infection), which interferes kidney
function.
Nursing Management
Problem Prioritization
inflammation of bladder
I’ve arranged my problems
mucosa as evidenced by 3
according to airway, breathing
verbal reports, facial grimace
and circulation since
and guarding
Increased temperature related Maslow’s hierarchy of needs
warm to touch.
Risk for fluid volume excess 2
Nursing Care Plan
Scientific
Assessment Diagnosis Planning Intervention Rationale Evaluation
Rationale
Subjective: Acute Pain Shorter length of After 8 hours Independent: After 8 hours
>”Masakit pag related to urethra, of nursing Establish rapport. To build nurse- of nursing
umiihi ako” as inflammation anatomical intervention patient intervention
verbalized by of bladder proximity to the patient will Perform a relationship. the patient
the patient. mucosa as vagina report pain is comprehensive To assess etiology/ report pain is
evidenced by relieved/ assessment of pain precipitating relieved/
Objective: verbal reports, Ascending controlled. to include location, contributory controlled.
>facial facial grimace infection after characteristic, onset/ factors.
grimace and guarding. entry by way of duration, frequency,
>guarding the urinary quality, severity,
>expressive meatus and precipitating/
behavior aggravating factors.
(restlessness, Infection Note client’s locus
crying, of control
irritability) Pain (internal/external)
>self focusing
Individuals with
external locus of
control may take
little or no
Provide comfort responsibility for
measure (e.g., back pain management.
rub, change of To provide non-
position, use of pharmacologic pain
heat/cold). management.
Work with client to
prevent pain. Use
flow sheet to Timely
document pain, intervention is
therapeutic more likely to be
interventions, successful in
response, and length alleviating pain.
of time before pain
recurs.
Encourage patient to
drink plenty of
fluids.
To promote urinary
output and to flush
Instruct patient to out bacteria from
void frequently urinary tract.
(every 2-3 hours) To enhance
and to empty bacterial clearance,
bladder completely. reduces urine statis,
Review drug and prevent
regimen (note use of reinfection.
drug which are Some drugs may
nephrotoxic). result in urinary
Monitor medication retention.
regimen and
antimicrobials. To identify
patient’s response
Dependent: in treatment
Instruct patient to
maintain acidic
environment of the To discourage
bladder by use of bacterial growth
agents such as when appropriate.
vitamin C.
Encourage patient to
take prescribed
analgesics and
antispasmodics as To relive pain.
ordered.
Assist in thorough
diagnosis including
neurologic and
psychologic factors
as appropriate when To know where the
pain persists. pain starts.
Scientific
Assessment Diagnosis Planning Intervention Rationale Evaluation
Rationale
S: Increased Infectious agents After 2 hours Independent: After 2 hours
>“Mainit ang temperature (Pyrogens) of Monitor heart rate Dysrhythmias and of compre-
pakiramdam related to stimulate comprehensive and rhythm. changes arecommon hensive
ko” as infectious nursing dueto electrolyte nursing
verbalized by process Monocytes intervention, imbalance and intervention,
the patient. possibly Release the patient dehydration and the patient
evidenced by temperature direct effect of temperature
O: elevated body Pyrogenic will lower hyperthermia on lowers down
>Flushed skin, temperature, cytokines down to blood and cardiac to normal
warm to skin flushed/ Stimulate normal levels: tissues. levels: T:
touch. warm to T: 36.5°C – To monitor or 36.5°C – 37.
>Restlessness touch. Anterior 37.5°C potentiates fluid and
>V/S taken as hypothalamus electrolyte loses.
follows: results in Record all sources
T: 38.1 of fluid loss such as
P: 70 Elevated urine, vomiting and To decrease
R: 19 thermoregulator diarrhea. temperature by
BP: 110/90 y set point Promote surface means through
leads to cooling by means evaporation and
of tepid sponge conduction.
Increased Heat bath. To minimize
conservation shivering.
(Vasoconstriction Wrap extremities
/behaviour with cotton
changes) blankets. To offset increased
Provide oxygen demands
Increased Heat supplemental and consumption.
production oxygen. To support
(involuntary circulating volume
muscular and tissue perfusion.
contractions) Administer To reduce metabolic
result in replacement fluids demands and
and electrolytes. oxygen
FEVER consumption
Maintain bed rest. To increased
metabolic demands.
Provide high
calorie diet, tube
feedings, or To facilitate fast
parenteral nutrition. recovery.
Dependent:
Administer
antipyretics orally
or rectally as
prescribed by the
physician.
Client’s response to
Date given Type of IVF Indication/ Purpose
treatment
04/26/10 Isotonic Restore sodium and Same osmolarity as
chloride losses. the cells (270 – 300
PNSS 1L x 20 A solution that has the mmol/L). Equal solute
gtts/min same salt concentration Dilute or dissolve and water—exact
as the normal cells of drugs for IV, IM, or same number of
the body and the blood. SC use. particles in both
As opposed to a
solutions—no net
hypertonic solution or a
Flushing for IV movement of water.
hypotonic solution. An
catheters. Does not change cell
isotonic beverage may
be drunk to replace the volume.
Extracellular fluid
fluid and minerals
which the body uses replacement. Priming
during physical activity. solution for
hemodialysis.
Metabolic alkalosis
where there is fluid
loss and mild sodium
depletion.
Client’s response to
Date ordered Indication/ Purpose Type of foods taken
treatment
April 26-30, 2010 (Please refer to the The client is well
course in the ward.) nourished and strong.
Generic Name: Ranitidine hydrochloride Trade Name: Zantac
Route of Administration: Intravenous Dosage: 50 mg q 8°
Mode of Indications/ Adverse Nursing Health
Drug Class Drug Interaction
Action Contraindications Reactions Considerations Teachings
Histamine competetively Indication: • Constipation, • Antacids may Do not confuse Take as
H-2 inhibits gastric • Short-term(4-8 nausea and decrease Zantac with directed with or
receptor secretion by weeks) and vomiting, ranitidine Xanax or with immediately
blocking blocking the maintenance diarrhea, absorption Zyrtex following
drug effects of treatment of abdominal pain, • Decrease Give antacids meals, wait 1
duodenal ulcer pancreatitis Cyanocobalami concomitantly hr. before
histamine on (rare) n absorption r/t for gastric pain taking an
• Pathologic
histamine H-2 hypersecretory • Headache, increased although they antacid
receptors; both conditions such dizziness, gastric pH may interfere Do not drive or
daytime and as Zollinger- malaise, • Decrease with ranitidine operate
nocturnal basal Ellison insomnia, diazepam absorption machinery until
gastric acid are syndrome and vertigo, effects r/t About one-half drug effects are
systemic confusion, decreased GI of the clients realized;
inhibited, weak
mastocytosis anxiety, tract absorption may heal dizziness or
inhibitor of agitation, drowsiness may
• Short-term • May increase completely
cytochrome P- depression, warfarin within 2 weeks; occur.
treatment of
450; drug active benign fatigue, hypoprothrombi thus,
interactions ulcers somnolence, nemic effects endoscopy may
involving Contraindication: hallucinations • Increase show no need
inhibition of • Cirrhosis of the • Bradycardia, Glipzide effects for further
hepatic liver, impaired tachycardia, treatment
renal or hepatic premature No dilution is
metabolism are ventricular beats
function required for IM
not expected to following rapid use
occur IV use, For IV
vasculitis, injection, dilute
cardiac arrest 50 mg in 0.9%
• Thrombocytope NaCl injection
nia, to a total
pancytopenia, volume of 20
leucopenia, mL
aplastic anemia
Generic Name: Potassium Chloride Trade Name: Kalium durule
Route of Administration: P.O Dosage: 750 mg Twice a day
Mode of Indications/ Adverse Nursing Health
Drug Class Drug Interaction
Action Contraindications Reactions Considerations Teachings
Electrolyte Potassium is Indication: • Paresthesias of • None Give PO doses Dilute or
readily and • Treat the extremities, significant 2-4 times per dissolve PO
rapidly hypokalemia due listlessness, day. Correct liquids,
absorbed from to digitalis mental hypokalemia effervescent
intoxification, confusion, slowly over a tablets, or
the GI tract.
diabetic acidosis, weakness or period of 3-7 soluble powders
Through a heaviness of days to in 3-8 oz of
diarrhea and
number of salts vomiting, limbs, flaccid minimize risk cold water, fruit
can be used to familial periodic paralysis of or vegetable
supply the paralysis, certain • Peripheral hyperkalemia juice, or other
potassium cases of uremia, vascular If with suitable liquid
cation, hyperadrenalism, collapse with esophageal and drink
starvation and fall in blood compression, slowly.
potassium
debilitation, and pressure, administer If GI upset
chloride is the cardiac dilute liquid occurs, products
corticosteroid or
agent of choice diuretic therapy arrhythmias, solutions of can be taken
since • Hypokalemia heart block, potassium after meals or
hypochloremia with or without possible cardiac rather than with food with
frequently metabolic arrest tablets a full glass of
accompanies acidosis and • Nausea, Do not water.
potassium following vomiting, administer Swallow
surgical abdominal pain, potassium IV enteric-coated
deficiency. diarrhea, GI undiluted. tablets and
conditions
accompanied by ulcerations Usual methods extended-
nitrogen loss, • Oliguria is to administer release capsules
vomiting and • Cold skin, gray by slow IV do not chew or
diarrhea, suction pallor infusion in dissolve in the
drainage and dextrose mouth.
increased urinary solution at a ; Report any
excretion of concentration adverse side
potassium of 40-80 effects and keep
Contraindication: mEq/L at a rate all visits for lab
• Severe renal not to exceed and exams.
function 10-20 meEq/hr.
impairment with
azotemia or
oliguria,
postoperatively
before urine flow
has been
reestablished
Generic Name: Ascorbic acid Trade Name:Vitamin C
Route of Administration: P.O Dosage: 500 mg; once a day
Mode of Indications/ Adverse Nursing Health
Drug Class Drug Interaction
Action Contraindications Reactions Considerations Teachings
. Indication: • Faintness or • None Use cautiously Advised to take
• dizziness with significant in G-6PD before
Contraindication: fast IV deficiency to breakfast;
administration avoid preferably to
•
• Diarrhea, possibility of take with
epigastric hemolytic orange juice for
burning anemia better
• Acidic urine, Avoid rapid IV absorption
oxaluria, renal administration
calculi Protect solution
from light
Discourage
self-
administration
for colds;
harmful side
effects are
possible
IV form used
investigationall
y in some
cancer centers
as adjunct to
treat some
forms of cancer
Generic Name: Cefuroxime Trade Name: Ceftin
Route of Administration: IV Dosage: 750 mg IV Q8°
Mode of Indications/ Adverse Drug Nursing Health
Drug Class
Action Contraindications Reaction Interaction Considerations Teachings
Cephalos- Second Indications: CV: phlebitis, Drug-drug. • Before • Tell patient to
porin, second generation • Pharyngitis, thrombo- Aminoglycoside giving drug take drug as
generation cephalosporin tosilitis, phlebitis. s: May cause ask patient if prescribed,
that inhibits infection of the GI: pseudo- synergistic he is allergic even after he
cell-wall urinary or lower membranous activity against to penicillins feels better.
synthesis, respiratory colitis, nausea, some or • Instruct patient
promoting tracts, and skin anorexia, organisms; may cephalosporins to take oral
osmotic or skin-structure vomiting, increase . form with
instability, infection caused diarrhea. nephrotoxicity. • Obtain food.
usually by Streptococcus Hematologic: Loop diuretics: specimen for • Instruct patient
bactericidal pneumoniae and transient May increase culture and to notify
S. pyogenes, neutropenia, risk of adverse sensitivity prescriber
Haemophilus eosinophilia, renal reactions. tests before about rash or
influenza, hemolytic, Probenecid: giving first evidence of
Staphylococcus thrombo- May inhibit dose. Therapy superinfections
aureus, E.coli, cytopenia. excretion and may begin .
Moraxella Skin: increase while awaiting • Advice patient
catarrhalis, maculopapular cefuroxime results. receiving drug
Neisseria and erythematous level. • Absorptio IV to report
gonorrhea, and rashes, urticaria, Drug-food. Any n of oral drug discomfort at
Klebsiella and pain, induration, food: may is enhanced by IV insertion
Enterobacter sterile abscesses, increase food. site.
species. temperature absorption. • Tablets • Tell patient to
• Serious lower elevation, tissue may be notify
respiratory tract sloughing at IM crushed, if prescriber
infection, UTI, injection site. absolutely about loose
bone or joint Other: necessary, for stools or
infection, hypersensitivity patients who diarrhea.
septicemia, reactions, serum can’t swallow
meningitis, and sickness, tablets.
gonorrhea. anaphylaxis. • If large
doses are
Contraindications: given, therapy
• Contraindicated is prolonged,
in patients or patient at
hypersensitive to risk, monitor
drug or other patient for
cephalosporins. signs and
• Use cautiously in symptoms of
patients super-
hypersensitive to infection.
penicillin
because of
possibility of
cross-sensitivity
with other beta-
lactam
antibiotics.
• Use cautiously in
breastfeeding
women and in
patients with
history of colitis
or renal
insufficiency.
• Paracetamol
• Cefuroxime
• Ascorbic acid
• Potassium Chloride
• Ranitidine hydrochloride
• Ferrous sulfate
Exercise/Activities
Participation in aerobic exercise, including jogging, walking, swimming and bicycling, can
enhance circulation and aid in the elimination of blood congestion in the pelvic area. Inverted-
position exercises, such as yoga headstands and shoulderstands, and rotating the legs in a
bicycle-like motion, are also beneficial for improving circulatory functioning. If you suffer from
back or neck pain and are unable to perform these exercises, you can use an old door couch and
the other on the floor. The slanted position of the body facilitates the transport of blood away
from the pelvic region and toward the head. It is advisable to limit such exercises to 3 to 5
minutes at a time because remaining in a slanted position for extended periods can cause
dizziness.
Treatments
• The first step in treating urinary tract infections is prevention. Prevention measures
include drinking plenty of fluids, urinating as soon as possible when the urge is felt, and
intercourse, wiping the genital area from front to back after urinating or defecating, and
not using douches or deodorant feminine products. These can be irritating to the genitals.
• Other treatments:
A mixture of 1/2 tsp baking soda in eight ounce glass of water can be very
helpful on the first signs of urinary tract infection. The presence of baking
soda in your system raises the acid-base balance of the acidic urine.
It is very important for your system to have a good flow of urine. This can
Cranberry juice disallows bacteria to cling to the cell, which line the
urinary tract. It is a great remedy to fight this infection. If you cannot have
the cranberry juice directly you can mix it with apple juice to add some
taste.
bergamot, tea tree, frankincense and juniper. Mix all these ingredients to
make an oil to be rubbed over your bladder area. Continue this massaging
Health teachings
c. Cleanse around the perineum and urethral meatus after each bowel movement,
• Avoid bladder irritants – coffee, tea, alcohol, cold drinks, and aspartame.
• Avoid external irritants such as bubble baths, talcum powders, perfumed vaginal
cleansers or deodorants.
• Patients with persistent bacteria may require long-term antimicrobial therapy to prevent
concentration of drug overnight because low rates of urine flow and infrequent
Out-patient/ Follow up
• Advise women with simple, uncomplicated cystitis that they do not require follow-up as
• Since bacteria that cause infections in your urinary tract cannot live in very acidic
conditions, one of the suggestions you should heed if you are prone to urinary tract
infections is to increase your intake of vitamin-C-rich foods and to drink citrus juices that
have a lot of vitamin C. Not only will this increase the acidity of your urine, it will also
• Some foods may have to be avoided when you have UTI, and these include processed
foods, cheeses, and other dairy products. You may also need to avoid chocolates, coffee,
• Other things you may need to avoid when you have urinary tract infections include spicy
food, fizzy drinks or soda pop, beer, and other alcoholic beverages.
• Try to increase your intake of healthy substances like vegetables and fruits. You can also
have these in fresh juice form by juicing them or pureeing them. You can also mix fruit
and vegetables in one healthy juice that you can drink every day for your health.
Spiritual/Sexual
intercourse
Conclusion
As a conclusion of this study, it is very important to maintain the basic ways to attain
wellness. Proper care is the key in achieving health. Since women are more susceptible in having
Urinary Tract Infections they should have enough knowledge in providing self care and proper
This study awakened me in such a way that as an infection occurs, from an infection
alone, it can lead to other complications and might as well have an irreversible condition of not
prevented ad treated. So it is important to learn how to prevent it before its too late for it to be
ceured.
Also, the health care providers, being the ones who interact with the patients and being
one of the sources of information should have broad knowledge or understanding for such
diseases. In promoting continuing care, health care providers should explain within the level of
Recommendation:
This study provides a brief background of causes and manifestations of the disease; it
recommends a good example in relating it with other cases as well as in looking for appropriate
It also recommends as a new case for doctors, that this study will serve as an
encouragement for further research about other onset of manifestations that can occur and the
newest treatment. For nurses, further nursing management can be added regarding patients with
this case will be done if further reading and research is done. As time goes by, many things have
been changed and improved. This study recommends and hopefully serve as encouragement to
Tortora, Gerard J.,Principles of Anatomy and Physiology .Tenth edition. Biological Sciences
Textbooks, Inc. 2003. p 1028-1048.
Doenges, Marilynn E., Moorhouse, Mary Frances, Murr, Alice C. Nurse’s Pocket Guide:
Diadnoses, Interventions, and Rationales. Ninth edition. F.A. Davis Company, Philadelphia,
2004.
Marieb, Elaine N., Essentials of Human Anatomy & Physiology. Eight edition. Pearson
Education, Inc,. 2006. p 535-557
Nursing 2007: Drug Handbook. 27th edition. Lippincott Williams & Wilkins. 2007