HYPOSPADIA WITH URINARY TRACT INFECTION

I. INTRODUCTION

 Is a congenital in which the urethral meatus is located on the urethral side or under surface of the penis. The meatus can be located anywhere on the glans, the penile shaft, base of the penis and at the penoscrotal junction. This is the common anomaly of the penis, it occurs in about 1 out of 300 infant boys and the incidence appears to be increasing.

 The cause of this condition is multifactorial and includes maternal intake of progestin, advance maternal age and environmental factors. Hypospadia may associated with chordee and undescended testes.

Classification of hypospadias

URINARY TRACT INFECTION Is the inflammation of urinary epithelium usually caused by E.coli. It is common in women due to the shorter urethra and the proximity of the anal opening to the urethral orifice in females.

 But in infant, the males are more common due to uncircumcised penis.
The urinary tract usually protected from pathogenic organism by the flushing action of urination and constant sloughing of the epithelium.

 The acidity of normal urine also inhibits the growth of microorganism. There are two routes by which bacteria can reach the kidneys: 1. Through the bloodstream 2. As an ascending infection from the lower urinary tract.

PREDISPOSING FACTORS: Gender more common in female (above 60 years old and school age girls) Mechanical Factors e.g catheterization, sexual intercourse, kidney stones and improper use of tampons and douches.

 Metabolic Disorders e.g the increased sugar content of urine in diabetes, making it conducive to bacterial growth. Anatomic abnormalities of the urinary tract cause obstruction or incomplete voiding of urine or reflux of urine.

ETIOLOGY: Common etiologic agent E. coli 50 to 80% of cases, gram negative found in anal and perineal region Staphylococcus saprophyticus Enterococci (enterococcus fecalis) Opportunistic pathogens (pseudomonia, protozoa, seratia)

Less common etiologic agent Bacteria S. Aureus, corynebacteria, lactobacilli Yeast candida Viruses adenovirus type 2

CLASSIFICATION OF UTI: Bacteria presence of bacteria in urine Asymptomatic bacteriuria significant bacteria with no evidence of clinical infection (usually defined as greater than 100,000 colony forming units <CFu) Symptomatic bateriuria accompanied by physical signs of urinary infection (dysuria, suprapubic pain, hematuria, fever)

 Recurrent UTI repeated episode of bacteruiria of symptomatic UTI. Persistent UTI persistence of bacteriuria despite antibiotic treatment Febrile UTI bacteriuria accompanied by fever and other physical signs of UTI: presence of fever typically implies a pyelonephritis

 Cystitis inflammation of the bladder Urethritis inflammation of the uretra Pyelonephritis inflammation of the upper urinary tract and kidneys. Urosepsis febrile urinary tract infection coexisting with systemic sign of bacterial illness: blood culture reveals presence of urinary pathogen.

Signs and symptoms: (1-24 months) Poor feeding Vomiting Failure to gain weight Excessive thirst Frequent urination Staining/screaming on urination

Foul smelling urine Pallor Fever Persistent diaper rashes Seizure (with or without fever) Dehydration Enlarged kidney or bladder

Treatment/Management: Objective of surgical correction. Enable child to void in standing position and direct stream voluntary and usual manner. Improve physical appearance of genitalia Produce a sexually adequate organ

II. Patients Profile

Patients name: BMW
Age: 3 months Gender: male Chief complain: fever with rashes and crying upon urination Medical diagnosis: Hypospadia with UTI

HISTORY OF PRESENT ILLNESS

Patient already has Hypospadia since birth. 1 week PTA, parents reported that the infant was not as alert and interactive as usual. He seems uncomfortable and sleeps somewhat restlessly. 5 days before the admission, patient became fussy and had poor oral intake. Parents noted that he is going to the breast more frequently but is sucking only for about 1-2 minutes at a time.

3 days PTA up to now, patient had 3 day history of on and off fever ranging from 37.5 up to 39 degrees Celcius. He was provided with TSB by his mother and was given Paracetamol every 4 hours. Rashes were present on patients perineal area. Parents reported that he is always crying upon his urination. He has not had any vomiting or diarrhea.

PAST MEDICAL HISTORY:

Patient was born at term by Normal Spontaneous Delivery (NSD) with mild complication of Penile Shaft Hypospadia. He was then given supportive care from his parents. He was already immunized with BCG, first and second dose of his DPT, OPV and HEPA B vaccine. Patient had a past history of UTI a month ago. He was also hospitalized and treated with Sulfamethoxazole-trimethoprim (Bactrim). He has no past history of asthma and allergy.

GRANDPARENTS
b 45 D 07 stroke b 47 HYPERTENSION

GRANDPARENTS
b 42 D 01 CHRONIC RENAL FAILURE b 45 DIABETES

AUNTS/UNCLES
b 69
HYPOSPADIA traeted by surgery

FATHER
b 75 CHAIN SMOKER (farmer)

MOTHER
b 79 DIABETIC b 76

AUNTS/UNCLES
b 73 D - 2010 PROSTATE CANCER

SIBLINGS
b 00 HYPOSPADIA (underwent 1st surgical operation)

PATIENT
b 11 HYPOSPADIA WITH UTI

b 06 UTI (6 mos. Ago)

LEGEND: - female
- male / - deceased

b - year of birth D - year of death

committed relationship (marriage) biological relationship (child)

III. Physical Assessment

PARTS

NORMAL FINDINGS

Head

Rounded (normocephalic ) ; smooth skull contour, Has no tenderness.

PHYSICALRounded ) ASSESSMENTThe patient had (normocephalic a normal size of

; smooth skull contour, Has no tenderness. Normal

ACTUAL FINDINGS

INTERPRETA TION

ANALYSIS

head ; and has no tenderness ; no masses The patient had evenly distributed with no patches of hair loss.

Hair

Evenly distributed Evenly with no patches distributed of hair loss with no patches of hair loss

Normal

Eyes

Symmetrical eye brows, Intact eyelids, normally aligned eyeballs, Blink reflex are present, Clear cornea Iris.

Symmetrical eyebrows, Eyelids are intact , Clear cornea Iris (+) Blink Reflex

Normal

The patient had a symmetrical eyebrows eyelids are intact, Clear cornea Iris

PARTS

NORMAL FINDINGS

ACTUAL FINDINGS

INTERPRETATION

ANALYSIS

Ear

Can hear normal volume of tone

Can hear normal volume of tone

Normal

Can hear normal volume tones or words.

Mouth

Symmetric and straight

Symmetric and straight

Normal

The patient had a mouth symmetric and straight.

The patient had uniform in color , nasal septum intact and in midline

Nose

Uniform color with nasal flaring, Nasal septum intact and in midline .

Uniform color with nasal flaring, Nasal septum intact and in midline .

Normal

Hands

Can fold without the help

Can fold without the help

Normal

The patient hands can fold by his own

Chest

-two nipples-may have, some enlargement

-two nipples -no enlargement

Normal

The patient had two nipples and no enlargement

PARTS Back (-spine ) Abdomen

NORMAL FINDINGS - Spine straight Has a symmetrical abdominal contour. Abdominal movements noted when inhaling

ACTUAL FINDINGS - Spine straight Has a symmetrical abdominal contour. Abdominal movements noted when inhaling

INTERPRETATION Normal Normal

ANALYSIS The patient had a straight back The patient had symmetrical abdominal con tour. Movements noted when inhaling.

Reproductive (Penis)

The penis appears small ; the urethral opening is in the of tip the penis.

Hooded appearance of the penis; the end of the penis may be curved downward: Opening of the urethral meatus is on the underside of the penis

Abnormal

The patient had a frequent urination; The urethral opening is in the bottom of the penis

Legs and Feet

legs same span & complimentary movement

legs had equal span & complimentary movement

Normal

The patient had a same span and complimentary of legs

PARTS Skin

NORMAL FINDINGS skin has the rep of being soft, smooth, and sweetsmelling.

ACTUAL FINDINGS

INTERPRETA ANALYSIS TION Abnormal (perineal The patient rashes) looks have a like irritated perineal and red, rashes caus chances are ed by the he has it. His wearing of skin may also diapers be a little puffy and warm when you touch

IV. ACTIVITIES OF DAILY LIVING according to Gordons Functional Pattern

FUNCTIONAL HEALTH PATTERN

BEFORE HOSPITALIZATION

DURING HOSPITALIZATION

INTERPRETATION

ANALYSIS

Nutrition The client is lack of water intake.

Administrati on of IV fluid upon doctors order. Breastfeedin g is needed to be maintained.

The client has poor breastfeedi ng habits.

Breastfeeding ma y help to prevent UTIs during the first 6 months of life.

FUNCTIONAL HEALTH PATTERN

BEFORE DURING HOSPITALIZATION HOSPITALIZATION

INTERPRETATION

ANALYSIS

Elimination

The client often experience difficulty in urinating and accompanied with high fever with irritability. Urine has a foul smelling odor.

The clients condition is well monitor by a physician. The client will have a lab test to check for any presence of bacteria in the urine, such as a urinalysis and a urine culture. Antibiotics may prescribe.

Functions of kidney usually diminish with age, but not significantly below normal levels, unless a disease process intervenes.

UTI is an infection in the urinary tract. Infections are caused by microbes organisms too small to be seen without a microscope. Bacteria are the most common cause of UTIs.

FUNCTIONAL HEALTH PATTERN

BEFORE DURING HOSPITALIZATION HOSPITALIZATION

INTERPRETATION

ANALYSIS

Hygiene

The clients hygiene is maintained by daily bed bath and sponge bath. His sheets are changed every day or as needed.

Temperature is monitor. If fever is Increase Tepid Sponge Bath (TSB) will be the next step to decrease the fever. Frequent changing of diaper.

Ill people may not have the motivation or energy to attend to hygiene.

The client has a fair hygiene and needs assistance.

FUNCTIONAL HEALTH PATTERN

BEFORE DURING HOSPITALIZATION HOSPITALIZATION

INTERPRETATION

ANALYSIS

Sleep and Rest pattern

The client lack of sleep and rest. Hes always restless and agitated when his disease or complication arises, especially during high fever.

The client is Abnormal usually on bed rest, he cried very often because of high fever, and especially during urination.

Illness that causes pain or physical distress can result in sleep problems.

V. Developmental Task according to Erik Erikson

VI. Laboratory and Diagnosis

URINALYSIS >It is one of the most commonly

performed laboratory test. > 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

ASSESSMENT

NORMAL

ACTUAL

INTERPRETATION ANALYSIS

APPEARANCE

Pale to dark yellow or amber in color and clear

Cloudy red brown

abnormal

Cloudy there is presence of WBC and pus Red brown due to hematuria Restricted fluid intake indicates urine concentration Dehydration Presence of solid materials in urine

OSMOLALITY

50-1,400 mOsm/L

1,500 mOsm/L

High Concetrated urine

SPECIFIC GRAVITY

1.001 1.030

1.060

High Above normal

pH

4.8 7.8

5.5

Normal

pH is normal because there is no present urease in urine

ASSESSMENT

NORMAL

ACTUAL

INTERPRETATION ANALYSIS

PROTEIN

Absent

Absent

Normal

Protein is not normally found in urine Kidney filters glucose and send into the bloodstream Normally ketone passed in the urine but large amount of ketones in urine may indicate diabetic ketoacidosis is present Usually bacteria that convert nitrate to nitrite is E.coli

GLUCOSE

Absent

Absent

Normal

KETONE

Absent to a few

Few

Normal

NITRITES

absent

present

abnormal

ASSESSMENT

NORMAL < 1-2

ACTUAL 5

INTERPRETATION ANALYSIS Above normal Normal response of body to foreign body There is inflammation and injury in urinary tract that causes blood in urine Presence of bacteria There is no presence of cast because cast is formed in tiny tube of kidneys Subsequent with WBC

WHITE BLOOD CELL

RED BLOOD CELL

< 1-2

Above normal

BACTERIA

Absent to a few

120,000 organism/mL Absent

Infection (bacteriuria) Normal

CAST

Occassional

PUS

Absent

Present

pyuria

URINE CULTURE
1. Purpose 2. When it is ordered 3. Urine Sample Collection procedures 4. Proper Labeling and Storage 5. Sent to the Laboratory 6. Results

COMPLETED CULTURE RESULT

ESCHERICHIA COLI

NORMAL FINDINGS

ACTUAL FINDINGS

ANALYSIS

INTERPRETATION

No growth of bacteria NEGATIVE

120,000 bacteria/ml POSITIVE

Abnormal

Greater than 100,000 bacterias/ml in urine indicates an infection.

SUSCEPTIBILITY TESTING

ANTIMICROBIAL AGENT

SUSCEPTIBLE

INTERMEDIATE

RESISTANT

TMP-SMX AMPICILLIN NITROFURANTOIN CIPROFLOXACIN

82.4 61.2 98.3 97.7

0.1 0.7 0.9 0.1

17.5 38.0 0.8 2.3

LEVOFLOXACIN
NORFLOXACIN ORFLOXACIN

97.3
97.8 97.7

0.1
0.1 0.4

2.5
2.1 1.9

NALIDIXIC ACID

96.5

<0.1

3.5

Lets proceed to ANATOMY AND PHYSIOLOGY

THE MALE URINARY SYSTEM

WHAT IS THE NORMAL FUNCTION OF URINE?

Specialized Unit (NEPHRON)

VIII. Pathophysiology

IX. Nursing Care Plan

Nursing Care Plan for PAIN

ASSESSMENT

DIAGNOSIS

PLANNING

INTERVENTION Determine / Document presence of possible pathophysiological cause of pain.

RATIONALE

EVALUATIO N After four hours of nursing intervention , the client was relieved from urinary tract infection and rashes free as indicated on his relaxed facial expressions.

SUBJECTIVE:

Acute pain related to Umiiyak ang urinary anak ko alteration as habang umiihi manifested by sya as crying upon verbalized by urination, the mother of fever and the patient. facial expression of pain.

Short term goal: After 4 hrs of nursing intervention, the client will show some signs of comfort such as absent crying upon urination, and temperature will be in normal range

To help determine possibility of underlying condition.

Observe nonverbal cues/pain behaviours

An indicator that is present for the client who is unable to verbalize.

Usually altered in acute pain.

Monitor skin color, temperature and vital signs.

ASSESSMENT OBJECTIVE:
loud crying Facial expression of pain(brows lowered & drawn together, eyes tightly closed,& mouth open and squarish, nosebroadened/bulg ing Poor urine stream Poor feeding Foul smelling urine Persistent diaper rash

DIAGNOSIS

PLANNING Long term goal: After 1 week of nsg. Intervention , the client will be relieved from acute pain and the rashes will be deminished.

INTERVENTIO N Determine clients acceptable level of pain/pain control goals. Provide comfort measures. Record of urine I & O.

RATIONALE Varies with individual and situation.

EVALUATION

To promote nonpharmacologi cal pain mngt. To measure if I & O is balanced/ Altered due to pain.

Encourage To prevent adequate rest fatigue/Stress periods. to the patient.

ASSESSMENT

DIAGNOSIS

PLANNING

INTERVENTIO N Dependent: Administer analgesics as indicted . Frequently encourage the family to complete the full prescribed course of the medications even though the child is feeling better

RATIONALE

EVALUATION

To maintain acceptable level of pain. To prevent developing stronger strain of any microorganis m

ASSESSMENT

DIAGNOSIS

PLANNING

INTERVENTIO N Evaluate/ Document clients response to analgesia with assist in transitioning/ altering drug regimen, based on patients needs. Collaborative: Discuss in SOs ways in which they can assist client with the precipitating condition

RATIONALE Increasing/ Decreasing dosage helps in the mngt of pain.

EVALUATION

To reduce precipitating factors that may cause increase pain

Nursing Care Plan for FEVER

ASSESSMENT SUBJECTIVE: Nilalagnat ang anak ko at laging umiiyak kapag umiihi sya as verbalized by the mother of the patient.

DIAGNOSIS

PLANNING SHORT TERM GOAL After 3 hours of nursing intervention the patients temperature will be subside from 38.1 to normal value.

INTERVENTIO N INDEPENDEN Performed tepid sponge bath Note for core temperature of the patient every 1 hour

RATIONALE

EVALUATION SHORT TERM GOAL After 3 hours of nursing intervention, the patients temperature was subsiding from 38.1 to normal value. .

Hyperthermia related to present medical condition as evidenced by the verbal report of the mothers patient OBJECTIVE: nilalagnat Flushed skin ang anak ko at warm to umiiyak kapag touch umiihi sya Facial grimace and Weak temperature appearance value of 38.1 VITAL SIGN: C. TEMP: 38.1 PR: 112 RR: 53

To decrease temperature by means of conduction To check if the patient temp is decreasing or increasing

Maintain bed To reduce rest metabolic demand and oxygen consumption

ASSESSMENT

DIAGNOSIS

PLANNING

INTERVENTIO N Monitor and record all sources of fluid loss such as urine

RATIONALE

EVALUATION

LONG TERM GOAL After 4 days of nursing intervention the patient will relieve from discomfort during urination.

To monitor or potentiates fluid and electrolyte loses

Monitor To assess if heart rate and theres any rhythm changes in patient cardiac rhythms Encouraged the mother of the patient to increased fluid intake of her child To prevent dehydration and to replace the fluid loss of the patient

LONG TERM GOAL: After 4 days of nursing intervention the patient was relieved from discomfort during urination. Therefore goal was met

ASSESSMENT

DIAGNOSIS

PLANNING

INTERVENTIO N Instruct the mother to dress the patient with thin cloth. Wrap the extremities of the patient Promote client safety Maintain well ventilated environment

RATIONALE

EVALUATION

To promote rapid decreasing of the temperature To minimize shivering To prevent stress and injury to the patient To promote comfort to the patient

ASSESSMENT

DIAGNOSIS

PLANNING

INTERVENTIO N DEPENDENT :

RATIONALE

EVALUATION

Give To facilitate antipyretics as fast recovery ordered. of the patient Administer oxygen as ordered. Administer bactrim as ordered To meet oxygen needs For treating infection

ASSESSMENT

DIAGNOSIS

PLANNING

INTERVENTIO N

RATIONALE

EVALUATION

COLLABORATI VE:

Get urine sample as ordered and submit to the laboratory for urinalysis and urine culture

To determine the etiology of crying during urination.

Nursing Care for proper HYGIENE

ASSESSMENT Subjectiv e: Ano po bang mga dapat at hindi dapat gawin ko tungkol sa kondisyon ng anak ko? as verbalized by the mother of the patient.

DIAGNOSIS

PLANNING

INTERVENTIO N TSB every 15 mins.

RATIONALE

EVALUATION

Deficient knowledge related to unfamiliarity to the condition as evidence by inappropriate hygiene for the infant as well as inadequate environment al hygiene.

STG: After 1 hour of rendering nursing intervention the mother of the patient will be able to know the proper way of promoting good hygiene to his son.

To maintain the temperat ure on its normal range. To determin e changes in V/S especiall y the temp

Monitor and record Vital signs.

After 1 hour of renderin g nursing interventi on the mother of the patient has known the proper way of promotin g good hygiene to his son.

ASSESSMENT

DIAGNOSI S

PLANNING

INTERVENTIO N Change diaper regularly. Demonst rate proper perineal care to the mother.

RATIONALE

EVALUATION

Objective : Improper changing of diaper Inappropr iate wiping of the anal and genital area. Perineal rashes

LTG:

After 3 days of rendering nursing intervention the patient will be able to feel more comfortable and the mother will be able to maintain proper hygiene of her son.

avoid rushes.

To let the mother of the patient know the proper way of cleaning the perineum

After 3 days of rendering nursing interventio n the patient will be able to feel more comfortabl e and the mother will be able to maintain proper hygiene of his son

Therefore goal was met.

ASSESSMENT

DIAGNOSIS

PLANNING

INTERVENTIO N

RATIONALE

EVALUATION

Evaluate the learning process of the mother

To know if the mother was able to understand purpose of hygiene care

let the mother to do proper hygiene care to his son

To determine if the mother had learned something about hygiene

To prevent dehydration

Increase oral fluid intake of the patient

ASSESSMENT

DIAGNOSIS

PLANNING

INTERVENTIO N

RATIONALE

EVALUATION

apply zinc oxide in the rashes Maintain the rashes dry

to fasten the healing process To avoid colonization of bacteria in the skin To know if the mother has gained enough knowledge regarding what she was asking before

Evaluate the mother about what she learned

X. Drug Study

Name of Drug Generic Classification (Brand)

Generic name: Amoxicillin trihydrate Brand name: amoxil, amoxial pediatric drops, apo-amoxi (CAN), dispermox, novamoxin (CAN), Nu-amoxi (CAN), trimox

Dose Frequency Action

Mechanism of Action

antibiotic (penicillin-ampicillin type)

Pediatric patients 3mo Bacteriacidal : inhibits and older weighing synthesis of cell wall 40kg of sensitive organisms, causing URIs GU infx, skin cell death. and soft tissues infx--20 mg/kg/day PO in divided dose q12 hours. Severe infx--- 40 mg/kg/day PO in divided dose q12 hrs. or 45 mg/kg/day PO in divided dose q12 hrs.

Specific Indication

Side Effects

Nursing Implications

Infections due to: susceptible strains of haemophilus influenza e.coli neisserria gonorrhea streptococcus pneumonia producing staphylococci. prophylaxis against bacillus anthracis

lethargy Hallucinations Seizures Glositis Stomatitis Gastritis sore mouth furry tongue nausea and vomiting Diarrhea abdominal pain bloody diarrhea pdesudomemebranous colitis

Culture infected area prior to treatment; re-culture area if response is not as expected. Give in oral preparations only; amoxicillin is no taffected by food Continue therapy for at least 2 days after signs of infection have disappeared; continuation for 10 full days is recommended. Use corticosteroids or antihistamines for skin reaction. Report any side effects If GI upset occurs, take with meals

Name of Drug Generic Classification (Brand)

Generic name: Cefixime Brand name: Suprax

Dose Frequency Action The recommended dose is 8 mg/kg/day of the suspension.

Mechanism of Action

Anti-bacterial

Like all beta-lactam antibiotics, cefixime binds to specific penicillin-binding This may be proteins (PBPs) administered as a located inside the single daily dose or bacterial cell wall, may be given in two causing the inhibition divided doses, as 4 of the third and last mg/kg every 12 hours. stage of bacterial cell wall synthesis. Cell lysis is then mediated by bacterial cell wall autolytic enzymes such as autolysins; it is possible that cefixime interferes with an autolysin inhibitor.

Specific Indication

Side Effects

Nursing Implications

Suprax (cefixime) is indicated in the treatment of the following infections when caused by susceptible strains of the designated microorganisms: Uncomplicated Urinary Tract Infections caused by Escherria coli and Proteus mirabilis. Otitis Media caused by Haemophilus influenzae (beta-lactamase positive and negative strains), Moraxella (Branhamella) catarrhalis, (most of which are beta-lactamase positive) and S. pyogenes.

Stomach upset/pain, diarrhea, nausea, gas, headache, or dizziness may occur. Serious side effects such as: severe stomach/abdominal pain, persistent nausea/vomiting, yellowing eyes/skin, dark urine, unusual tiredness, new signs of infection bruising/bleeding, change in the amount of urine

Assess for infection at beginning of and throughout therapy. Obtain specimens for culture and sensitivity before initiating therapy. Observe patient for signs and symptoms of anaphylaxis ( rash, pruritus, laryngealedema wheezing) Take with meals.

Name of Drug Generic Classification (Brand)

GENERIC NAME: Cefadroxil BRAND NAME: Duricef

Dose Frequency Action Tablets: 1 g. Capsules: 500 mg. Powder for suspension: 125, 250, 500 mg/teaspoon (5 ml). The recommended dose for children is 30 mg/kg/day as a single dose or two divided doses.

Mechanism of Action Bactericidal: inhibits the synthesis of bacterial cell wall , causing cells death.

Cefadroxil is used for treating infections of the urinary tract skin and softtissue, parhynx (t hroat), and tonsils (tonsilitis) caused by bacteria that are susceptible to its effect.

Specific Indication

Side Effects

Nursing Implications

This medication is a cephalosporin-type antibiotic used to treat a wide variety of bacterial infections (skin and urinary tract infections). It works by stopping the growth of bacteria. This antibiotic treats only bacterial infections. It will not work for viral infections.

The most common side effects Take this medication exactly are: as directed by your doctor

diarrhea or loose stools Nausea and vomiting rash.

Take each dose with a full glass of water.

Cefadroxil can be taken on an empty stomach or with food or milk if it causes stomach upset.

Name of Drug Generic Classification (Brand)

GENERIC NAME : Vantin BRAND NAME : Cefpodoxime proxetile

Dose Frequency Action 5 mg/kg per dose every 12 hours

Mechanism of Action Bactericidal: Inhibits synthesis of bacterial cell wall causing cell death.

Antibiotic

Specific Indication

Side Effects

Nursing Implications

UTIs caused by Escherrichia coli, proteus mirabilis

Otitis Media caused by S. pnuemoniae , H. Influenzae

Lower respiratory infection caused by S. Pneumoniae

CNS: headache Dizziness lethargy paresthesisas. GI: Nausea and vomiting anorrexia Hepatotoxicity HEMATOLOGIC: Bone marrow depression.

Take this drug w/ food. Complete the full course of this drug even if you feel better. This drug is prescribed for particular infection, DO NOT SELF-TREAT any other infections.

Name of Drug Generic Classification (Brand)

Cephalexin

Dose Frequency Action 25-50 mg/kg/day PO in divided dose

Mechanism of Action Bactericidal: Inhibits synthesis of bacterial cell wall causing cell death.

Antibiotic

Specific Indication

Side Effects

Nursing Implications

Respiratory tract infections caused by S. pnuemoniae group A beta hemolytic Sterptococci Skin and skin structure infection Otitis Media caused by S. Pnuemoniae

CNS: headache dizziness lethargy paresthesias GI: Nausea and vomiting diarrhea anorexia abdominal pain flatulence hepatotoxicity GU: nephrotoxicity HEMATOLOGIC: Bone marrow deppresion

Take this drug with food. Refrigerate suspension; discard after 14 days. Complete the full course of this drug even if the patient feels better. Report if severe diarrhea with blood or pus or mucus, rash or hives, DOB, unusual tiredness, fatigue, unusual bleeding bruising occurs.

Name of Drug Generic (Brand)

Bactrim (co-trimoxazole)

Classification

Dose Frequency Action

Mechanism of Action Co-trimoxazole contains 2 active ingredients acting synergistically by blockade of 2 enzymes that catalyze successive stages in the biosynthesis of folinic acid in the microorganism. This mechanism usually results in bactericidal activity in vitro at concentrations at which the individual components are only bacteriostatic. In addition, cotrimoxazole is often effective against organisms that are resistant to one of the active component

Antibiotic

8 mg/kg/day TMP and 40 mg/kg/day SMZ PO in two divided dose every 12 hours

co

Specific Indication

Side Effects

Nursing Implications

GI upsets stomatitis skin reactions Renal and Urinary Tract tinnitus Infections erythema multiforme leukopenia Genital infections in both neutropenia sexes including urethritis, thrombocytopenia gonococcal. megaloblastic anemia pancytopenia or purpura GIT infections, including hyperkalemia typhoid and paratyphoid fever hypoglycemia and treatment of persistent serum sickness carriers, bacillary, dysentery, periarteritis nodosa cholera (as an adjunct to fluid allergic myocarditis and electrolyte replacement). purpura Skin and soft tissue infections; cholestasis pyoderma, furuncles, glossitis abscesses and infected convulsion wounds. vertigo Upper and Lower Respiratory Tract Infections

Treatment should be discontinued immediately at the first appearance of skin rash or any other serious adverse reaction Take this drug with food. Complete the full course of this drug even if the patient feels better. Report if severe diarrhea with blood or pus or mucus, rash or hives, DOB, unusual tiredness, fatigue, unusual bleeding bruising occurs

Name of Drug Generic Classification (Brand)

GENERIC NAME: ZINC OXIDE - TOPICAL (zink OX-ide)

This medication is used to treat and prevent prevent diaper raash and other minor BRAND NAME(S): Desitin skin irritations (e.g., burning cuts, scrapes).

Zinc the topical Apply

formula on the site of irritation as long as the irritation relieves.

Dose Frequency Action

Mechanism of Action It works by forming a barrier on the skin to protect it from irritants/moisture

Specific Indication

Side Effects

Nursing Implications

Relieves burns, abrasions and diaper rash.

No serious side effects other If skin irritation persists than skin irritation consult physician.

Keep away from children. It is dangerous

XI. Discharge Planning

H YGIENE must be maintain. Y EARLY health examination such as routine analysis. P ROVIDE clean and Comfortable Environment. O UT PATIENT must have a regular check-up to the nearest health center for the development of the treatment. S ECURE appropriate intake of regular medications given by the physician. P ROMOTE deep breathing exercise for good circulation of blood and relaxation A - PPLY Zinc Oxide to relieves diaper rash, and also Multi-Vitamins for immunity. D OCTOR should be inform for any complications encountered. I NSTRUCT the mother or SOs of Pt. to limit his activity for 24hrs 48 hrs after discharge. A VOID use of Straddle toys walkers, or bicycle until it is approved by doctor. S PIRITUAL prayers to provide presence and Guidance of the Lord.

W EAR cotton underwear and loose clothing.

I NFORM the mother or the SOs of the pt. about the generic name of his meds. These inform to them that they can save money from buying

generic drugs.
T RAIN the mother to empty bladder completely with each void. H ELP the patients mother to be supportive regarding her sons condition.

U RINE culture should obtain after discharge. T HINK positive and everything will be put into place. I NCREASED FLUID INTAKE, give foods high in Fiber such as cereal or fruits to prevent constipation.

References:
8th Edition Wongs Nursing Care of Infants and Children Vol.1 (pp. 486-487) Microbiology & Parasitology by Bartolome Understanding pathophysiology 4th edition by Sue Hueeher Pathophysiology 4th edition by Barbara Bullock Maternal & Child by Pilliteri

THANK YOU!