Impaired Urinary Elimination and Risk for Infection r/t Urethral Stricture

Urethral stricture is more common in men than women, especially because of the difference in length of the urethra. (C. Long, Barbara; 1996 case 338)

Urethral stricture causing disturbances in micturition, urinary flow ranging from shrinking until completely unable to drain urine out of the body. Urine can not get out of the body can lead to many complications, with the heaviest complication is kidney failure.

Urethral stricture may occur:

1. Congenital
Urethral stricture may occur separately or in conjunction with other urinary tract anomalies.

2. Learned.
Urethral injury (due to the insertion of surgical equipment for transuretral surgery, indwelling catheters, or cystoscopy procedure).
Injuries due to stretching.
Injuries due to accidents.
Urethritis gonorheal untreated.
Muscle spasm.
External pressure eg tumor growth.
(C. Smeltzer, Suzanne;2002 hal 1468 dan C. Long , Barbara;1996 hal 338)

3. Postoperative
Some operations on the urinary tract can cause urethral strictures, such as prostate surgery, surgery with endoscopic instruments.

4. Infection
Infection is the most frequent factors that cause urethral strictures, such as infection by gonococcal bacteria that cause gonorrhea urethritis or non urethral gonorrhea has infected several years earlier, but now it is rare due to the use of antibiotics, most of these strictures located in the pars membranacea, although also found in places other; chlamydia infection is now a major cause but can be prevented by avoiding contact with infected individuals or using condoms.

Clinical manifestations

Beam strength and decreased urine output.
Symptoms of infection.
Urinary retention.
The presence of back flow and trigger cystitis, prostatitis, and pyelonephritis.
(C. Smeltzer, Suzanne; 2002 case 1468)



Nursing Care Plan for Urethral Stricture

Nursing Diagnosis for Urethral Stricture : Impaired Urinary Elimination related to Post-Op Cystotomy.

Nursing Interventions:

1. Monitoring of urine output and characteristics.
Rationale: Detecting interference elimination pattern: urination early.

2. Maintaining a constant bladder irrigation for 24 hours.
Rationale: Preventing blood clots block the flow of urine.

3. Maintaining patency of foley catheter with irrigation.
Rationale: Preventing blood clots clogging the catheter.

4. Ensuring fluid intake (2500-3000).
Rationale: To smoothen the flow of urine.

5. Once the catheter is removed, continue to monitor the symptoms of bladder elimination disorders.
Rationale: Detecting early bladder elimination disorders.



Nursing Diagnosis for Urethral Stricture : Risk for Infection

Nursing Interventions :

1. Monitoring of vital signs, reported symptoms of shock and fever.
Rationale: Prevent before the shock.

2. Monitoring urine color of fresh red blood, not dark red, a few hours after the new surgery.
Rationale: Urine color change from dark red to red fresh on day 2 and 3 after surgery.

3. Counseling to patients in order to prevent the Valsalva maneuver.
Rationale: Can irritate, prostate bleeding in the early postoperative period due to pressure.

4. Preventing the use of a rectal thermometer, rectal examination at least 1 week.
Rational: It can cause bleeding.

5. Maintaining aseptic techniques of urinary drainage system, irrigation if necessary alone.
Rationale: Minimizing the risk of entry of germs that can cause infection.

6. Ensuring intake that much.
Rational: It can lower the risk of infection.

Risk for Infection related to Nasopharyngeal Carcinoma

Nursing Diagnosis for Nasopharyngeal Carcinoma : Risk for Infection

Objectives: After nursing intervention, there were no risk factors for infection in the client,

evidenced by adequate client imune status: free of symptoms of infection, normal leukocyte numbers (4-11000).

Nursing Interventions:

  Control of infection:
1. Clean up the environment after use for other patients.
2. Maintain isolation techniques.
3. Limit visitors when necessary.
4. Instruct family to wash their hands when contact and thereafter.
5. Use anti-microbial soap to wash hands.
6. Make hand washing before and after nursing actions.
7. Use clothes and gloves as a protective device.
8. Maintain aseptic environment during the installation of equipment.
9. Perform wound care and infusion dresing every day.
10. Increase the intake of nutrients.
11. Give antibiotics according to the program.

Protection against infection
1. Monitor signs and symptoms of systemic and local infections.
2. Monitor granulocytes and WBC count.
3. Monitor susceptibility to infection.
4. Maintain aseptic technique for each action.
5. Maintain isolation techniques if necessary.
6. Inspection of the skin and mucous mebran redness, heat, drainage.
7. Inspection of the condition of wounds, surgical incisions.
8. Take culture if necessary
9. Push the input of nutrients and adequate fluid.
10. Encourage adequate rest.
11. Monitor changes in energy levels.
12. Encourage increased mobility and exercise.
13. Instruct the client to take antibiotics according to the program.
14. Teach family / client about the signs and symptoms of infection.
15. Report suspicion of infection.
16. Report if positive cultures.

Nursing Diagnosis Risk for Infection - NCP Impetigo

Nursing Diagnosis Risk for infection - NCP Impetigo

Nursing Diagnosis Risk for Infection related to decreased immune system, malnutrition, inflammation, and invasive procedures.

Expected outcomes are:

• Clients are free from signs and symptoms of infection.
• Showed the ability to prevent infection.
• Demonstrate healthy behavior.
• Describe the process of transmission of the disease, factors that influence transmission.

Nursing Interventions - Nursing Care Plan for Impetigo :

• Monitor for signs and symptoms of infection.
• Monitor susceptibility to infection.
• Limit the visitor when necessary.
• Instruct patient visitors to wash their hands during a visit and after leaving the patient.
• Maintain aseptic environment during ongoing treatment.
• Give skin care in the area epidema.
• Inspection of skin and mucous membrane of the redness, heat.
• Inspection of the condition of the wound.
• Give antibiotic therapy if necessary.
• Teach how to avoid infection.

Nursing Care Plan for Peritonitis Nursing Diagnosis Risk for Infection

Nursing Diagnosis Risk for Infection Nursing Care Plan

Definition: At increased risk for being invaded by pathogenic organisms
Related Factors: See Risk Factors.

Risk Factors:

Invasive procedures; insufficient knowledge regarding avoidance of exposure to pathogens; trauma; tissue destruction and increased environmental exposure; rupture of amniotic membranes; pharmaceutical agents (e.g., immunosuppressants); malnutrition; increased environmental exposure to pathogens; immunosuppression; inadequate acquired immunity; inadequate secondary defenses (e.g., decreased hemoglobin, leukopenia, suppressed inflammatory response); inadequate primary defenses (e.g., broken skin, traumatized tissue, decrease in ciliary action, stasis of body fluids, change in pH secretions, altered peristalsis); chronic disease.

NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels

Immune Status
Knowledge: Infection Control
Risk Control
Risk Detection

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels

Infection Control
Infection Protection

Client Outcomes

Remains free from symptoms of infection
States symptoms of infection of which to be aware
Demonstrates appropriate care of infection-prone site
Maintains white blood cell count and differential within normal limits
Demonstrates appropriate hygienic measures such as hand washing, oral care, and perineal care.

Nursing Interventions Risk for Infection for Peritonitis

Independent:

1. Note the example of individual risk factors abdominal trauma, acute appendicitis, peritoneal dialysis.
Rational: Affects choice of interventions

2. Assess vital signs with frequent, noted no improvement or continuing hypotension, decreased pulse pressure, tachycardia, fever, tachypnea.
Rationale: Signs of septic shock, endotoxin circulation causes vasodilation, loss of fluid from the circulation, and low cardiac output status.

3. Note the change in mental status (eg, confusion, fainting).
Rational: Hypoxaemia, hypotension, and acidosis can cause irregularities in mental status.

4. Note the color, temperature, humidity.
Rational: Warm, redness, dry skin is an early sign of septicemia. Further manifestations include cold, pale skin moist and cyanosis as a sign of shock.

5. Monitor urine output.
Rational: Oliguria occurred as a result of reduced renal perfusion, the toxin in the circulation affects the antibiotic.

6. Maintain strict aseptic technique in the treatment of abdominal drain, wound incision / open, and the invasive side.
Rationale: Prevent the spread and limit the spread of infectious organisms / cross contamination.

7. Observations on wound drainage.
Rationale: Provides information about the status of infection.

8. Maintain sterile technique when the patient is placed catheters, and catheter care provided / or perineal hygiene routine.
Rasonal: Preventing the spread, limiting the growth of bacteria in the urinary tract.

9. Supervise / limit visitors and staff as needed. Provide insulation protection when indicated.
Rational: Reduce the risk of exposure to / add a secondary infection in patients who experienced immune pressure.


Collaboration:

1. Take for example / watch the results of serial blood, urine, wound cultures.
Rationale: Identifying microorganisms and assist in assessing the effectiveness of antimicrobial program.

2. Assist in the peritoneal aspiration, if indicated.
Rational: Guide to drain fluids and to identify infectious organisms so that appropriate antibiotics but can be given.

3. Prepare for surgical intervention when indicated
Rationale: Treatment of choice (curative) in acute peritonitis or local, for example a local abscess drainage, peritoneal exudate throw, throw rupturapendiks / gall bladder, cope with perforated ulcer, or bowel resection.

 Reference : http://careplannursing.blogspot.com/2011/12/risk-for-infection-nursing-care-plan.html