I. General profile Name: Mrs.

LVG Age: 31 years old Gender: Female Civil Status: Married Birth Date: August 6, 1980 Place of Birth: San Fabian, Pangasinan Address: San Marcos, Agoo, Launion Religion: Roman Catholic Occupation: Fish Vendor Nationality: Filipino Ward: Medical Ward Admitting Physician: Dr. V.D Date and Time Admitted: November 20, 2011; 9:30am Admitting diagnosis: Urinary Tract Infection, Severe Typhoid Fever II. Chief Complaint The client experienced fever, dysuria, hypogastric pain, vomiting and urinary frequency hence, she sought medical care. III. History of Present Illness According to the patient, two weeks prior to admission, she experienced pain on the hypogastric area (which she described as dull and rated 7/10, with 10 as the worst), painful urination (rated 5/10), fever, urinary frequency and urgency but passes urine in small amount only. The patient also verbalizes disturbance in her sleep pattern because often times, she wakes up at night feeling the urge to urinate. No consultation was done and no medication was taken. Eight days prior to admission, the signs and symptoms still persisted. She consulted an albularyo because she believed that this is a form of being possessed, still, no consultation and no medications were given. Five days prior to admission, patient experienced chills, on and off fever, 4 episodes of watery stool/ diarrhea, low back pain (rated 5/10) and body weakness and she still believed that these were symptoms of being possessed, still no consultation was done and no medications was taken. One day prior to admission, the sign and symptoms still persisted. A few hours prior to admission, patient felt hypogastric pain rated 7/10, dysuria with frequency, urgency and passage of urine in small amounts, vomiting (3 episodes), 4 episodes of watery stool and fever. Due to persistent of the sign and symptoms, the patient and her husband decided to seek medical consultation at La Union Medical Center where she was admitted for management and further evaluation.

IV. Past Medical History According to Mrs. LVG, this was her first time to be hospitalized. When she gave birth, she only delivered at home since her neighbor is a manghihilot. About 9 years ago, she had a miscarriage with her supposed first baby at 3 months age of gestation. She was attended by her manghihilot. Other past diseases usually includes cough and colds and no previous history of being diagnosed with urinary tract infection and typhoid fever. V. Social and Environmental History Patient LVG is a fish vendor while her husband works as a farmer. Their income is not enough for their needs since her husband work only during planting and harvest season of rice. She believes in manghihilot /albularyo since her neighbor is a manghihilot. She also believed in the concept of witchcraft and of being possessed by evil spirits. When inflicted with a disease, they usually ask their neighbor manghihilot first for consultation. They also turn to God and attend a mass when they believe that the illness is caused by being possessed. VI. Family History Pertinent family reveals no significant finding. Also the patient has no known family history of hypertension, asthma, and diabetes mellitus. Also, no other family member is having, as well as any history of having, urinary tract infection nor typhoid fever. VII. Physical Examination (13 Areas of Assessment) I. Social Status Mrs. LVG is 31yrs. old, born on August 6, 1980. She resides at San Marcos, Agoo, La Union together with her husband, two children and in-laws. Her children ages 6 and 7 years old both male. Mrs. LVG is an extended family, Roman Catholic and a fish vendor, while her husband works as a farmer only during planting and harvest season of rice, both are high school graduate with a family income of 5 thousand pesos per month which according to Mrs. LVG is not enough for them to meet their basic needs. Mrs. LVG resides in a medium size house made up of concrete with two rooms. The house is located in a congested area. Deep well is their source of water and their garbage is disposed only at the back of their house. Their comfort room is common with their two neighbors. Due to present illness her lifestyle is affected. Before she had this disease patients was socially active, since she is a fish vendor she is easily get along with and had a charistma to her costumer but at present she was not able to sell in the market and mingle with her neighbor. Mrs. LVG also stated that she do not smoke and drink alcohol.

II. Mental Status Mrs. LVG is conscious and coherent, oriented to time and date, she is a high school graduate and is able to read and right and follow instructions, able to maintain eye contact. Her chronological age is directly proportional to her developmental age where her focused includes financial security, career and family according to Sullivans stages of development. She is open and approachable and is able to converse with the student nurses.

III. Emotional Status Prior to hospitalization, according to Mrs. LVG she is cheerful, she loves making conversation with her neighbors and co-vendors in the market, during hospitalization she is still cheerful and makes some joke during assessment, but when it comes to financial aspect she stated that they do not know where to get money for her hospitalization since majority of their income comes from her as a fish vendor. She is also worried to her two children because ever since she experiences her sickness they were not able to go to school.

IV. Sensory Perception She is using reading glasses due to blurring of vision. Her hearing ability is normal using whisper test with distance of two feet. Her sense of smell is normal and she can distinguish foul and fresh odor. Her lips are light brown in color. Her tongue is slightly pink and she can taste whatever food she eats.

V. Motor Ability According to Mrs. LVG, she usually has leg cramps that occur anytime of the day. There is no presence of deformity. Patient can bend her legs and arms and no need of assistance when standing and going to the comfort room.

VI. Temperature The table below shows the temperature of Mrs. LVG during the shift Date November 21 November 22 November 23 Time 11 pm 3 am 11 pm 3am 11pm 3am Temperature 37.9C 38.2C 36.9C 38.3C 37.3C 37.4C

VII. Respiratory Status Respirations were normal in pattern. Table below shows respiratory patterns during shift; Date November 21 November 22 November 23 Time 11pm 3am 11pm 3am 11pm 3am Respiratory Rate 21Bpm 20Bpm 23Bpm 21Bpm 22Bpm 20Bpm

VIII. Circulatory Status Upon admission, the patients heart rate is 89bpm with a blood pressure of 110/80mmHg. On the initial student nurse-patient interaction, the heart rate is 89bpm with a blood pressure of 110/80mmHg. The rhythm is regular and with normal peripheral pulse (moderate pressure felt on the fingers). Upon auscultation, normal heart sounds were heard and no murmurs. No jugular vein distension and no pallor or cyanosis was noted and with capillary refill of less than 2 seconds. IX. Nutritional Status Mrs. LVG stated that prior to hospitalization, Madalas isda ang ulam namin, yung natitira sa tinitinda ko yun din ang inuulam namin. She drinks only 3-4 glasses of water a day, and because of her occupation as a vendor in the market she consumed more softdrinks and they called palamig than water. She usually eats in karinderia during lunch time. The patient is with ongoing IVF of D5LRS 1 litter x 30gtts/min. X. Elimination Status Mrs. LVG stated that she usually defecates a semi formed stool once a day in the morning before going to the market, but prior to hospitalization she defecated three times. She usually voids three to four times a day but when she had a UTI she passes a small amount of urine. She also vomited 3 times during her stay in the hospital.

XI. Reproductive System According to Mrs. LVG, she had her menarche when she was 13 years old with an OB score of G3P2. She had 1 miscarriage more than 9 years ago. She had no history of surgical operation. such as BTL and did not undergo Caesarian Section. She uses oral contraceptive as her contraception or family planning. XII. Physical Rest and Comfort Prior to hospitalization, Mrs. LVG stated that she sleeps 4-6 hours a day without any routine going to sleep. She stated sanay naman na ako sa puyatan kasi medaling araw palang nasa bagsakan na ako sa palengke para makakuha ng ititinda ko. She also stated that if she have time at day time she take a nap for a while. She is not comfortable due to painful urination she experiencing. XIII. State of Skin As we assessed the client, there is IV site at his right hand. There is absence of infiltration or phlebitis. Client was pinched at her arms; we observed that the skin returns to its original state slowly. His skin is warm and non tender. Skin is dry. M r s . L V B h a i r i s b l a c k w i t h e v e n d i s t r i b u t i o n o n t h e s c a l p , eyebrows and eyelashes.

XIII. Diagnostics

Date and time the diagnostic procedure is conducted 11-20-2011 9:30am

Diagnostic procedure Urinalysis

Description of the diagnostic procedure Urinalysis is the physical, chemical, and microscopic examination of urine. It involves a number of tests to detect and measure various compounds that pass through the urine

Significance/purpos e of the procedure Urinalysis serves many functions. It can be used to screen patients for kidney and urinary tract disease and can help detect metabolic or systemic disease. Results of urine test are based on the elements that make up urine. Even with normal findings, these elements have certain characteristics.

Implications of the findings The appearance of the urine is turbid, it indicates there are cells or other particulate matter. The ph value is 5 and the normal value is 5.0 -9.0.. Albumin value is +++ scale of albumin indicates that there is a protein excretion of over 2500mg/24hrs. which may indicate renal disease. There is no sugar found in the urine. The specific gravity is within normal range. Pus cells are present which could indicate presence of urinary tract infection. RBC level is >20 This indicates that there is a complicated urinary tract infection. The amount of epithelial cells found are within the normal range. Epithelial cells found are occasional, there should be none or rarely found in the urine it indicates that there is inflammation on the bladder. The appearance is slightly turbid it indicated there are still cells or other particulate matter. The PH value is 5and it is still with in the normal range. Same as Specific gravity. There is still trace of albumin, No sugar found in the urine. Pus cells value 10-12 still elevated it means that there is urinary tract infection. The RBC value is 0-2 and it is with in the normal range. Epithelial cells found are plenty, there should be none or rarely found in the urine it indicates that there is inflammation on the bladder IgM and IgG are both positive. This indicates that the body has produced antibodies against typhoid bacilli

11-22-2011

Urinalysis

The procedure was repeated to know if the treatment is responding to the patient

11-20-2011

Serology typhidot

Thyphidot is a test involving agglutination of typhoid bacilli when they are

This test is done to diagnose typhoid fever.

IX. Medical Diagnosis Final/ Principal: Urinary Tract Infection; Severe Typhoid Fever

XI. Treatment/ Management a. Drug Study Trade Name and Generic Name (-N-Acetyl-paminophenol) Acetaminophen Classification of the drugs Antipyretic Analgesic(nonopioid) Mechanism of action

Side effects

Nursing interventions Do not exceed the recommended dosage. Consult physician if needed for children less than 3 year; if needed for longer than 10 days; if continued fever, severe or recurrent. pain occurs (possible serious illness). Avoid using multiple preparations containing acetaminophen. Carefully check all OTC products. Give drug with food if GI upset occurs. Discontinue drug if hypersensitivity reactions occur. Treatment of overdose: Monitor serum levels regularly, N- acetylcysteine should be svsilsble as a specific antidote; basic life support measures may be necessary.

Antipyretic- Reduces fever by acting directly on the hypothalamic heat-regulating center to the cause vasodilatation and sweating, which helps dissipate heat. Analgesic- Site and mechanism of action unclear.

SNS: Headache CV: Chest pain, dyspnea, myocardial damage when doses of 5-8g/day are ingested daily for several weeks or when doses of 4g/day are ingested for 1 yr. GI:Hepatic toxicity and failure, jaundice GU: Acute renal failure, renal tubular necrosis Hematologic: Methemoglobinemia -cyanosis, hemolytic anemia-hematoria, anuria; nuetropenia, leucopenia, pancytopenia, thrombocytopenia, hypoglycemia Hypersensitvity: Rash, fever

Trade Name and Generic Name Hyoscine n-butylbromide/ Scopolamine butylbromide ( Buscopan)

Classification of the drugs Belladonna, alkaloid, antimuscarini

Mechanism of action Inhibits muscarinic actions of acetylcholine on autonomic effectors innervated by postganglionic cholinergic neurons. May affect neural pathways originating in the inner ear to inhibit nausea and vomiting.

Side effects CNS: disorientation, restlessness, irritability, dizziness, drowsiness, headache, confusion, hallucinations, delirium, impaired memory CV: paradoxical bradycardia, palpitations, tachycardia, flushing EENTL dilated pupils, blurred visions, photophobia, increased intraocular pressure, difficulty swallowing GI: constipation, dry mouth, epigastric distress, nausea, vomiting GU: urinary hesitancy, urine retention RESPIRATORY: bronchial plugging, depressed respirations SKIN: rash, dryness, contact dermatitis with transdermal patch OTHER: heat intolerance

Nursing interventions .Raise side rails as a precaution because some patients become temporarily excited or disoriented and some develop amnesia or become drowsy. Reorient patient, as needed Tolerance may develop when therapy is prolonged. Atropine like toxicity may cause dose-related adverse reactions. Individual tolerance varies greatly. Overdose may cause curare like effects such as respiratory paralysis. Keep emergency equipment available.

Trade Name and Generic Name

Rocephin Ceftriaxone

Classification of the drugs

Antibiotic Cephalosporin(third generation)

Mechanism of action
Bactericidal, inhibits cynthesis of bactericidal cell wall, causing ioncell death

Side effects
CNS: Headache, dizziness, lethargy, paresthesias GI:Nausea,vomiting, diarrhea,anorexia, abdominalpain, flatulence, pseudomembranous colitis, hepatotoxicity. GU:nephrotoxicity Hematologic: Bone marrow depressiondecreased WBC, decreased platelets, decreased Hct. Hypersensitivity: Ranging from rash to fever to anaphylaxis; serum sickness reaction. Local: Pain, abscess at injection site; phlebitis, inflammation at IV site. Other: Superinfections, disulferam-like reaction with alcohol.

Nursing interventions
Culture infection, and arrange for sensitivity test before and during therapy if expected response is not seen. Reconstitute for IM use with sterile water injection, 0.9% sodium chloride, solution, 5% dextrose solution, bacteriostatic water with 0.9% benzyl alcohol, or 1% lidocaine solution (without epinephrine); inject deeply into a large muscle group. Check manufacturers inserts for specific details. Stability of reconstituted and diluted solution depends on diluent , concentration and type of container (eg, glass, PVC) Protection drug from light. Monitor ceftriaxone blood levels in patients with severe renal impairment and in patients with renal and hepatic impairment. Have vitamin K available in case

hypoprothrombinemia occurs. Discontinue if hypersensitivity reaction occurs.

Trade Name and Generic Name Ciprofloxacin Cipro, Cipro I.V, Cipro XR, Ciproxin, Proquin XR

Classification of the drugs Fluoroquinotone

Mechanism of action Inhibits bacterial DNA synthesis, mainly by blocking DNA gyrase; bactericidal

Side effects CNS: confusion, depression, dizziness, drowsiness, fatigue, hallucination, headache, insomnia, light-headedness, paresthesia, restlessness, tremor CV: chest pain, edema, thrombophlebits GI: diarrhea, nausea, abdominal pain or discomfort, constipation, dyspepsia, flatulence, oral candidiasis, vomiting GU: crystalluria, interstitial nephritis MUSCULOSKELETAL: aching, arthralgia, arthropathy, joint inflammation, joint or back pain, joint stiffness, neck pain, tendon rupture SKIN: rash, burning, erythema, exfoliative dermatitis, photosensitivity,pruritis OTHER: hypersensitivity reactions

Nursing interventions Monitor patients intake and output and observe patient for signs of crystalluria. Some drugs may require waiting up to 6 hours after giving this drug to avoid decreasing its effects. Food doesnt affect absorption but may delay peak levels. Tendon rupture may occur in patients receiving quinolones. If pain or inflammation occurs or if patient ruptures a tendon, stop drug

Trade Name and Generic Name Multi vitamin + Fe Fero-Folic 500, Theragran Hematinic, Iberet-Folic-500, Dialyvite, Chromagen FA (obsolete), Chromagen Forte (obsolete), TriHEMIC 600, Chromagen (obsolete), Nephro-Vite with Fe, Allbee-C 800 with Iron, Livitrinsic-F, Foltrin, Intrinsitinic, Ferotrinsic, Contrin, Trinsicon, Niferex-150 Forte (obsolete), Iberet-500, Generet-500 with Folic Acid, Vi-Daylin with Iron, Dayalets Plus Iron, Nephron-FA, Sesame St. Vitamins Plus Iron

Classification of the drugs Vitamins and or minerals

Mechanism of action Multivitamin and iron are used to provide vitamins and iron that are not taken in through the diet. They are also used to treat iron or vitamin deficiencies caused by illness, pregnancy, poor nutrition, digestive disorders, and many other conditions.

Side effects severe stomach pain, vomiting, bloody diarrhea, coughing up blood, constipation, loss of appetite, hair loss, peeling skin, warmth or tingly feeling, changes in menstrual periods, weight loss, severe headache, muscle or joint pain, severe back pain, blood in your urine or stools, black and tarry stools, pale skin, easy bruising or bleeding, weakness, shallow breathing, weak and rapid pulse, pale skin, blue lips, and seizure (convulsions).

Nursing interventions Never take more than the recommended dose of a multivitamin. Avoid taking any other multivitamin product within 2 hours before or after you take multivitamin with iron. Taking similar vitamin products together at the same time can result in a vitamin overdose or serious side effects. Do not take this medication with milk, other dairy products, calcium supplements, or antacids that contain calcium. Calcium may make it harder for your body to absorb certain ingredients of the multivitamin with iron.

b. IV Fluids Type of IV Fluid 5%dextrose in lactated ringers solution

Components of the fluid Water, electrolytes, and calories. One liter has an ionic concentration of 130 mEq sodium, 4 mEq potassium, 2.7 mEq calcium, 109 mEq chloride and 28 mEq lactate. The osmolarity is 525 mOsmol/L (calc). Each 100 mL contains 5 g Dextrose Hydrous, USP*; 600 mg Sodium Chloride, USP (NaCl); 310 mg Sodium Lactate (C3H5Na03); 30 mg of Potassium Chloride, USP (KCl); and 20 mg Calcium Chloride, USP (CaCl22H20). It contains no antimicrobial agents Water, electrolytes, and calories. One liter has an ionic concentration of 130 mEq sodium, 4 mEq potassium, 2.7 mEq calcium, 109 mEq chloride and 28 mEq lactate. The osmolarity is 525 mOsmol/L (calc). Each 100 mL contains 5 g Dextrose Hydrous, USP*; 600 mg Sodium Chloride, USP (NaCl); 310 mg Sodium Lactate (C3H5Na03); 30 mg of Potassium Chloride, USP (KCl); and 20 mg Calcium Chloride, USP (CaCl22H20). It contains no antimicrobial agents.

Classification of the fluid HYPERTONIC

Effects or use/s 5% Dextrose in Lactated Ringer's Injection provides electrolytes and calories, and is a source of water for hydration. It is capable of inducing diuresis depending on the clinical condition of the patient. This solution also contains lactate which produces a metabolic alkalinizing effect.

Significance This solution is indicated for use in adults and pediatric patients as a source of electrolytes, calories and water for hydration. This solution should be used with care in patients with hypervolemia, renal insufficiency, urinary tract obstruction, or impending or frank cardiac decompensation

Plain Lactated Ringers solution

HYPOTONIC

Sterile, nonpyrogenic solution for fluid and electrolyte replenishment and caloric supply in a single dose container for intravenous administration. It contains no antimicrobial agents. Composition, osmolarity, pH, ionic concentration and caloric content

This solution should be used with care in patients with hypervolemia, renal insufficiency, urinary tract obstruction, or impending or frank cardiac decompensation

XII. Nursing Diagnosis ASSESSMENT S> patient verbalized pain on the hypogastric area rated at 7/10; patients verbalized painful urination rated at 5/10; patient verbalized low back pain rated at 5/10 O> with facial grimaces; guarding behavior noted; Nsg dx: Acute pain related to inflammatory process secondary to Urinary tract infection and Typhoid fever EXPLANATION OF THE PROBLEM Due to the invasion of microorganism in the body, an inflammatory response is activated in the bodys attempt to fight the foreign bodies. Due to affectation in the lining of the urinary tract, pain during urination is felt as well as bladder distension causes pain and thus, pain in the hypogastric area is felt. Because of ascending infection, the kidney is affected, thus referred pain on the lower back is felt. GOALS AND OBJECTIVES After 8 hours of nursing interventions, the patients pain will be relieved or controlled. INTERVENTION Independent: Assess pain, noting location, intensity (scale of 0 10), duration. RATIONALE Provides information to aid in determining choice or effectiveness of interventions. Increased hydration flushes bacteria and toxins. Urinary retention may develop, causing tissue distention ( bladder or kidney), and potentiates risk for further infection. Accumulation of uremic waste EVALUATION After 8 hours of nursing interventions, the patients pain will be relieved or controlled.

Encourage increased fluid intake. Investigate report of bladder fullness.

Observe for changes in

mental status, behavior or level of consciousness. Provide comfort measure like back rub, helping patient assume position of comfort. Suggest use of relaxation technique and deep breathing exercises. Encourage use of sitz baths, warm soaks to the perineum.

and electrolyte imbalances may be toxic to the CNS. Promotes relaxation, refocuses attention, and may enhance coping abilities.

Promotes muscle relaxation.

Collaborative: Administer antibacterial as prescribed

Reduces bacteria present in urinary tract and those introduced by drainage system

ASSESSMENT S> patient verbalized feeling feverish and chills O> Body temperature of 38 oC upon admission, skin warm to touch, patient appears weak. A = Hyperthermia r/t inflammatory response secondary to Infection

EXPLANATION OF THE PROBLEM When a bacteria invades the body, the body triggers its inflammatory response. The thermoregulatory center of the body is then triggered to increase the bodys temperature in its attempt to help fight the infection.

GOALS AND OBJECTIVES STO After 4 hours of nursing intervention the patients temperature will be able to: decrease from 38 oC to 37.0 oC LTO After 2 days of nursing interventions patients temperature will stabilize at normal range body temperature.

INTERVENTION . Dx Monitored vital signs

RATIONALE

EVALUATION STO fully met if:

Monitored intake and output

Assess skin status

Assess mental status

Vital signs provide more accurate indication of core temperature Fluid resuscitation may be necessary to correct dehydration Warm and dry skin indicates increase in body temperature and dehydration Febrile patient may experience alteration in mental status because o dehydration. These decreases warmth and increases

After 4 hours of nursing intervention the patients temperature will decrease from 38 oC to 37.0 oC After 2 days of nursing interventions patients temperature will stabilize at normal range body temperature.

Tx

 Loosen clothing, and remove excess covers Turn of the Phototherapy for a while

evaporative cooling. To prevent further rising of temperature.Tem perature above 40 Celsius for extended periods can cause cellular damage and delirium To provide information

Edx Explain temperature measurement and treatments to the significant others Provide information regarding normal temperature and control

This is especially necessary for patients with conditions or in situations putting them at risk for hyperthermia

EXPLANATION OF THE PROBLEM S> hindi ako Because of the nkakatulog masyado sa affectation in the gabi kasi parati ako bladder due to naiihi. Pero pagumihi infection, the bladders naman ako paunti-unti distension is painful lang as verbalized by thus making it the patient sensitive to little amount of urine in the O> patient appears weak, bladder, hence the frequently yawns, feeling of urgency and frequent visit to the frequency. Because of bathroom to urinate this, the patient wakes up at night because of A: Sleep disturbance the urge to urinate thus related to frequent altering the patients urination sleeping pattern.

ASSESSMENT

GOALS AND OBJECTIVES STO: After 8 hours of nursing intervention the patient will have an improvement in sleep pattern LTO: After 3 days of nursing intervention the patient will be able to return to regular sleeping pattern and feel rested.

INTERVENTION Assess the cause of inability to sleep. Assist patient in observing any previous bedtime ritual. Advised daytime physical activities as indicated.

RATIONALE

EVALUATION

STO: To determine the proper After 8 hours of nursing intervention the patient will have an improvement in sleep To pattern promote relaxation. LTO: After 3 days of nursing intervention the patient will be able to return to regular sleeping pattern and feel rested.

Limit fluids before bedtime.

To promote urinary elimination thus reducing bladder distention to promote sleep during night time. To prevent urinary bladder retention causing dribbling of urine

ASSESSMENT S> patient verbalized that 5 days prior to admission, she had episodes of diarrhea; patient verbalized that few hours prior to admission, she had vomiting. O> no actual signs and symptoms. Hematocrit, still in normal range. A: risk for fluid volume deficit

EXPLANATION OF THE PROBLEM Because of the ingestion of food contaminated with salmonella, the body tries to expel the microorganisms by triggering the vomiting reflex and also by increasing intestinal motility. Because of increased motility, nutrients and water are not absorbed well thus, the stool is watery.

GOALS AND OBJECTIVES After 8 hours of nursing intervention, the patient will be able to maintain fluid volume status. After 2 to 3 days of nursing intervention, the patient will be able to recover and be treated from the underlying cause.

INTERVENTION Monitor intake and output (I&O).

RATIONALE Provides information about overall fluid balance Indicates excessive fluid loss or resultant dehydration.

EVALUATION After 8 hours of nursing intervention, the patient will maintain fluid volume status. After 2 to 3 days of nursing intervention, the patient will recover and be treated from the underlying cause.

Observe for excessively dry skin and mucous membranes, decreased skin turgor, slowed capillary refill. Maintain oral restrictions, bedrest and avoid exertion.

Colon is placed at rest for healing and to decrease intestinal fluid losses.

ASSESSMENT S> patient verbalized diarrhea episodes 5 days PTA; patient verbalized vomiting a few hours PTA; patient verbalized loss of appetite during hospitalization; O> no actual weight loss signs and symptoms. A: Risk for nutrition imbalance: less than body requirement related to intolerance in food ingestion (lack of appetite that may be due to an effect of the neurologic dysfunction)

EXPLANATION OF THE PROBLEM Because of the ingested microorganisms, the body tries to expel the microorganisms by triggering the vomiting reflex and also by increasing intestinal motility. Because of increased motility, nutrients and water are not absorbed well thus, the stool is watery. Because of disease process, the appetite center in the brain is also triggered thus the patient also lost her appetite.

GOALS AND OBJECTIVES STO: After 8 hours of nursing intervention the patient will be able to eat small
frequent feedings of food diet.

INTERVENTION
Dx

RATIONALE
To determine what possible foods he will indulge to eat - To assess and determine other factors that may contribute to his lack of appetite - It will provide him his needed nutrition without forcing his tolerance - This will facilitate and aide the family in feeding the patient -

EVALUATION STO: After 8 hours of nursing intervention the patient will eat small frequent
feedings of food diet.

Tx -

assess food preferences assess eating habit

LTO: After 3 days of nursing intervention the patient will be able to improve
appetite and be able to finish all food served

offer small frequent feedings encourage patient to verbalize his desire to eat preferred food and for the watcher to provide food preferences assist the patient in brushing his teeth instruct patient not to force himself into eating if he really cant

LTO: After 3 days of nursing intervention the patient will improve appetite
and be able to finish all food served

Ed - teach the patient about the importance of eating enough food

- This will increase his sense of taste that may increase his appetite - Forcing the patient may bring about harm rather than good to the patient.

- This will make him realize his need to eat

XIII. Conclusion and Recommendation A urinary tract infection is an infection that begins in your urinary system. Your urinary system is composed of the kidneys, ureters, bladder and urethra. Any part of your urinary system can become infected, but most infections involve the lower urinary tract the urethra and the bladder. Usually, germs get into your system through your urethrathe tube that carries urine from your bladder to the outside of your body. The germs that usually cause these infections live in your large intestine and are found in your stool. If these germs get inside your urethra, they can travel up into your bladder and kidneys and cause an infection. Women tend to get more bladder infections than men. This is probably because women have shorter urethras, so it is easier for the germs to move up to their bladders. Having sex can make it easier for germs to get into your urethra. You may be more likely to get an infection if you do not drink enough fluids, you have diabetes, or you are pregnant. The chance that you will get a bladder infection is higher if you have any problem that blocks the flow of urine from your bladder. Examples include having kidney stones or an enlarged prostate gland. How is typhoid fever spread? Salmonella Typhi lives only in humans. Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract. In addition, a small number of persons, called carriers, recover from typhoid fever but continue to carry the bacteria. Both ill persons and carriers shed SalmonellaTyphi in their feces (stool). You can get typhoid fever if you eat food or drink beverages that have been handled by a person who is shedding Salmonella Typhi or if sewage contaminated with Salmonella Typhi bacteria gets into the water you use for drinking or washing food. Therefore, typhoid fever is more common in areas of the world where handwashing is less frequent and water is likely to be contaminated with sewage. Once Salmonella Typhi bacteria are eaten or drunk, they multiply and spread into the bloodstream. The body reacts with fever and other signs and symptoms.

The Following are Recommendations to prevent the occurrence of UTI USE OF A HEATING PAD on your abdomen to minimize bladder pressure or discomfort BATHING AND HYGIENE Choose sanitary pads instead of tampons, which some doctors believe make infections more likely. Change the pad each time you use the bathroom. Do not douche or use feminine hygiene sprays or powders. As a general rule, do not use any product containing perfumes in the genital area. Keep your genital area clean. Clean the genital and anal areas before and after sexual activity. Take showers instead of baths. Avoid bath oils.

 The genitals should be cleaned and wiped from front to back to reduce the chance of dragging E. coli bacteria from the rectal area to the urethra. Appropriate hygiene and cleanliness of the genital area may help reduce the chances of introducing bacteria through the urethra. Females are especially vulnerable to this, because the urethra is in close proximity to the rectum. Urinate when you feel the need; don't resist the urge to urinate. CLOTHING Avoid tight-fitting pants. Wear cotton-cloth underwear and pantyhose, and change both at least once a day. Choose sanitary napkins instead of tampons (which some doctors believe encourage infection). Napkins and tampons, in any case, should be changed after each urination. DIET Drink plenty of fluids (2 to 4 quarts each day) to dilute your urine and help flush out bacteria. Avoid coffee, alcohol, and soft drinks containing citrus juices and caffeine until your infection has cleared. They can irritate your bladder and tend to aggravate your frequent or urgent need to urinate Sexual Precautions In women using contraceptives, consider alternatives, particularly if exposed to spermicides from condoms or diaphragms. Discuss the best contraceptive choice with a doctor. Avoid sex with multiple partners. This can cause many health problems, including sexually transmitted diseases and UTIs. Cranberries, Blueberries, and Lignonberries Cranberries, blueberries, and lignonberry, a European relative of the cranberry, are three fruits that may have protective properties against urinary tract infections. Researchers are finding that red pigments in these closely related fruits called tannins (or proanthocyanadins) prevent E. coli bacteria from adhering to cells in the urinary tract, thereby inhibiting infection. Fructose, which is commonly used to sweeten fruit juices, may also interfere with bacterial adhesion. Cranberry juice is the best-studied home remedy for UTIs. Evidence indicates that cranberry juice may help decrease the number of symptomatic UTIs, especially for women with recurrent urinary tract infections. It is not clear what the optimum dosage is for cranberries, or whether it is best to use juice or tablet form. Some research recommends drinking at least 1- 2 cups of 30% cranberry or lignonberry juice daily, or taking at least 300 - 400 mg in tablet form twice daily. Probiotics, Lactobacilli, and Fermented Milk Products Probiotics are beneficial bacteria that may protect against infections in the genital and urinary tracts. The best-known probiotics are the lactobacilli strains, such as acidophilus, which is found in yogurt and other fermented milk products (kefir), as well as in dietary supplement capusles. The probiotics bifidobacteria and GG lactobacilli may prove also be helpful. Other probiotics include the lactobacilli rhamnosus, casel, plantarium, bulgaricus, and salivarius, and also Enterococcus faecium and Streptococcus thermophilus.

Lactobacilli may have the potential to help protect women from UTIs by maintaining a low pH environment, hindering E. coli growth, and producing hydrogen peroxide, which produces an environment hostile for bacteria. Not all studies show a benefit for probiotics in preventing urinary tract infections. More research is needed.