"Nursing Diagnostic Statement 1- Acute pain caused due to inflammation and infection of theurethra, bladder, and urinary tract structure. It is evident as the client states he has pain anddescribes the pain as my head hurts. A score of 10 on Wong-Baker Faces pain rating scale indicatesworst pain. Client’s father informed that client complained of painful urination. Nursing Goal: Pain is reduced or lost within 60 minutes and spasms are controlled. Expected Outcome 1: Client reports no pain during voiding. The client describes adequate paincontrol with a rating of less than 3 or 4 on the pain assessment scale. Nursing Intervention 1: The nurse will consult the physician and administer analgesics orantispasmodics as per physician’s orderRationale 1: Antispasmodic agents decrease bladder irritability and analgesics block the synthesis ofprostaglandins and provide pain relief. They can be used for managing mild to moderate pain.Therefore, they can help to alleviate pain in the client (Yvette C. Terrie, 2009). Nursing Intervention 2: The nurse will record the location and intensity of pain using the pain ratingscale for every 1 hourRationale 2: It helps to evaluate the cause of pain and assess the place of obstructionNursing Intervention 3: The nurse will provide comfort measures such as back rub or massageRationale 3: Massage increases endorphin levels and reduces tissue edema. It reduces paintransmission, improves muscle relaxation and reduces muscle tension (Morhenn V1 & Beavin LE, ZakP, 2012). Nursing Intervention 4: The nurse will engage the client in fun activities such as solving a puzzle ordrawingRationale 4: Distraction techniques will reduce the stress, tension and provide relaxation which inturn reduces the perception of pain (Donna Koller, & Ran D. Goldman, 2012). Nursing intervention 5: The nurse will encourage the client to take oral fluids (2- 3 liters) Rationale 5: Increased hydration helps to eliminate or flush the bacteria and toxins (Manz, F. ,2007).Nursing intervention 6: The nurse will provide adequate rest periods while involving the client indistraction techniques to promote relief, sleep, and relaxation. Rationale 6: Exhaustion can increase the intensity of pain. Providing a peaceful quiet environmentwill help the client to rest which in turn can relax the muscles. Nursing Diagnostic Statement 2- Impaired urinary elimination due to dysuria. The client complainedof pain during urination. The client’s father informed that client urinated at school and since thendid not void due to which the sample for urinalysis is not yet collected. Nursing Goal: Improve the client’s urinary elimination pattern.Expected Outcome 1: Client does not hesitate to urinate and achieves normal urinary eliminationpattern with no sign of dysuriaNursing Intervention 1: The nurse will assess the client’s elimination pattern Rationale 1: It helps to determine and plan appropriate interventions Nursing Intervention 2: The nurse will palpate the client’s urinary bladder every 4 hours Rationale 2: It helps identify the presence of urinary retentionNursing intervention 3: The nurse will encourage the client to take 2 to 3 litres of fluids Rationale 3: It improves the renal blood flowNursing Intervention 4: The nurse will encourage the client to void every 2 to 3 hoursRationale 4: It prevents the accumulation of urine and limits the number of bacteria.Nursing Intervention 5: The nurse will monitor and review if the client has full bladder complainsRationale 5: Urinary retention may cause bladder distensionNursing Intervention 6: The nurse will provide berry juice to the clientRationale 6: It keeps the urine acidic and inhibits the growth of bacterial by increasing urine aam. Nursing diagnostic statement 3: Fever or hyperthermia due to inflammation or infection. Theo client’s body temperature is found to be 40.2 C during admission. The forehead is warm to touchwhereas upper and lower extremities are cool. Nursing Goal: The body temperature reaches within normal levelsExpected outcomes: Client does not have a fever, absence of palpable heat, vital signs are withinnormal limits. Nursing Intervention1: The nurse will notify the physician and receive an order to administerantipyretic drugs. Rationale 1: Antipyretics helps to control body temperature and reduces fever (Sullivan, J. E., &Farrar, H. C., 2011).Nursing intervention 2:The nurse will place a warm compress on the client’s forehead and both theaxillaRationale: Warm compress stimulates hypothalamus which a processing center in the brain andsends nerve impulse for thermoregulation and controls body temperature (Mahmood, S. S., et al.,2009) (McArdle, W. D., et al., 2010).Nursing intervention 3: The nurse will monitor the client at regular intervals and assess for the signsof increased body temperature. Rationale 3: Sweating, shivering, headache, warm skin, and body malaise are symptoms of high bodytemperature. It helps to determine the effectiveness of treatment and to plan appropriateinterventions for the client. Nursing intervention 4:The nurse will monitor the vital signs of the client especially bodytemperature Rationale 4: It helps to determine and plan appropriate interventions. Nursing Intervention 5: The nurse will provide a tepid sponge bathRationale 5: Tepid Sponge Bath helps to reduce body temperature Reduction. It is mostlyo recommended for the clients whose temperature is102.2ºF(39 C) or more. It is considered as oneof the best cooling treatment and found to be effective to reduce fever in young childrenJeong, Y. S.,& Kim, J. S., 2010). Nursing Intervention 6:The nurse will encourage the client to take adequate fluids. Rationale: It helps to prevent dehydrationNursing intervention 7: The nurse will provide adequate bed rest Rationale 7: Adequate bed rest reduces metabolic demands or oxygen consumption (Winkelman, C.,2009).Nursing Diagnostic Statement 4:Client has a risk of infection due to improper toileting and urinaryretention. Fever and painful micturition are the possible evidence for risk of infection. Nursing Goal and Desired Outcomes: The client will be free of urinary tract infection which can beidentified by the absence of fever, chills, clear non-foul smelling urine and a normal white blood cellcount. Nursing Interventions 1: The nurse will assess the client for signs and symptoms of urinary tractinfection. Rationale 1: Fever, chills, cloudy urine, and burning on urination are common symptoms of infection.It helps to plan appropriate interventions(Santos, J. C. D., et al., 2007). Nursing Intervention 2: The nurse will assess for risk factors for urinary tract infection.Rationale 2: It helps to plan appropriate treatment for the client (Santos, J. C. D., et al., 2007).Nursing Intervention 3: The nurse will monitor WBC count and urinalysis reportRationale 3: WBC count increases as a response to infection. Bacterial counts of 105help todiagnose UTI. However, lower courts may also indicate UTI (Santos, J. C. D., et al., 2007). Nursing intervention 4: The nurse will check the reports of client’s urine culture and sensitivity Rationale 4: It helps to determine the most suitable antibiotics for the treatment of urinary tractinfection in the client(Santos, J. C. D., et al., 2007).. Nursing Intervention 5: The nurse will encourage the client to urinate every 2 to 3 hours a day andempty the bladder.Rationale 5: It helps to prevent bladder distension, facilitates flushing of the bacteria and avoidsreinfection (Bhat, R. G., et al.,2011).Nursing Intervention 6: The nurse will encourage the client to drink 2 to 3 liters of water or fluids aday Rationale 6: Drinking appropriate amount of fluids will facilitate urine production and flushesbacteria from the urinary tract (Lotan, Y.,e al, 2013).Nursing Intervention 7: The nurse will provide four to six 8 ounce glasses of cranberry juice per dayto the clientRationale 7: Cranberry juice decreases the adherence of bacteria to the uroepithelial cells in theurinary tract (Pietro Ferrara, et al., 2009).Nursing Intervention 8: The nurse will receive a prescription of antibiotics from the physician andensure that client finish the prescribed duration of the antibiotics.Rationale 8: Antibiotics destroy bacteria and reduce the symptoms of infection. Completes the givencourse of antibiotics even if the symptoms disappear, prevent reinfection. Handover of care (ISOBARformat):Handover of Care:Identification: My name is ___________, I am caring for Lachlan Emmerson, DOB- 03/01/2010,Client identification number-V00012356789. The client is suffering with urinary tract infection.Situation: Lachlan Emmersona 6-year old boy who is admitted today in the afternoon. The chiefcomplain of the client was pain when voiding, fever and vomiting. o Observation: During the time of admission the client’s body temperature was found to be 39.2 C ato school and during assessment it was found to be 40.2 C. The heart rate was 140 bpm, BP was 90/60mmHg, rate of respiration -28 bpm. Client is suffering from acute pain and has shown a rate of 10 onthe Wong Baker Faces pain rating scale. The client has nausea and vomited twice at school and oncesince admission. Client complains of painful micturition. Background: Client has a history of chickenpox when he was 4 years old. However, no sequelae isobserved. Client received vaccine for diphtheria, rubella, mumps, measles, Hep A/B, polio andtuberculin. Client has been hospitalized twice with UTI at the age of 4 years and 5 years. Client hasbeen diagnosed with Vesicoureteral Reflux (VUR) in August 2016. No drug reactions or allergiesreported. Currently the client is not on any medications. A dose of paracetamol 1g orallywas given today in the morning to the patient by school nurse. Assessment and Recommendation:For Nursing Diagnosis 1: Acute painAssessment: A present the client reports no pain while urinating. A score of zero was obtained onthe pain rating scale. The client has been administered analgesic medication as prescribed. Nursingintervention to relive pain are followed.Recommendations: Analgesics should be given as per order. Pain assessment should be done in themorning. For Nursing Diagnosis 2: Impaired urinary eliminationAssessment: The client reports no pain while urinating. The patient’s urine output is 30 mL/hr. Thepatient does not have symptoms of dehydration. The vitals of the client are monitored for every 2 to4 hours. The client is encouraged to drink adequate fluids and void every 2 to 3 hours. Recommendations: Urine output should be monitored. The client should be given adequate fluidsand encouraged to void every 2 to 3 hours. For Nursing Diagnosis 3: Fevero Assessment: A present the client’s body temperature is 36.0 C, 120/80 mm Hg, Heart rate is 80bpmand rate of respiration is 16 bpm. The client has been administered antipyretic medication asprescribed. Nursing interventions to relive fever are followed. Recommendations: Antipyretics should be administrated to the client as directed by the physician.The body temperature, urine output, BP. Heart rate and RR should be assessed. For Nursing Diagnosis 4: Risk of infectionAssessment: Urinalysis reports of the client indicate increase in WBC count. Client’s urine culturesuggests presence of E.coli. The client is given antibiotics as prescribed by the physician. The vitals ofthe client are monitored for every 2 to 4 hours. The client is encouraged to drink adequate fluids andvoid every 2 to 3 hours. Recommendations: Antibiotics should be administrated to the client as directed by the physician.The body temperature, urine output, BP. Heart rate and RR should be assessed. The client scheduledto undergo urinalysis and urine culture tomorrow in the morning 0600 hrs. Discharge Plan:For Nursing Diagnosis 1: Acute painFollow-up Instructions: Consult the physician immediately if there are symptoms of painful micturition Medications: Complete the course of analgesics prescribed by the physicianAdhere to the dose and dosing frequencyAdditional Instructions:? Drink at least 3 to 4 litters of fluid daily? Follow distraction techniques for pain relief? Take adequate rest? Empty your bladder every 2-3 hours or as soon as you feel the urge to urinateFor Nursing Diagnosis 2: Impaired urinary eliminationFollow-up Instructions: Consult the physician immediately if there is difficulty in urination, pain during micturition ordecreased frequency of urinationAdditional Instructions:? Drink at least 3 to 4 litters of fluid daily? Drink a glass of cranberry juice daily? Take adequate rest? Empty your bladder every 2-3 hours or as soon as you feel the urge to urinateFor Nursing Diagnosis 3: FeverFollow-up Instructions: Consult the physician immediately if there are symptoms of fever or hyperthermia such as the0forehead is warm to touch or the body temperature is more than 100.4 F (38. C) See the physician within 7 daysMedications: Complete the course of antipyretics prescribed by the physicianAdhere to the dose and dosing frequencyAdditional Instructions:? Drink at least 3 to 4 litters of fluid daily? Take adequate restFor Nursing Diagnosis 4: Risk of infection Follow-up Instructions:Consult the physician immediately if there are symptoms of fever or hyperthermia, painfulmicturition, nausea or vomitingUndergo the clinical and laboratory test as prescribed. Do not miss the scheduled follow-up visitsMedications: Complete the course of antibiotics prescribed by the physicianAdhere to the dose and dosing frequencyAdditional Instructions:? Drink at least 3 to 4 litters of fluid daily? Drink a glass of cranberry juice daily? Take adequate rest? Practice good toilet hygiene? Empty your bladder every 2-3 hours or as soon as you feel the urge to urinateReference: Yvette C. Terrie,(2009).Urinary Tract Infections.Pharmacy Times.Accessed on 4 May 2017 fromhttp://www.pharmacytimes.com/publications/issue/2009/2009-02/2009-02-9995Pietro Ferrara, Luciana Romaniello, OttavioVitelli, Antonio Gatto, Martina Serva, and Luigi Cataldi.(2009). Cranberry juice for the prevention of recurrent urinary tract infections: A randomizedcontrolled trial in children. Scandinavian Journal Of Urology And Nephrology.43(5).Accessed on 4May 2017 from http://dx.doi.org/10.3109/00365590902936698Morhenn V1 &Beavin LE, Zak P (2012).Massage increases oxytocin and reduces adrenocorticotropinhormone in humans.AlternTher Health Med, 18(6):11-8.Donna Koller, & Ran D. Goldman, (2012).Distraction Techniques for Children Undergoing Procedures:A Critical Review of Pediatric Research. Journal of Pediatric Nursing, 27(6), 652-681. Accessed on 4May 2017 from https://doi.org/10.1016/j.pedn.2011.08.001Manz, F. (2007).Hydration and disease.Journal of the American College of Nutrition, 26(sup5), 535S- 541S. Accessed on 4 May 2017 from http://dx.doi.org/10.1080/07315724.2007.10719655Lotan, Y., Daudon, M., Bruyère, F., Talaska, G., Strippoli, G., Johnson, R. J., & Tack, I. (2013). Impact offluid intake in the prevention of urinary system diseases: a brief review. Current opinion innephrology and hypertension, 22, S1-S10. Accessed on 4 May 2017 from doi:10.1097/MNH.0b013e328360a268 "