UTI-Diverticulitis Care Plan PDF

Preview

Summary

Care Plan...

Description

Student Name:

Date:

Client Data: Initials: GM

Age: 93

Gender: Male

Weight: 66 kg (145 lbs)

Height: 167.67 cm (6 ft 6 inch)

Race/Ethnicity: Caucasian/White

Diet: Regular

Religion: Catholic

Room Number: 77-2

Allergies: Codeine

Marital Status: Widow

Code Status: Full code

Past Surgeries: 2001- Pacemaker placement 2005- Seed implantation in prostate 2006- Carotid endarterectomy 2010- Partial resection of colon 2015- Insertion revision pacemaker 2019- Cystoscopy suprapubic tube replacement and urethral dilation Vital Signs:

Consults: Home health care

Social Habits: Former smoker -Quit 20+ years ago Current everyday beer drinker Substance abuse – Never Lives alone Has worked for over 20 years in a flea market

B/P: 158/61

P: 70

R: 18

T: 97.6

SAO2 sat: 98% RA

150/64

72

18

97.3

98% RA

Present History: Admitting Medical Diagnosis: A. Why client is in hospital: 

Patient reports leaky catheter and loose stool.

B. Admitting Diagnosis Information: 

Urinary tract infection

Definition/Etiology/Pathophysiology: Urinary tract infections (UTI) are caused by pathogenic microorganisms that enter the urinary tract (kidney, bladder, urethra). Usually, bacteria that enters the urinary tract system is eliminated by the body before they can cause symptoms. However, in some cases, bacteria overcome the natural defenses of the body, therefore causes infection (Cleveland Clinic, 2020). An infection in the urethra is called urethritis. This type of UTI can occur when GI bacteria spread from the anus to the urethra. In females, the urethra is close to the vagina, sexually transmitted infections, such as herpes, gonorrhea, chlamydia, and mycoplasma can cause urethritis (Cleveland Clinic, 2020). A bladder infection is called cystitis. 80% - 90% of the time, this type of UTI is caused by Escherichia coli (E. coli), a bacterium commonly found in the gastrointestinal (GI) tract. However, sometimes other bacteria are responsible such as Klebsiella, Enterococcus, Proteus mirabilis, and Staphylococcus saprophyticus (Cleveland Clinic, 2020). Bacteria may ascend to the ureters to multiply and cause the infection of the kidneys, which is called pyelonephritis (Cleveland Clinic, 2020). Asymptomatic bacteriuria is present if a patient has two consecutive urine cultures showing more than 100,000 colony-forming units (CFU) in urine but does not have any symptoms of a UTI. This is only treated in some instances, such as before a urological operation, immunosuppressed people, men, pregnant women, diabetics, those with a history of pyelonephritis, or those with structural abnormalities of the urinary tract (Lees, n.d.).

According to Mayo Clinic (2021), he following are risk factors: 

Female anatomy. A woman has a shorter urethra than a man, which shortens the distance that bacteria must travel to reach the bladder.



Sexual activity. Sexually active women tend to have more UTIs than men who are not sexually active. Having a new sexual partner also increases your risk.



Certain types of birth control. Women who use diaphragms for birth control may be at higher risk and women who use spermicidal agents.



Menopause. The decline of estrogen causes changes in the urinary tract that make you more vulnerable to infection.



Urinary tract abnormalities. Babies born with urinary tract abnormalities that do not allow urine to leave the body normally or cause urine to back up in the urethra have an increased risk of UTIs.



Blockages in the urinary tract. Kidney stones or an enlarged prostate can trap urine in the bladder and increase the risk of UTIs.



Suppressed immune system. Diabetes and other diseases that impair the immune system can increase the risk of UTIs.



Catheter use. People who cannot urinate independently and use a catheter to urinate have an increased risk of UTIs. This may include hospitalized people, people with neurological problems that make it difficult to control their ability to urinate, and paralyzed people.



A recent urinary procedure. Urinary surgery or an exam of the urinary tract involving medical instruments can increase the risk of developing a urinary tract infection.

Clinical Manifestations/signs and symptoms: Urinary tract infections are not always symptomatic, but when they do, they may include (Mayo Clinic, 2021): 

A strong, persistent urge to urinate



Incontinence



A burning sensation when urinating



Passing frequent, small amounts of urine



Cloudy urine



Red, bright pink, or amber-colored urine indicates blood in the urine



Strong-smelling urine



Mental changes or confusion



Pain during sex



Vomiting



Fever



Fatigue



Penis pain



Pressure in the lower pelvis

In older adults, UTIs can be mistaken for other conditions. Each type of UTI may result in more specific signs and symptoms, depending on which part of the urinary tract is infected (Mayo Clinic, 2021). 





Pyelonephritis 

Back pain or flank pain



High fever



Shaking and chills



Nausea



Vomiting

Cystitis 

Pelvic pressure



Lower abdomen discomfort



Frequent, painful urination



Blood in urine

Urethritis 

Burning with urination



Discharge

Medical Management: The course of action and length of treatment for urinary tract infections depends on the severity and type of bacteria found in the urine (Mayo Clinic, 2021) Drugs commonly recommended for simple UTIs include:  Trimethoprim/sulfamethoxazole (Bactrim, Septra)  Fosfomycin (Monurol)  Nitrofurantoin (Macrodantin, Macrobid)  Cephalexin (Keflex)  Ceftriaxone Antibiotic medicines known as fluoroquinolones, such as ciprofloxacin (Cipro), are generally not recommended for simple UTIs, as the risks outweigh the benefits. In complicated UTI or kidney infection, the healthcare provider might prescribe a fluoroquinolone medicine if there are no other treatment options. Usually, UTI symptoms clear up within a few days from starting treatment. However, antibiotic treatment may need to continue for a week or more. Take the entire course of antibiotics as prescribed. For an uncomplicated UTI that occurs when otherwise healthy, the healthcare provider may recommend a shorter course of treatment, such as taking an antibiotic for one to three days. Nevertheless, whether this short course of treatment is enough to treat the infection depends on the symptoms the person is experiencing and the medical history. The healthcare provider may also prescribe a pain medication (analgesic) that numbs the bladder and urethra to relieve burning while urinating, but the pain usually is relieved soon after starting an antibiotic. For frequent urinary tract infections, the healthcare provider may make certain treatment recommendations, such as:  Low-dose antibiotics: initially for six months but sometimes longer  Self-diagnosis and treatment: only if the patients are in constant communication with the healthcare provider  A single dose of antibiotic after sexual intercourse: if the infections are related to sexual activity  Vaginal estrogen therapy: for postmenopausal women For severe UTIs, treatment with intravenous antibiotics in a hospital may be needed.

Past History/Secondary Diagnosis: 

Diverticulitis

Definition/Etiology/Pathophysiology: Diverticulitis is a condition where small, bulging pouches, named diverticula, develop in the colon or large intestine, and become inflamed or infected. They can show up anywhere in the intestines. These pouches generally are not harmful. Sometimes, diverticulitis is minor, but it can also be severe. Diverticulitis can cause massive infections, abscesses, or perforation in the bowel (Mayo Clinic, 2020) According to Mayo Clinic (2020), several factors may increase the risk of developing diverticulitis, such as:  Gender- Males are more at risk of developing diverticular diseases  Aging- The incidence of diverticulitis increases with age.  Obesity- Being seriously overweight increases the odds of developing diverticulitis.  Smoking- People who smoke cigarettes are more likely than nonsmokers to experience diverticulitis.  Lack of exercise- Vigorous exercise appears to lower the risk of diverticulitis.  Diet high in animal fat and low in fiber- A low-fiber diet in combination with a high intake of animal fat seems to increase risk, although the role of low fiber alone is not clear.  Certain medications- Steroids, opioids, and NSAIDs, such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), are associated with an increased risk of diverticulitis. About 25% of people with acute diverticulitis develop complications, which may include:  Abscesses occurs when pus collects in the pouches.  A blockage in the bowel caused by scarring.  An abnormal passageway, known as fistula, between sections of the bowel or between the bowel and other organs.  Peritonitis can occur if the infected or inflamed pouch ruptures, spilling intestinal contents into the abdominal cavity. Peritonitis is a medical emergency and requires immediate care.

Clinical Manifestations/signs and symptoms: The signs and symptoms of diverticulitis include:  Pain  It may be constant and persist for several days. The lower left side of the abdomen is the usual site of the pain. Sometimes, the right side of the abdomen is more painful, especially in people of Asian descent.  Nausea and vomiting  Fever  Abdominal tenderness  Constipation  Diarrhea (uncommon)  Rectal bleeding

Medical Management: For mild cases of diverticulitis, healthcare providers will prescribe oral antibiotics such as:  Metronidazole (Flagyl)  Trimethoprim-sulfamethoxazole (Bactrim)  Ciprofloxacin (Cipro)  Amoxicillin  Clavulanic acid (Augmentin) Rest, taking over-the-counter medications for pain, and following a low-fiber diet or a liquid diet may be recommended until symptoms improve. Once symptoms improve, you can slowly return to soft foods, then a more normal diet, including many high-fiber foods. For more severe diverticulitis, if experiencing rectal bleeding or repeat bouts of diverticulitis, hospitalization may be needed to receive intravenous antibiotics and fluids or possible surgery. Surgical intervention is considered if the patient has:  Abscesses- A contained or “walled-off” infection in the abdomen. If the fluid in an abscess is not successfully drained with a needle or catheter, surgery is needed. In surgery, the abscess is cleaned up, and the affected part of the colon is removed.  Perforation/peritonitis- A tear in the colon that allows pus or stool to leak into the abdominal cavity, resulting in peritonitis. A life-threatening infection that requires emergency surgery to clean the cavity and remove the damaged part of the colon.  Blockages or strictures- Previous infections in the colon can cause scars to form, resulting in a partial or complete blockage or narrowing of sections of the colon. A complete blockage requires surgery; partial blockage does not.  Fistulas- Abnormal passageway or tunnel that forms and connects with another organ. A fistula in the colon can connect to the skin, bladder, vagina, uterus, or another part of the colon. Most fistulas do not close on their own, so surgery is needed.  Continued rectal bleeding (also called diverticular bleeding)- Occurs when a small blood vessel near the diverticula bursts. Mild bleeding usually stops on its own, but about 20% of cases require treatment. Surgery may be needed if other attempts to stop the

bleeding fail, such as clipping, drug infusion, or cauterizing the bleeding artery. If bleeding is heavy and rapid, emergency surgery is needed.  Severe diverticulitis that has not responded to other treatment methods.  Multiple bouts id diverticulitis despite following a high-fiber diet. You and your surgeon may decide that removing the diseased part of the colon is the best method to prevent future attacks. Surgery usually involves removing part of the colon. During surgery, the diseased section of the colon is removed, and the colon is reattached to the rectum. Depending on the extent and severity of the disease, surgery can be performed in a single surgery, in two surgeries, in an open procedure, or by a minimally invasive laparoscopic procedure. A colostomy is not always needed, but in severe cases, a colostomy may be needed temporarily while the colon heals. Once healed, the colon is reattached to the rectum, and the colostomy remove. A colostomy involves bringing the healthy end of the colon to the skin's surface through a hole made in the abdominal wall. A colostomy bag attaches to the colon on the surface of the skin to collect fecal waste.

List of Medications Medication Name/ Frequency

Nursing Implication

Indication

Actions

Contraindication

Side Effects

Piperacillin/Tazobact am (Zosyn)- 3.375g, IVPM every 8 hours x 7 days

Indicated for the treatment of patients with moderate to severe infections caused by susceptible isolates of the designated bacteria in the conditions listed below: - Intra-abdominal Infections - Skin and Skin Structure Infections - Female Pelvic Infections - Community-acquired Pneumonia - Nosocomial Pneumonia

Tazobactam inhibits beta lactamase and prevents the destruction of piperacillin. Therefore, tazobactam is given with piperacillin to enhance the activity of piperacillin in eradicating bacterial infections. Piperacillin kills bacteria by inhibiting the synthesis of bacterial cell walls.

Piperacillin and tazobactam for injection is contraindicated in patients with a history of allergic reactions to any of the penicillin, cephalosporins, or βlactamase inhibitors.

confusion, dizziness, headache, insomnia, lethargy. diarrhea, constipation, drug-induced hepatitis, nausea, vomiting. interstitial nephritis. rashes (increased in cystic fibrosis patients), urticaria. bleeding, leukopenia, neutropenia, thrombocytopenia. pain, phlebitis at IV site. hypersensitivity reactions, fever (increased in cystic fibrosis patients), superinfection.

Assess patient for infection (vital signs, appearance of wound, sputum, urine and stool, and WBC count) at beginning of and during therapy. Obtain medication allergy history. Obtain specimens for culture and sensitivity prior to initiating therapy. Observe for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue and notify healthcare provider if these occur. Keep epinephrine, and resuscitation equipment close by in the event of an anaphylactic reaction. Evaluate renal and hepatic function, CBC, serum potassium, and bleeding times prior to and routinely during therapy. Family and patient education: Report rash, itching, or other signs of hypersensitivity immediately. Report loose stools or diarrhea as these may indicate pseudomembranous colitis. Do not breast feed while taking this drug without consulting physician.

Ondansetron hydrochloride (Zofran) 4mg- 2mL, IV, Inj. Every 4 hours as needed for nausea

Zofran tablets are indicated for the prevention of nausea and vomiting associated with: highly emetogenic cancer chemotherapy, including cisplatin greater than or equal to 50 mg/m2

Zofran is a selective 5HT3 receptor antagonist. While its mechanism of action has not been fully characterized, ondansetron is not a dopamine-receptor antagonist. Serotonin receptors of the 5-HT3 type are present both

Zofran is contraindicated in patients: Known to have hypersensitivity (e.g., anaphylaxis) to ondansetron or any of the components of the formulation

More common: Confusion Dizziness Fast heartbeat Fever Headache Shortness of breath Weakness

Receiving concomitant apomorphine due

Less common: Decrease in the

Monitor fluid and electrolyte status. Diarrhea, which may cause fluid and electrolyte imbalance, is a potential adverse effect of the drug. Monitor cardiovascular status, especially in patients with a history of coronary artery dis-

initial and repeat courses of moderately emetogenic cancer chemotherapy radiotherapy in patients receiving either total body irradiation, single high-dose fraction to the abdomen, or daily fractions to the abdomen Ondansetron tablets are also indicated for the prevention of postoperative nausea and/or vomiting.

Famotidine (Pepcid) 20mg – 1 tablet by mouth once a day

Short term treatment of active duodenal ulcer. Maintenance therapy for duodenal ulcer patients at reduced dosage after healing of active ulcer. Short term treatment of active benign gastric ulcer. Short term treatment

peripherally on vagal nerve terminals and centrally in the chemoreceptor trigger zone of the area postrema. It is not certain whether ondansetron’s antiemetic action is mediated centrally, peripherally, or in both sites. However, cytotoxic chemotherapy appears to be associated with release of serotonin from the enterochromaffin cells of the small intestine. In humans, urinary 5hydroxyindoleacetic acid (5-HIAA) excretion increases after cisplatin administration in parallel with the onset of emesis. The released serotonin may stimulate the vagal afferents through the 5-HT3 receptors and initiate the vomiting reflex.

to the risk of profound hypotension and loss of consciousness

Famotidine competitively inhibits the binding of histamine to H2receptors on the gastric basolateral membrane of parietal cells, reducing basal and nocturnal gastric acid secretions. The drug also decreases the gastric acid response to stimuli such as food, caffeine, insulin, betazole, or

Hypersensitivity to any component of these products. Cross sensitivity in this class of compounds has been observed. Therefore, PEPCID should not be administered to patients with a history of hypersensitivity to other H2-receptor antagonists.

frequency of urination Decrease in the urine volume Difficulty with passing urine Painful urination Rare: Arm, back, or jaw pain Chest pain or discomfort Chest tightness or heaviness Convulsions Cough Decreased urine Breathing difficulty Swallowing difficulty Dry mouth Fast, pounding, or irregular heartbeat or pulse Increased thirst Loss of appetite Loss of bladder control Loss of consciousness Mood chances Muscle pain or cramps Nausea and vomiting Numbness or tingling in the hands, feet, or lips Puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue Skin rash, hives, or itching Sweating Side effects of Pepcid are not common, but may include: Constipation Diarrhea Fatigue Dizziness Weakness Mood changes Headache Insomnia Muscle pain or cramps Joint pain Dry mouth

ease. Rare cases of tachycardia and angina have been reported. Family and patient education: Be aware that headache requiring an analgesic for relief is a common adverse effect.

If using one dose a day, admin...