Acute Pain related to Urinary Tract Infection

Urinary Tract Infection (UTI) is one of the infections that are very common both in men and women. Pains that are unbearable and discomfort go along with urinary tract infection. Urinary tract infection is caused by bacteria particularly E. coli that enter the urinary tract, urethra and bladder.

Some symptoms of these are frequent urge to eliminate urine, blood in the urine, pains in the abdomen, and pain every time the patient urinate. Urinary tract infection recovery time differ as its seriousness does.

Generally, these kinds of infections are caused by bacteria from outside the body getting a foothold in the urinary tract. Poor hygiene and sexual intercourse are among the leading ways that these bacteria get in.

Irritants such as catheters can increase the chances of getting a UTI by wearing away at the protective layers of tissue in the urinary tract itself.

Home based or over the counter urinary tract infection remedies include:

• Drink lots of water. This will help flush the system and reduce the bacteria level to the point that your immune system can handle it.


• Avoid sugar, which will help to feed the bacteria.


• Unsweetened cranberry juice is a proven urinary tract infection remedy. Chemicals in the juice help prevent the bacteria from finding a purchase on the urinary tract walls.


• Orange juice and other acidic fruit juices help by increasing the acid content of the urine, which will further inhibit bacterial growth.

Nursing Diagnosis Acute Pain related to Urinary Tract Infection

Results Criteria:

• Patients report no pain during urination.


• There is no tension Bladder


• The patient appeared calm


• Calm expression

Nursing Interventions Acute Pain related to Urinary Tract Infection:

1. Assess the intensity, location, and factors that aggravate or relieve pain.
Rational: Pain is a great sign of infection

2. Provide adequate rest periods and activity levels that can be tolerant.
Rationale: Clients can rest in peace and to relax the muscles

3. Encourage drinking lots of 2-3 liters if no contraindications
Rational: To assist clients in urination

4. Give analgesics according to the therapy program.
Rational: Analgesic block the path of pain

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Angina Pectoris Nursing Care Plan

The classic symptom of coronary artery disease (CAD) is angina—pain caused by loss of oxygen and nutrients to the myocardial tissue because of inadequate coronary blood flow. In most but not all patients presenting with angina, CAD symptoms are caused by significant atherosclerosis. Unstable angina is sometimes grouped with MI under the diagnosis of acute coronary syndrome. Angina has three major forms: (1) stable (precipitated by effort, of short duration, and easily relieved), (2) unstable (longer lasting, more severe, may not be relieved by rest/nitroglycerin; may also be new onset of pain with exertion or recent acceleration in severity of pain), and (3) variant (chest pain at rest with ECG changes due to coronary artery spasm). The AHCPR guidelines of May 1994 state that unstable angina is a transitory syndrome that causes significant disability and death in the United States.

CARE SETTING
Patients judged to be at intermediate or high likelihood of significant CAD are often hospitalized for further evaluation and therapeutic intervention. Classification of angina (provided by Canadian Cardiovascular Society Classification [CCSC]) aids in determining the risk of adverse outcomes for patients with unstable angina and, therefore, level of treatment needs. Class III angina is identified as occurring if the patient walks less than two blocks and normal activity is markedly limited, and class IV angina occurs at rest or with minimal activity and level of activity is severely limited. These two classes may require inpatient evaluation/therapeutic adjustments.

NURSING PRIORITIES

1. Relieve/control pain.
2. Prevent/minimize development of myocardial complications.
3. Provide information about disease process/prognosis and treatment.
4. Support patient/SO in initiating necessary lifestyle/behavioral changes.

 DISCHARGE GOALS

1. Achieves desired activity level; meets self-care needs with minimal or no pain.
2. Free of complications.
3. Disease process/prognosis and therapeutic regimen understood.
4. Participating in treatment program, behavioral changes.
5. Plan in place to meet needs after discharge.

Desired Outcomes

1. Report/display decreased episodes of dyspnea, angina, and dysrhythmias.
2. Demonstrate increased activity tolerance.
3. Participate in behaviors/activities that reduce the workload of the heart.

Nursing intervention with rationale:

1.Maintain bed/chair rest in position of comfort during acute episodes.
Rationale: Decreases oxygen consumption/demand, reducing myocardial workload and risk of decompensation.
2. Monitor vital signs (e.g., heart rate, BP) and cardiac rhythm.
Rationale: Tachycardia may be present because of pain, anxiety, hypoxemia, and reduced cardiac output. Changes may also occur in BP (hypertension or hypotension) because of cardiac response. ECG changes reflecting ischemia/dysrhythmias indicate need for additional evaluation and therapeutic intervention.
3. Auscultate breath sounds and heart sounds. Listen for murmurs.
Rationale: S3, S4, or crackles can occur with cardiac decompensation or some medications (especially beta-blockers). Development of murmurs may reveal a valvular cause for chest pain (e.g., aortic stenosis, mitral stenosis) or papillary muscle rupture.
4. Provide for adequate rest periods. Assist with/perform self-care activities, as indicated.
Rationale: Conserves energy, reduces cardiac workload.
5. Stress importance of avoiding straining/ bearing down, especially during defecation.
Rationale: Valsalva maneuver causes vagal stimulation, reducing heart rate (bradycardia), which may be followed by rebound tachycardia, both of which may impair cardiac output.
6. Encourage immediate reporting of pain for prompt administration of medications as indicated.
Rationale: Timely interventions can reduce oxygen consumption and myocardial workload and may prevent/minimize cardiac complications.
7. Monitor for and document effects of/adverse response to medications, noting BP, heart rate, and rhythm (especially when giving combination of calcium antagonists, betablockers, and nitrates).
Rationale: Desired effect is to decrease myocardial oxygen demand by decreasing ventricular stress. Drugs with negative inotropic properties can decrease perfusion to an already ischemic myocardium. Combination of nitrates and betablockers may have cumulative effect on cardiac output.
8. Assess for signs and symptoms of heart failure.
Rationale: Angina is only a symptom of underlying pathology causing myocardial ischemia. Disease may compromise cardiac function to point of decompensation.
9. Administer supplemental oxygen as needed.
Rationale: Increases oxygen available for myocardial uptake to improve contractility, reduce ischemia, and reduce lactic acid levels.
10. Administer medications as indicated: Calcium channel blockers, e.g., diltiazem (Cardizem), nifedipine (Procardia), verapamil (Calan), bepridil (Vascor), amlodipine (Norvasc), felodipine (Plendil), isradipine (DynaCirc).
Rationale: Although differing in mode of action, calcium channel blockers play a major role in preventing and terminating ischemia induced by coronary artery spasm and in reducing vascular resistance, thereby decreasing BP and cardiac workload.

Angina Pectoris Nursing Care Plan

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Nursing Care Plan for Anorexia Nervosa

Anorexia nervosa is an illness of starvation, brought on by severe disturbance of body image and a
morbid fear of obesity. Bulimia nervosa is an eating disorder (binge-purge syndrome) characterized by extreme overeating, followed by self-induced vomiting. It may include abuse of laxatives and diuretics. Binge-eating is defined as recurrent episodes of overeating associated with subjective and behavioral indicators of impaired control over and significant distress about the eating behavior but without the use of inappropriate compensatory behaviors (e.g., purging, fasting, excessive exercise).

DSM-IV
307.1 Anoxexia nervosa
307.51 Bulimia nervosa
307.50 Eating disorders NOS
Binge-eating disorder (proposed, requiring further study)

ETIOLOGICAL THEORIES
Psychodynamics
The individual reflects a developmental arrest in the very early childhood years. The tasks of trust, autonomy, and separation-individuation are unfulfilled, and the individual remains in the dependent position. Ego development is retarded. Symptoms are often associated with a perceived loss of control in some aspect of life and may center on fears of sexual maturity/intimacy. Although these disorders affect women primarily, approximately 5% to 10% of those afflicted are men. Additionally, eating disorders are often associated with depression, anxiety, phobias, and cognitive problems.

Biological
These disorders may be caused by neuroendocrine abnormalities within the hypothalamus. Symptoms are linked to various chemical disturbances normally regulated by the hypothalamus. Furthermore, a physiological defect may make it difficult for the individual to interpret sensations of hunger and fullness.

Family Dynamics
Issues of control become the overriding factors in the family of the client with an eating disorder. These families often consist of a passive father, a domineering mother, and an overly dependent child. There is a high value placed on perfectionism in this family, and the child believes she or he must please others and satisfy these standards.

NURSING PRIORITIES
1. Reestablish adequate/appropriate nutritional intake.
2. Correct fluid and electrolyte imbalance.
3. Assist client to develop realistic body image/improve self-esteem.
4. Provide support/involve SO, if available, in treatment program to client/SO.
5. Coordinate total treatment program with other disciplines.
6. Provide information about disease, prognosis, and treatment.

DISCHARGE GOALS
1. Adequate nutrition and fluid intake maintained.
2. Maladaptive coping behaviors and stressors that precipitate anxiety recognized.
3. Adaptive coping strategies and techniques for anxiety reduction and self-control implemented.
4. Self-esteem increased.
5. Disease process, prognosis, and treatment regimen understood.
6. Plan in place to meet needs after discharge.

Nursing diagnosis of Anorexia Nervosa and Bulimia Nervosa: NUTRITION: altered, less than body requirements may be related to inadequate food intake; self-induced vomiting and chronic/excessive laxative use possibly evidenced by body weight 15% (or more) below expected (anorexia), or may be within normal range (bulimia, binge-eating), pale conjunctiva and mucous membranes; poor skin turgor/muscle tone, edema, excessive loss of hair; increased growth of body hair (lanugo), amenorrhea, hypothermia, bradycardia, cardiac irregularities, hypotension, electrolyte imbalances.

Desired Outcome:
1. Verbalize understanding of nutritional needs.
2. Establish a dietary pattern with caloric intake adequate to regain/maintain appropriate weight.
3. Demonstrate weight gain toward expected goal range.

Nursing intervention with rationale:
1. Establish a minimum weight goal and daily nutritional requirements.
Rationale: Malnutrition is a mood-altering condition leading to depression and agitation and affecting cognitive functioning/decision-making. Improved nutritional status enhances thinking ability, and psychological work can begin.

2. Involve client with team in setting up/carrying out program of behavior modification. Provide reward for weight gain as individually determined; ignore loss.
Rationale: Provides structured eating stimulation while allowing client some control in choices. Behavior modification may be effective only in mild cases or for short-term weight gain. Note: Combination of cognitive-behavioral approach is preferred for treating bulimia.

3. Use a consistent approach. Sit with client while eating; present and remove food without persuasion and/or comment. Promote pleasant environment and record intake.
Rationale: Client detects urgency and reacts to pressure. Any comment that might be seen as coercion provides focus on food. When staff member responds consistently, client can begin to trust her or his responses. The single area in which client has exercised power and control is food/eating, and she or he may experience guilt or rebellion if forced to eat. Structuring meals and decreasing discussions about food will decrease power struggles with client and avoid manipulative games.

4. Provide smaller meals and supplemental snacks, as appropriate.
Rationale: Gastric dilation may occur if refeeding is too rapid following a period of starvation dieting. Note: Client may feel bloated for 3–6 weeks while body readjusts to food intake.

5. Make selective menu available and allow client to control choices, as much as possible.
Rationale: Client who gains self-confidence and feels in control of environment is more likely to eat preferred foods.

6. Be alert to choices of low-calorie foods/beverages; hoarding food; disposing of food in various places such as pockets or wastebaskets.
Rationale: Client will try to avoid taking in what is viewed as excessive calories and may go to great lengths to avoid eating.

7. Maintain a regular weighing schedule, such as Monday/Friday before breakfast in same attire, on same scale, and graph results.
Rationale: Provides accurate ongoing record of weight loss/gain. Also diminishes obsessing about changes in weight.

8. Weigh with back to scale (depending on program protocols).
Rationale: Although some programs prefer client to see the results of weighing, this approach can force the issue of trust in client who usually does not trust others.

9. Consult with dietitian/nutritional therapy team.
Rationale: Helpful in determining individual dietary needs and appropriate sources. Note: Insufficient calorie and protein intake can lower resistance to infection and cause constipation, hallucinations, and liver damage.

10. Transfer to acute medical setting for nutritional therapy, when condition is life-threatening.
Rationale: The underlying problem cannot be cured without improved nutritional status. Hospitalization provides a controlled environment in which food intake, vomiting/elimination, medications, and activities can be monitored. It also separates the client from SO(s) and provides exposure to others with the same problem, creating an atmosphere for sharing.

Nursing Care Plan for Hypertension : Assessment, Diagnosis and Interventions

 Hypertension

The definition of hypertension, many raised by health experts. WHO suggests that hypertension occurs when blood pressure above 160/95 mmHg, meanwhile, Smelttzer & Bare (2002:896) suggests that hypertension is a persistent blood pressure or continuous thus exceeding the normal limit in which the systolic pressure above 140 mmHg and diastolic pressure above 90 mmHg.

There are differences about the limits of hypertension as proposed by Kaplan (1990:205), namely men, aged less than 45 years, said hypertension when blood pressure when lying above or equal to 130/90 mm ​​Hg, whereas at the age of 45 years, said hypertension when blood pressure above 145/95 mmHg.Whereas in women with blood pressure above 160/95 mmHg.

Based on these definitions can be concluded that hypertension is an increase in blood pressure where systolic pressure over 140 mmHg or diastolic over 90 mmHg.

The classification of hypertension are also expressed by many experts, including WHO set a classification of hypertension into three levels namely:

Level I: increased blood pressure without symptoms of the disorder or damage to the cardiovascular system.
Level II: blood pressure with symptoms of cardiovascular hypertrophy, but without any symptoms of damage or disruption of the appliance or other organs.
Level III: blood pressure increased with obvious symptoms of damage and disruption of the target organ physiology.

The cause of hypertension varied are: stress, obesity, smoking, hypernatremia, water and salt retention that is not normal, sensitivity to angiotensin, obesity, hypercholesterolemia, adrenal gland disease, kidney disease, toxemia gravidarum, increased intra-cranial pressure, caused by brain tumors, influence of certain drugs eg oral contraceptives, high salt intake, lack of exercise, genetics, obesity, atherosclerosis, kidney abnormalities, but largely unknown cause.

Nursing Care Plan for Hypertension

Nursing Assessment Nursing Care Plan for Hypertension


According to Doenges, (2004:41-42) and argued that the assessment of patients with hypertension include:

a. Activity and rest include: weakness, fatigue, shortness of breath, heart frequency increases, changes in heart rhythm.

b. Circulation includes: a history of hypertension, coronary heart disease, episodes of palpitations, increased blood pressure, tachycardia, sometimes sounding S2 heart sounds at the base of S3 and S4.

c. Ego integrity include: anxiety, depression, euphoria, irritability, facial muscle tension, anxiety, respiratory haul, increased speech patterns.

d. Elimination include: history of kidney disease.

e. Food / fluids include: food preferences especially those containing high salt, high fat, and cholesterol, nausea, vomiting, weight changes, a history of diuretic drugs, presence of edema.

f. Neuro-sensory include: complaints headache, throbbing, sub-occipital headache, weakness on one side of the body, visual disturbances (diplopia, blurred vision), epistaxis.

g. Pain / discomfort: include intermittent pain in the limbs, sub-occipital headaches severe abdominal pain, chest pain.

h. Respiratory include: shortness of breath after activity, cough with or without sputum, smoking history, medication use respiratory Bantu, additional breath sounds, cyanosis.

i. Security include: gait disturbance, paresthesia, postural hypotension.

j. Pembalajaran / extension in the presence of family risk factors are arteriosclerosis, heart disease, diabetes, kidney disease.

Nursing Diagnosis Nursing Care Plan for Hypertension (Doengoes, 2004)

a. Decreased cardiac output

b. Activity intolerance

c. Acute pain

d. Imbalanced Nutrition: More Than Body Requirements

e. Ineffective coping

 Nursing Diagnosis and Interventions for Hypertension

"My Personal Nursing Diagnosis"

 So…. In case any of you were wondering, I started nursing school at Lakeview College of Nursing a few weeks ago. I’ve been wanting to post sooooo many life happening moments to my blog since I started the program but that has been IMPOSSIBLE! Looking back at this summer, I wish I would’ve posted more things because I actually had time, but now I have no time. I wish I was exagerrating but I’m not…. so got some conclusions/jokes/thoughts/memorable moments/stuff, etc….. I would like to share from the last few weeks.

First off: I’ve met 3 AMAZING girls in my nursing program. Obviously I’ve met almost everyone (50 people) in the program… I see them all everyday…. but these three girls and I instantly hit it off.

My 3 Bffs are Kelsey, Holli, and Jenna. All very very individual…. such interesting ppl. I luv them. I get multiple texts from them. Daily. Poor Tyler, he just doesn’t understand why my phone keeps getting messages from these girls….. (my phone has a cool function where it states the name OUT LOUD when they call or text. Best thing ever, you might want to get it on your phone if you can.)

Found out in the 2nd week that Jenna has a boyfriend…. that’s a Miami Dolphin just got recruited as a corner and he played for U of I when they were pretty awesome. She’s so modest about it though, and its adorable. But I still thought it was funny when Tyler/my family turns on Sunday Football and they’re all asking about Jenna’s boyfriend…. and she’s like yeah he played, but they lost. She doesn’t highlight the fact that he plays, but he actually does play rather than stand on the sideline…. and when she talks about him its soooo sweet

ok, next bestie. She’s from F-ing town. Apparently we know the same people, but never knew each other and now we’re great friends. Then, I learned from my Aunt that Holli worked for the family that lived in the “mansion” in Effingham. Any of you that are from around this area know what I’m talking about. She was their nanny.

Then, there’s Kelsey. She’s a few years younger and she’s from my hometown. I’ve NEVER talked to her before seeing her at orientation. I’m shocked. She’s the most down-to-earth, sweetest girl I’ve ever met and I’m so glad we’ve become friends through this nursing thing.

Ok, so now to the good part, not that my friends aren’t interesting enough! This is what I’ve learned about nursing/myself in the last few weeks:

*I have the attention span of a Child! All of our classes are at least 3 hours long. After about 1 hour I’m all fidgety and I just CANNOT focus anymore. I tend to doodle a lot. Or daydream…. lately its been about weddings and I have no idea why. Maybe because there’s lots to think about with that…. and I tend to follow “New Beginnings” blog. And she had the most beautiful wedding and I’ve shown Tyler lots of pictures & explained that I want my ideal wedding like that. He doesn’t get it but at least he knows I have expectations for someday

*I’m the nerd of the class. Yep, who wants to be that kid. You know, “THAT” kid…. loser/teacher’s pet that raises their hand all the time…. that’s me. I can’t help it. I’ve had experience so I know the answers, but I also just wish the lecture would go quicker so we could get out sooner…..

*If I apply myself, I do well. I had a rough couple of years at U of I, but I’ve learned so much with how to take test and how to write papers. I’m still so glad to have that degree from U of I. this nursing stuff is TOUGH. I have no time at all, but at least it seems do’able as long as I read the material for class.

* I’ve lost my hearing. Okay, I’ve joked about it for years, but I really can’t hear. Even when I take blood pressures… its a struggle bc I simply CAN’T HEAR! I blame the headphones I used with my portable cd player in junior high… on the volleyball/cheerleader bus.

*I’m an ORANGE! We are taking this stupid weekend class for Lakeview and we have to attend 3 weekend classes this semester… the first weekend (6 days in a row for the first week of class.. plus only Sunday off, then 4 more lovely days of quizzes and tests), but we also have the weekend class this weekend…. and Halloween weekend. (don’t even get me started with that! It’s Henry’s first Halloween & I can’t do Friday or Saturday dressing up…. grrrr..) Back to topic. ORANGE. We took a personality test and had to pair up in groups. I scored very close in all catergories, but I had the most points in orange which is the Spontaneous person… very competitive, makes rash decisions. Our teacher decided to tell us that Oranges were BAD! um…. not too happy about that. Not at all. I used to be the “Blue” category, but I’ve become more Orange with life’s experiences.

*I love being in Nursing School when I can actually breathe and realize, “I’m in nursing school. This has been my ultimate goal.” seriously, I’ve waited to be in this program for so long, I’m just very very fortunate to be in it. And to be doing well in my grades. We have a test of quiz every time we go to class and its rough.

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Answer by Rachel Rose Griffin
Do you let your dog feed itself? I mean, just letting her eat whenever she feels like it? That could be the problem. I think there’s a certain amount you should feed your dog daily (like, example, 2 cups for 30lbs of dog). That could be the issue. There’s also treats that help with overweight dogs (not 100% positive if they work…but my dog certainly isn’t chunky and I let her feed herself

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If you enjoy woodworking, you’re most likely aware of the time and effort required to plan for a project. And just as likely, you’ve probably come up against the same old brick wall. I don’t know about you, but I like simple. I like it easy. I mean – Just think about it for a second.

and you probably wanted to call it quits or start again because your measurements were all wrong?

One of your free bonuses really sold me and it was the complete guide to shed woodworking techniques. The garden shed plans provided were also invaluable to me

Thanks again for your wonderful work and most of all for sharing your work in such a generous way"

I know because I wasted time and money at DIY stores. When I started on my first outdoor shed project 18 years ago, I thought I knew it all…

Dog training club to hold grooming seminar

Keeping one"s dog looking sharp between trips to the groomer is what the Sunday seminar of the Keystone Canine Training Club is all about. Titled "How to Maintain Your Dog Between Grooms," it will be held from 1 to 4 p.m. at the KCTC, 5167 Brownsville …

SPCA Offers Dog Training To Hawthorne Police

Hawthorne Police Chief Robert Fager is considering the offer to provide training for handling situations involving dogs that could be a threat, according to the spcaLA. "The more training you have, the more disciplined you are, the less likely you are …