Biographical Profile Patients Name: Age: Birth date: Address: Sex: Religion: Civil Status: Father: Mother: Diagnosis:

Physician: Admitting Date: Admitting Time: History of Present Illness

Patient X 9 yrs. old February 19, 2002 San Antonio Sto. Tomas, Batangas Male Catholic Child Father Y (Factory Worker) Mother Z (house wife) Acute Cystitis Dr. Eduardo Uycoque September 25, 2011 5:23 pm

One day prior to admission patient has fever accompanied by headache, and body malaise. Tempra was given by the mother and fever went off. Persistence of above symptoms prompted his family to consult a physician. On the day of consultation vomiting episodes and abdominal pain were noted. Past Medical History Patient has no history of previous hospitalization. Patient experienced common health problems such as fever, coughs, and colds. Tempra is given as a relief to fever.The mother also claimed that his son experienced Mumps, no treatment used. Never experience measles, chicken pox. Patient X is a fully immunized child, as what the mother said. Family History The mother claimed that they have heridofamilial disease, such as hypertension on the mother side. And asthma on paternal side. Birth History The client is the 2nd sibling of Mr. Y and Mrs. Z, via normal delivery last Februeary 19, 2002 at STGH. Lifestyle Patient loves to play outside their house with his neighbors. He is not fond of studying. Loves to eat junkfoods and salty foos. And has the habit of holding back his pee when playing.

Anatomy and Physiology

How does the urinary system work? The body takes nutrients from food and converts them to energy. After the body has taken the food that it needs, waste products are left behind in the bowel and in the blood. The urinary system keeps the chemicals and water in balance by removing a type of waste, called urea, from the blood. Urea is produced when foods containing protein, such as meat, poultry, and certain vegetables, are broken down in the body. Urea is carried in the bloodstream to the kidneys. Urinary system parts and their functions: Two kidneys - a pair of purplish-brown organs located below the ribs toward the middle of the back. Their function is to:

Remove liquid waste from the blood in the form of urine. Keep a stable balance of salts and other substances in the blood. Produce erythropoietin, a hormone that aids the formation of red blood cells.

The kidneys remove urea from the blood through tiny filtering units called nephrons. Each nephron consists of a ball formed of small blood capillaries, called a glomerulus, and a small tube called a renal tubule. Urea, together with water and other waste substances, forms the urine as it passes through the nephrons and down the renal tubules of the kidney. Two ureters - narrow tubes that carry urine from the kidneys to the bladder. Muscles in the ureter walls continually tighten and relax forcing urine downward, away from the kidneys. If urine backs up, or is allowed to stand still, a kidney infection can develop. About every 10 to 15 seconds, small amounts of urine are emptied into the bladder from the ureters. Bladder - a triangle-shaped, hollow organ located in the lower abdomen. It is held in place by ligaments that are attached to other organs and the pelvic bones. The bladder's walls relax and expand to store urine, and contract and flatten to empty urine through the urethra. The typical healthy adult bladder can store up to two cups of urine for two to five hours. Two sphincter muscles - circular muscles that help keep urine from leaking by closing tightly like a rubber band around the opening of the bladder. Nerves in the bladder -alert a person when it is time to urinate, or empty the bladder. Urethra - the tube that allows urine to pass outside the body. The brain signals the bladder muscles to tighten, which squeezes urine out of the bladder. At the same time, the brain signals the sphincter muscles to relax to let urine exit the bladder through the urethra. When all the signals occur in the correct order, normal urination occurs.

Pathophysiology Poor perineal hygiene Microorganisms access to the bladder Attachment and colonization of microorganisms in epithelium of urinary tract Evade host defense mechanisms Inflammatory changes occur in the affected lower portion of the Urinary tract. Acute cystitis

Introduction Acute Cystitis( Lower UTIs) is an inflammation of the bladder. It can be caused by infection from bacteria, viruses, fungi, or parasites. Several mechanisms maintain the sterility of the bladder: the physical barrier of the urethra, urine flow, ureterovesical junction competence, various antibacterial enzymes and antibodies, and antiadherent effects mediated by the mucosal cells of the bladder. Abnormalities or dysfunctions of these mechanisms are contributing factors to lower UTIs. Signs and Symptoms of cystitis vary from person-to-person and can range from mild to severe. They include:

Frequent and urgent need to urinate Passing only small amounts of urine Pain in the abdomen or pelvic area, or in the low back Burning sensation during urination Leaking urine Increased need to get up at night to urinate Cloudy, bad-smelling urine Blood in the urine Low-grade fever Fatigue

ACUTE CYSTITIS
A Case Study

Submitted By: Aiko A. Ramos BSN 3-2 Submitted To: Mrs. Marivic Rodelas Clinical Instructor

Nursing Care Plan

ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION

Subjective: I feel pain every time I urinate (Masakit po pag umiihi ako), as verbalized by the patient Objectives: -frequency -nocturia -dysuria -incontinence -weak in appearance -wong baker faces pain scale of 6/10 (0 being lowest or no hurt; 10 being the highest or hurts worst) -febrile (38 C) v/s taken as follows: T: 38 C P: 82 bpm R: 24 cpm BP: 90/60 Lab Results: * Urinalysis - WBC = 4 to 6 hpf(pyuria) -RBC = 1 to 3 hpf(hematuria) *CBC -WBC = 12, 100

Acute Pain related to inflammation and infection of the bladder

After 4 hours of nursing interventions patients pain will be lessen as evidenced of pain scale from 6 to 3-5

Pain is quickly relieved once effective antimicrobial is initiated Assess patients description of pain Applying heat to the perineum Encouraged patient to drink liberal amount of fluids (water is best choice)

The main intervention to wear off the pain is to kill the bacteria To know the severity of pain Help relieve pain and spasm To promote renal blood flow and to flush bacteria from the urinary To avoid irritating the urinary tract

Goal Met. Patient was able to lessen pain as evidenced of pain scale of 4.

Instructed patient to avoid urinary tract irritants i.e. coffee, tea, spices, and colas Encouraged patient to try frequent voiding Assisted nurse in giving medications

To empty the bladder completely To help relieve/reduce pain thru pharmacologic measures

ASSESSMENT DIAGNOSIS

PLANNING

INTERVENTIONS

RATIONALE

EVALUATION

Subjective: I love eating salty foods and I have a habit to hold back my pee (Mahilig ako sa mga maalat na pagkaen at mahilig ako magpigil ng ihi), as verbalized by the patient. I dont know how he acquired that disease (Hindi ko nga alam kung bakit nagkaroon yang anak ko ng UTI),as verbalized by the mother of the patient

Deficient knowledge related to factors predisposing the patient to infection and recurrence, detection and prevention, and pharmacologic therapy

Within the course of the shift, the patient together with his mother they will be able to verbalize understanding of the disease by showing cooperative attitudes

Assess patient and the patients mother level of awareness upon the disease Provide health teachings as follows: Promote proper hygiene i.e., handwashing After each bowel movement, clean the perineum and urethral meatus from front to back Increase fluid intake Avoid urinary tract irritants i.e. coffee, tea, spices, and colas Void regularly

It will serves as a basis in the health teaching plans

Goal Met. The patient and the mother was able to verbalize understanding of the disease by showing cooperative attitudes.

To minimize the spread of bacteria It will help to reduce concentrations of pathogens at the urethral opening To flush out bacteria To avoid irritating the urinary tract To prevent over distention of the bladder To ensure adequate medication To assess if there is recurrence of symptoms

Take medications properly Consult health care provider regularly for follow ups

Physical Assessment Genetourinary -frequency -nocturia -dysuria -incontinence -foul smelling odor(as what the patient have said) Laboratory Results CBC lab test results shows elevated WBC count indicating presence of infection Urinalysis- lab test results shows elevated WBC count indicating presence of infection in the urine and elevated RBC count indicating presence of blood in the urine Widal Test lab test results shows negative, indicating patient is negative for typhoid fever Drug Study Cefuroxime: