Reference no: EM133309940

QUESTION: Can you give 1 Goal and 3 or more Objectives to the given case scenario? With a Nursing Diagnosis of Risk for fluid volume deficit related to fever and increased urinary output?

Course in the Ward: Jhonna Angela, a 12-year-old child was brought to the hospital, parents explaining that their child has experienced five attacks of acute cystitis, all characterized by dysuria, increased frequency, and urgency. Parents reported that the child has "dirty" practices in performing personal hygiene whether at home or outside. Each case was diagnosed on the basis of the clinical picture and a laboratory urinalysis finding of bacteriuria. Lab tests history indicated that the first, second, and fifth infections were caused by Escherichia coli, while the third infection was caused by an enterococcus and the fourth infection was caused by Proteus mirabilis. Each infection responded to short-term treatment with trimethoprim-sulfamethoxazole. The recurrences occurred at intervals of 3 weeks to 3 months following completion of antibiotic therapy.

For the past two days, she has once again been experiencing dysuria, increased frequency, and urgency, so the child's parents decided that she goes to see her physician.

Her vital signs are

T = 37.2°C

P = 100/min

RR = 18/min

BP = 90/60 mm Hg.

Physical examination reveals a mild tenderness to palpation in the suprapubic area, but no other abnormalities. The most appropriate tests would include urinalysis with microscopic evaluation of clean-catch urine for bacteria and pyuria, a urine culture, and a CBC with differential. Laboratory tests indicate a Hgb of 13.6 g/dL, Hct 40.7%, MCV 84, and WBC count 10,910/microliter. White blood cells and bacteria are evident in the urine sediment. A urine culture indicates approximately 106 bacterial cells/ml. A Gram stain of the urine reveals Gram-positive cocci. The Gram-positive bacterium is isolated and is found to be catalase positive and coagulase negative. At present, the coagulase-negative Staphylococcus species that is mostly likely to cause cystitis in a young woman is Staphylococcus saprophyticus.

Patient was then advised for admission. Hooked to D5LR 1 L @ 100 ml/hr. Laboratory tests was also ordered.