GROUP 2 Alyanna Carmela Pechueco Lennie Marie Pelaez Christine A.

Pelingon Rhoda Pendon Paul Penaflorida Dareen Perez Roseanne Perez Mechelle Perol Cindy Grace Piamonte Grant Ireneo Pilla Eric Pinuela Jophadel Piojo Reyna Mari Plorgo Marianne Joy Polaron Jhelly Ann Polido Lessie Grace Puertollano Chrizelle Prieto

I. OBJECTIVES:
General Objectives
y

Define and understand the diseases that affect the clients present health status namely Gestational Diabetes Mellitus, Hepatitis B, and Urinary Tract Infection. Identify the causes, prevention of recurrence and treatment of these diseases. Define what is Gestational Diabetes Mellitus and its pathophysiology Identify its causes and its effects to the mother and to the fetus Teach client how to comply with the treatment of the disease.

Gestational Diabetes Mellitus

y y y

Hepatitis B
y y y

Define Hepatitis B, its risk factors and prevention Know the causes, mode of transmission and its susceptible host Maintain clients consistency of drug regimen compliance. Define Urinary tract infection and its predisposing factors Identify the causative agent of the infection and ways to reduce or eliminate its effects Treat the infection through drug regimen and imply ways to improve the clients voiding pattern

Urinary Tract Infection

y y y

II. PATIENT'S PROFILE

Patient's Name: Ms. J.F. Age: 19 Date of Birth: August 1, 1991 Sex: Female Address: Gines, Zarraga, Iloilo City Religion: Roman Catholic Weight: 65. 5 kg Height: 151 cm Religion: Roman Catholic

III. NURSING HISTORY

PRENATAL HISTORY
G1P0 LMP: July 18, 2010 EDC: April 25, 2011 Last November 23, 2010, patient J.F. was diagnosed to be positive for Hepatitis Patient J.F. went to Zarraga Health Center for her 4th prenatal check up on January 27, 2011. Laboratory examinations revealed a positive sugar in her urine. She was then advised to be tested for Fasting Blood Sugar (FBS) to determine the potential for developing Gestational Diabetes Mellitus which places every pregnant woman at risk for. Day after, FBS result is 80mg/dl which is in the normal range. She is currently under treatment for urinary tract infection as evidenced by pus cells of 112-140 obtained in the urinalysis. The patient claims to hold the urge to void oftentimes.

FAMILY HISTORY
Patient s father, R.F. is a jeepney driver and her mother, M.J. is a plain housewife. Both parents do not have hypertension, diabetes, or cardiovascular disease. She is third among ten children. None of them suffered from chronic illness and have no known allergies. The source of Hepatitis B infection is still unknown since the disease does not exist among family members on both sides and the partner is not diagnosed.

SOCIAL HISTORY
The patient is a high school graduate. She does not smoke nor drink alcohol. She is fond of eating sweets, fried meat, and seldom eats fruits and vegetables. She lives with his partner and his parents for almost a year. They were unwed. She had been involved in a sexual activity with only one partner. Neither her, nor his partner uses contraceptive during sexual contacts. Intercourse was still pursued even after diagnosis of Hepatitis B, as claimed.

IV. ASSESSMENT FINDINGS

Vital Signs: On 1st Prenatal Visit (September 30, 2010)
Weight: 60 kg BP: 120/80 mmhg

Upon Assessment (January 27, 2011)

Weight: Temperature: PR: RR: BP: 65 kg 36.6c 84bpm 18bpm 110/70

Physical Appearance
Looks more mature than her age. Has facial pallor. Body fat more on the abdominal portion. Limbs and trunk proportional to body height. Gait smooth. Lordosis apparent. Bad breath and body odor not noted.

b. Psychological presence Appears neat and clean. Dressed appropriately for weather. Cooperative and has pleasant manner. Speech is clear and understandable, responds to questions and commands easily. Has appropriate facial expression and clear unhurried speech with eye contact.

2. Skin
Has whitish skin. No bleeding, ecchymosis nor lesions noted. Skin is dry with minimum perspiration. Temperature is warm and equal bilaterally, hands and feet slightly cooler. Skin is smooth, even and firm. When skin is pinched and released, returns rapidly to its original contour. Edema not present.

3. Head and face

Hair is black and evenly distributed. Long, straight, and thick hair. Lesions or infestations not noted. Head is symmetrical and has normocephalic shape. It is smooth, non-tender, without masses as palpated. Scalp is shiny, intact and without lesions. Symmetrical oval shaped face. No discomfort on movements.

4. Eyes
No discharge and discoloration noted; with normal visual acuity; pupils in deep black and are equally round and reactive to light; with white sclera and pale conjuctiva; eyelids closed symmetrically; eyelashes slightly curled outward; eyebrow evenly distributed, aligned symmetrically.

5. Ears
Firm and no tenderness noted. Pinna recoils after being folded. No foreign bodies, redness noted. Small amount of orange-colored cerumen noted. Nodules, deformities and lesions not present. No pain noted over mastoid process upon palpation as verbalized. Aligned with the outer canthus of the eye.

6. Nose
Nasal cavity patent. No discharges, bleeding and lesions noted. With pink nasal musoca, without swelling. Nasal septum is at midline without perforation. 7. Mouth and oropharynx Bad breath not noted. Pale and dry lips, no lesions or inflammation. Not flaccid. Tongue is in midline of the mouth, rough without lesions, moves freely. Ventral portion moist without lesions. Buccal mucosa smooth, no lesions. No swelling or bleeding in gums. Has complete set of teeth with white shiny tooth enamel, no dental caries. Uvula in the midline, throat pink without swelling or exudates. Gag reflex present.

8. Neck Symmetrical, can perform full ROM. Lymph nodes not visible or inflamed. No bruits upon auscultation. Carotid pulse present. 9. Thorax/chest Shoulders and scapulas on the same height. Soft, low-pitched, gentle sighing sounds are heard at the base of the lungs upon inspiration as auscultated. Rhythmic and effortless respiration at the rate of 22 breaths per minute.

10. Back Spinal column erect; with symmetrical chest expansion; masses, discoloration and deformities not present; clear breath sounds. 11. Abdomen Protuberant abdomen. Striae gravidarum present. Linea nigra present. Umbilicus protruding. Rashes and lesions not noted. Normal bowel sounds upon auscultation. 12. Upper and Lower extremities Light bruises present on both arms. Erythema, swelling and deformities not noted. No tremors. With smooth and firm muscle tone as palpated. Joints move smoothly. On steady gait, walks unaided maintaining balance. No edema noted on both feet. Pulse present with a rate of 92 bpm. With smooth and slightly rounded nails. Capillary refill of less than 2 seconds.

13. Genitoanal Defecated a formed blackish stool in moderate amount. No pain upon defecation as verbalized. 14. Genitourinal Polyuria present with burning sensation upon urination. Suprapubic pain present. Voided a slightly hazy, straw-colored urine.

V. Laboratory Procedures
HEMATOLOGY Definition: Hematology refers to the scientific study of blood and blood forming tissues. It is a combination report of a series of tests of the peripheral blood. The quantity, percentage, variety, concentrations, and quality of blood cells are identified. Hematology includes the study of etiology, diagnosis, treatment, prognosis, and prevention of blood diseases. Purpose: To determine the presence of infection. To aid in diagnosis of certain disease. Constitute in the major signs and symptoms of determining certain blood disorders. Basic screening test that address disorders, hemoglobin and cell production, synthesis and function are also determined.

Full Name
Hemoglobin Hematocrit Erythrocyte Leukocyte Differential Count Neutrophils Segments Stab Juvenile Eosinophil Basophil Lymphocyte Monocyte TOTAL

Result
133 g/ L 0.39 L/L 4.17x 1014/L 12.0 x 10 g/L

Normal Values
120-160 gm/ L 0.37- 0.40 L/L 4.2- 5.4 x 1014/L 4.5-11.0 x 10g/L

Significance
Normal Normal Below normal range due to relative anemia. Slightly increase due to UTI and pregnancy.

0.72 0.10 0.00 0.00 0.00 0.28 0.00 1:1

0.50- 0.70 0.02- 0.06 0.00-0.01 0.01- 0.03 0.00- 0.01 0.22- 0.40 0.03- 0.08 1-1

Increase due to bacterial infection. Increase due to bacterial infection Normal Due to bacterial infection Normal Normal Slight decrease due to pregnancy

URINALYSIS Definition: A routine urinalysis is attest for urinary and systematic disorders. This test is used to evaluate physical characteristics (color, odor, turbidity, and opacity) of urine, determine specific gravity and pH; detects and measure protein, and glucose. Purpose: y To screen the patients urine for renal or urinary tract disease. y To help detect metabolic or systemic disease unrelated to renal disorder. y Essential component of a complete physical examination, especially when performed on admission to a health-care facility.

January 27, 2011 Color: Pale straw Transparency: Slightly hazy Reaction: 6.5 (Acidic) Specific Gravity: 1.010 Protein: (-) Sugar: (+) RBC: 2-3 Pus Cells: 112-140 (UTI) Amorphous Urates: Few Squamous Epithelial Cells: Occasional Renal Cells: Few Bacteria: Many FASTING BLOOD SUGAR Measures blood glucose levels without food for at least eight hours. It's reliable, and the results aren't affected by age or the amount of physical activity to do. Normal range of 80-120 mg/dl. January 23, 2011 88 md/gL January 28, 2011 80 mg/dL

VI. OVERVIEW GESTATIONAL DIABETES Gestational diabetes (or gestational diabetes mellitus, GDM) is a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy (especially during third trimester of pregnancy). Babies born to mothers with gestational diabetes are typically at increased risk of problems such as being large for gestational age (which may lead to delivery complications), low blood sugar, and jaundice. Gestational diabetes is a treatable condition and women who have adequate control of glucose levels can effectively decrease these risks. Women with gestational diabetes are at increased risk of developing type 2 diabetes mellitus (or, very rarely, latent autoimmune diabetes or Type 1) after pregnancy, as well as having a higher incidence of pre-eclampsia and Caesarean section; their offspring are prone to developing childhood obesity, with type 2 diabetes later in life. Most patients are treated only with diet modification and moderate exercise but some take anti-diabetic drugs, including insulin.

There are two subtypes of gestational diabetes (which began during pregnancy): Type A1: abnormal oral glucose tolerance test (OGTT) but normal blood glucose levels during fasting and 2 hours after meals; diet modification is sufficient to control glucose levels. Type A2: abnormal OGTT compounded by abnormal glucose levels during fasting and/or after meals; additional therapy with insulin or other medications is required. Gestational diabetes usually has no symptoms. That's why almost all pregnant women have a glucose-screening test between 24 and 28 weeks.However, if you're at high risk for diabetes or are showing signs of it (such as having sugar in your urine), your caregiver will recommend this screening test at your first prenatal visit and then repeat the test again at 24 to 28 weeks if the initial result is negative.By the way, if you get a positive result on a glucosescreening test, it doesn't necessarily mean that you have gestational diabetes. It does mean that you'll need to take a longer follow-up test (a glucose tolerance test, or GTT) to find out.

PATHOPHYSIOLOGY Increased physiologic demand

Increased level of Estrogen and Growth Hormone Stimulate Insulin Secretion

Over Secretion of Insulin

Decreased Cellular responsiveness

Impaired glucose metabolism Hyperglycemia

Pregnancy Complication

Congenital Malformation

Still births

Large for date babies

Signs and symptoms of UTI

or burning (discomfort) when urinating The need to urinate more often than usual A feeling of urgency when you urinate Blood or mucus in the urine Cramps or pain in the lower abdomen Pain during sexual intercourse Chills, fever, sweats, leaking of urine (incontinence) Waking up from sleep to urinate Change in amount of urine, either more or less Urine that looks cloudy, smells foul or unusually strong Pain, pressure or tenderness in the area of the bladder When bacteria spreads to the kidneys you may experience: back pain, chills, fever, nausea and vomiting
Pain

RISK FACTOR y Obesity y Age over 25 yrs y History of Large Babies (10lb or more) y History of unexplained fetal or perinatal loss y History of congenital anomalies in previous pregnancies y Family history of diabetes (one close relative or two distant ones) y Member of a population with a high risk for diabetes

TREATMENT Treatment for gestational diabetes includes eating a carefully planned diet, getting plenty of exercise, maintaining a healthy pregnancy weight, monitoring glucose levels and, if necessary, daily insulin injections.

y y y y

y y y y

Diet To help the blood sugar level to stay within a normal range (60 to 120 mg/dl): Avoid sugar and foods high in sugar. Eat complex carbohydrates such as pasta, rice, grains, cereals, crackers, bread, potatoes, dried beans and peas. Eat fiber-rich foods such as whole grain cereals and breads, fruits and vegetables. Avoid saturated fats such as fatty meats, butter, bacon, cream and whole milk cheeses. Eat a snack before bedtime that is protein and carbohydrate based. The doctor will help in determining a diet plan that fits the woman's needs.

y y

Exercise Talk with the doctor about what exercise program is right for the woman. According to the American College of Obstetricians and Gynecologists, women are encouraged to exercise at least three or four days a week, with each session lasting 15 to 30 minutes. Women should avoid very strenuous activity and should not become overheated. If the woman has not exercised prior to pregnancy, a gradual introduction to exercise is recommended. Talk with your doctor regarding individual exercise needs and limitations.

y y

Maintain a healthy pregnancy weight Optimal weight gain depends on the prepregnancy weight of the woman. If the woman is at a desirable weight for her body size and height, a weight gain of 25 to 35 pounds is recommended. If the woman is 20 pounds or more above the desired weight, a weight gain of 20 to 24 pounds is recommended. If the woman is underweight, a weight gain of 28 to 36 pounds is recommended. This is dependent on how underweight the woman is prepregnancy. Talk with the doctor about his or her views on how much the woman should gain during the entire pregnancy.

Monitor glucose levels y Depending on the severity of the gestational diabetes, the doctor may want a daily or weekly glucose level test performed. There is self-blood glucose monitoring tests available that can be administered at home. These tests are done by using a special device to obtain a drop of blood and test for the blood sugar level.
y

Daily insulin injections y Insulin injections may be necessary if the dietary changes and exercising does not bring the blood sugar level within normal range. When two abnormal values occur in one week, the doctor may recommend insulin. A typical regimen begins with a small dose of intermediate-acting and/or regular insulin, taken once or twice daily, with adjustments to be made as insulin resistance increases. The doctor will explain the different kinds of insulin, the right amount of insulin to take and when to take it, and how to change the dosage.
y

HEPATITIS B The cause of Hepatitis B (also known as Hepatitis B Virus of HBV) is a virus that infects and attacks your liver. If left untreated, the disease can become chronic and result in serious damage to your body, including liver disease and liver cancer. There is no cure for Hepatitis B but a Hepatitis B vaccination is now available. The majority of people who contract Hepatitis B will recover on their own. However, 15% to 25% of those with chronic infections die from the liver disease caused by the virus. Hepatitis B is an infectious hepatitis caused by the hepatitis B virus (HBV). This infection has two possible phases; 1) acute and 2) chronic.

Acute hepatitis B refers to newly acquired infections. Affected individuals notice symptoms approximately 1 to 4 months after exposure to the virus. In most people with acute hepatitis, symptoms resolve over weeks to months and they are cured of the infection. However, a small number of people develop a very severe, life-threatening form of acute hepatitis called fulminant hepatitis. Chronic hepatitis B is an infection with HBV that lasts longer than 6 months. Once the infection becomes chronic, it may never go away completely.

PATHOPHYSIOLOGY Virus/ Toxins

Damage to Hepatocytes

Inflammation; necrosis

Disrupts liver function/Disrupts flow of bile

Sign/Symptoms

Symptoms Appetite loss Feeling tired (fatigue) Nausea and vomiting Itching all over the body Pain over the liver (on the right side of the abdomen, under the lower rib cage) y Jaundice - A condition in which the skin and the whites of the eyes turn yellow in color y Urine becomes dark in color (like cola or tea). y Stools are pale in color (grayish or clay colored)
y y y y y

Transmission and Causes The hepatitis B virus is known as a blood-borne virus because it is transmitted from one person to another via blood or fluids contaminated with blood. Another important route of transmission is from an infected mother to a newborn child, which occurs during or shortly after birth. Direct contract with blood may occur through the use of dirty needles during illicit drug use, inadvertent needle sticks experienced by healthcare workers, or contact with blood through other means. Semen, which contain small amounts of blood, and saliva that is contaminated with blood also carry the virus. The virus may be transmitted when these fluids come in contact with broken skin or a mucous membrane (in the mouth, genital organs, or rectum) of an uninfected person.

Risk Factor y Men or women who have multiple sex partners, especially if they don't use a condom y Men who have sex with men y Men or women who have sex with a person infected with hepatitis B virus y People with other sexually transmitted diseases y People who inject drugs with shared needles y People who receive transfusions of blood or blood products y People who undergo dialysis for kidney disease y Institutionalized mentally handicapped people and their attendants, caregivers, and family members y Health care workers who are stuck with needles or other sharp instruments contaminated with infected blood y Infants born to infected mothers

Prevention y If you are sexually active, practice safe sex. Correct use of latex condoms can help prevent transmission of HBV, but even when used correctly, condoms are not 100% effective at preventing transmission. Men who have sex with men should be vaccinated against both hepatitis A and hepatitis B. y If you inject drugs, don't share needles or other equipment. y Don't share anything (including grooming products) that might have blood on it, such as a razor, toothbrush, fingernail clippers, etc. y Think about the health risks if you are planning to get a tattoo or body piercing. You can become infected if the artist or person piercing you does not sterilize needles and equipment, use disposable gloves, or wash hands properly. y Health care workers should follow standard precautions and handle needles and sharps safely. y If you are pregnant or think you might be pregnant, tell your health care practitioner if you have any of the risk factors for HBV infection.

Hepatitis B affects your Newborn Hepatitis B is especially dangerous for infants and newborns. If you are pregnant and have Hepatitis B it can be passed to your baby, resulting in severe damage to his health. The virus causing Hepatitis B can sometimes be exchanged through the umbilical cord to your baby. More often, your baby will become infected with the virus as she passes through the birth canal during birth. The vaginal fluids and blood present here carry the infection. y Without proper vaccination, 90% of newborns will become chronic Hepatitis B carriers. This puts them at a high risk of developing liver disease and liver cancer. If your newborn contracts the disease, he will also be able to infect others. It is important to get tested for Hepatitis B as soon as you become pregnant.
y

Symptoms of Hepatitis B in Newborns If you are infected, your baby will be probably be born with no symptoms of Hepatitis B. In fact, it can take years for Hepatitis B symptoms to develop. As your baby grows into adolescence, Hepatitis B signs and symptoms will begin to appear, including jaundice, joint pain, fatigue, nausea and loss of appetite. Your child s liver will be affected, beginning to swell. Some children will develop liver disease or liver cancer as a result of the damage caused by HBV to the liver.

Testing and Treatment

y

If you are pregnant, it is necessary that you get tested for HBV. A Hepatitis B vaccine is now available to prevent infection. If administered properly, this Hepatitis B treatment is highly effective. 95% of vaccinated newborns are protected from Hepatitis B for life. Hepatitis B treatment requires initial testing. Your doctor will perform a Hepatitis B blood test. This blood test will look for the presence of Hepatitis B surface antigens (HBsAg). These antigens are present in all of those who are infected with the virus. If you test positive for Hepatitis B, your doctor will recommend a hepatitis vaccination for your baby as soon as he is born. Your baby will receive two injections within twelve hours of birth, including Hepatitis B immunoglobulin and the first dose of the Hepatitis B vaccine. Your baby will receive two more doses of the vaccine, first at 1 to 2 months and then again at 6 months.

If you are going to deliver, and haven t been tested for the virus, your doctor will administer the first dose of the Hepatitis B vaccine to your baby within twelve hours of birth. Your blood will be sent for testing as soon as possible. If you test positive, your baby will receive continued treatment for Hepatitis B, including Hepatitis B immunoglobulin within 7 days of birth. Your baby will also receive two more doses of the Hepatitis B vaccine, at 2 months and 6 months of age. If you test negative, your baby will return later for the subsequent vaccines.

y y

NURSING MANAGEMENT Pregnant Hepatitis B carriers should be advised to Obtain vaccination against hepatitis viruses A as indicated. Abstain form alcohol use Avoid hepatotoxic drugs such as acetaminophen (Tylenol) that may worsen liver damage. Not donate blood, body organs, other tissue, or semen. Not share any personal items that may have blood on them (e.g., toothbrushes and razors). Inform the infant s pediatrician, OB/GYN, and labor staff that they are a hepatitis B carrier. Make sure their baby receives hepatitis B vaccine at birth, one month, and six months of age as well as H-BIG at birth. Be seen at least annually by their regular medical doctor. Discuss the risk for transmission with their partner and discuss the need for counseling and testing

URINARY TRACT INFECTION A urinary tract infection is an invasion of all or part of the urinary tract (kidneys, bladder, and urethra) by pathogens. UTIs are usually caused by bacteria, most typically E.coli, although and viral and fungal organisms may also cause UTI. UTIs may begin as pathogens from the perineum and ascend through the urethra to the urinary bladder. UTIs are common nosocomial infections and often result following instrumentation (e.g. , catheterization or diagnostic procedures of the genitourinary tract). UTIs are more common in women than men, particularly in sexually active, younger women. UTIs, which can be chronic and recurring, can lead to systemic infection such as urosepsis, which can be life threatening. In older patients, diagnosis and treatment of UTIs may be delayed because UTI maybe asymptomatic or accompanied by only subtle cognitive changes and urinary incontinence rather than the typical complaints of urgency, frequency, burning, and pain upon urination. If infections of the urinary tract are not treated effectively, renal damage and loss of renal function can occur.

PATHOPHYSIOLOGY Pregnancy and Urinary Tract Infections often go hand since pregnant women are at increased risk to develop UTI s

Pregnancy hormones cause changes in the urinary tract which predispose women to infections

As the uterus grows it presses on the bladder and can prevent complete emptying of urine This stagnant urine is a likely source for infection Untreated, these infections may lead to kidney infections

Urinary Tract infections in pregnant women should be treated to prevent complications

TREATMENT
y

Urinary tract infections are treated with antibiotics normally for seven to ten days. Occasionally, certain infections, only require a single dose of antibiotic. Your health care provider will determine the correct antibiotic for your UTI based on your health history and the type of bacteria that is the cause of your infection.

If you are pregnant, that will be a factor your health care provider considers when choosing the appropriate antibiotic to treat your urinary tract infections. Ask your health care provider about the risks and benefits of the various antibiotics. Talk with your health care provider about the risks and benefits of taking the different medications. y Pain associated with UTI may be treated with a prescription pain reliever. Other options for pain relief include over-the-counter pain relievers and using a heating pad.
y

VII. DRUG STUDY GENERIC NAME: Cefuroxime (Antibiotic) ACTION: Bactericidal- inhibits synthesis of bacterial cell wall causing cell death. INDICATION: Urinary Tract Infection CONTRAINDICATION: Use cautiously with renal failure, lactation, and pregnancy DOSAGE: 500 mg BID NURSING CONSIDERATION: Give oral drug with food to decrease GI upset and enhance absorption. Discontinue if hypersensitivity occurs TEACHING POINTS: Take full course of therapy even if you are feeling better. Drug is specific for this infection and should not be used to selftreat other problems. ADVERSE EFFECTS: headache, dizziness, nausea, diarrhea, abdominal pain, flatulence

CUES
Subjective: Masakit akon pangihi as verbalized by the patient Objective: -Labs.: Urinalysis: PUS cells: 112-140 -Burning Sensation upon urination -Frequent urination -Suprapubic pain

Nursing Diagnosis
Infection related to insufficient knowledge to avoid exposure to pathogens (UTI) as manifested by: Subjective: Masakit akon pangihi as verbalized by the patient Objective: -Labs.: Urinalysis: PUS cells: 112-140 -Burning Sensation upon urination -Frequent urination -Suprapubic pain

Outcome Criteria
After 8 hours of nursing intervention: Patient will be able to prevent infection and verbalize understanding of individual causative factors of infection as evidenced by -Normal laboratory results -Absence of burning sensation upon urination -Absence of suprapubic pain -normal urination -Verbalize knowledge of causes and treatment of UTI

Intervention
1. Assess for any history that would predispose patient to infection (UTI) Assess signs and symptoms of UTI. 2. Provide health teaching 3.Encourage to increase fluid intake 4. Instruct patient to empty bladder completely Dependent: 5. Encourage to take vitamin C 500 mg1000mg/day 6. Encourage patient to finish all prescribed antibiotics

Rationale
1. History of UTI s, sexual activity; History of signs of sexually transmitted disease, may all place the individual at increased for developing UTI. 2.Reduce recurrence of infection 3. Fluids promotes renal blood flow and pushes bacteria from urinary tract; minimum fluid intake is 1 to 2L/day 4.Enhances bacterial clearance, reduce urine stasis and prevents reinfection 5. This acidifies urine; bacteria grow poorly in an acidic environment. Ideal urine ph around 5 6. Reduce development of resistance

Discharge Planning
M- Encourage patient to continue medications as prescribed by the physician. E- Provide a safe and clean environment. T- Encourage patient to drink fluids frequently especially water. H- Continue prescribed medications at home. O- Follow-up health care if any untoward signs and symptoms occur D- Encourage patient to eat foods rich in vitamin C. S- Assist patient in medication and treatment therapy; provide emotional support.