Question

A 78-Year-old Female who is a known Diabetic (type 2 diabetes) comes into the Clinic with a 3 days history of Urgency, Frequency, and Burning when urinating. Patient had some episode of being Incontinent at home as well which she says is stressful.

Past Medical Hx

Dm Type 2 for 20 years Insulin Dependency, C section x2, Ankle Fracture 5 years ago. Continuous to have chronic pain in the Right ankle. Patient take Tylenol TID for pain.

BP 115/68, P=108, RR=16 T=101

Question 1. What should be Included in the Assessments?

  

Question 2. What Blood Test will be Ordered for this Patient to Evaluate her Diabetes? And what would be the result to demonstrate that Her DM is Under Control?

Patient has a UTI, which test would/could be abnormal. Prescribed an antibiotic from MD.

Write a Nursing Diagnosis?

Goal:

Two Nursing Intervention with Rationales?

What Teaching would need to be done Prior to discharge from Clinic?

How would the nurse Know that the discharge teaching has been effective?

Answer 1

1.The following has to be included in the assessment part for thus patient are

• Past medical history:Type 2 diabetes ×20 years
• Present medical history or presenting complaints or chief complaints:
  • Urgency ,frequent and burning micturation
  • Stressful
  • Pain in right ankle
• Past surgical history:C section ×2, Ankle fracture

Nursing Assessment

Subjective data:

• Frequent, urgent and burning urination
• Pain in Right ankle
• Stress

Objective data:

• Vitals:T:101 (elevated body temperature)
• Tachycardia (108bpm)
• Incintinency
• Stressful appearance

2.To evaluate her Diabetes the following test has to be done

• Random blood sugar immediately to know the current status (to demonstrate normal range of should be below 140mg/dl)
• Fasting and post pradial to assess the ranges and plan for treatment (to demonstrate normal range fasting should be less than 110mg/dl and post prandial:less than140mg/dl )
• Urine routine to rule out presence of any glucose,ketone in it (negative for glucose and ketone)
• HbA1C to asses the average blood sugar level of last 3 months (should be less than 6mmol/L for diabetic individual )

For UTI the following tests are required

• Blood test:CBC to rule out infection
• QUltrasound to assess the structure
• Urine routine or Urine analysis
• Urine culture for growth of any microorganisms
• Cystoscopy to rule out the structure of the bladder
• Intravenous program
• A CT scan to diagnose in detail

The preferred choice of antibiotics are Ciprofloxacin, Ceftriazone, amoxicillin, etc.,

Nursing Diagnosis

Impaired elimination pattern related to psychological factor ,weak pelvic floor ,increased age as evidenced by urgency, difficulty and burning urination

Nursing intervention and rationale

• Administer antibiotics as per order to treat infection
• Encourage patient to drink plenty of liquids to flush out the toxins and bacteria
• Maintain intake and output chart as dehydration can occur because of this condition

Some of the teaching necessary for patient are

• Perineal hygiene to prevent infection
• Adequate hydration to prevent dehydration
• Complete the antibiotic course as prescribed
• Report any severe lower abdominal pain ,hematuria or anu discomfort to the healthcare professionals
• Encourage cran berry juice this can flush the bacteria fro the urinary tract,vitamin C rich foods
• Void when feeling the urgency

The nurse could know the effectiveness of teaching by patient verbalizing in a positive way of following the above advice