Author: Dr. Prince

Advocacy Through Legislation – Best Assignment Sample Solutions(2022)

This article provides solution to the assignment on Advocacy Through Legislation : “Identify a problem or concern in your state community or organization that has the capacity to be advocated through legislation. Research the issue and complete the sections below.”

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Nurses often become motivated to change aspects within the larger health care system based on their real-world experience. As such, many nurses take on an advocacy role to influence a change in regulations, policies, and laws that govern the larger health care system.
For this assignment, identify a problem or concern in your state, community, or organization that has the capacity for advocacy through legislation. Research the issue and use the \”Advocacy Through Legislation\” template to complete this assignment.
…

Solution

Advocacy Through Legislation

Identify a problem or concern in your state community or organization that has the capacity to be advocated through legislation. Research the issue and complete the sections below. For each topic that requires the listing of criteria, a minimum of two criteria should be identified and discussed. Add more rows as is appropriate for the topic/proposal.

Problem In no more than 250 words, describe the problem, who is affected, and the current ramifications. Explain the consequences if the issue continues.
Pennsylvania is facing an opioid crisis as it has one of the highest death rates from opioid overdoses in the country. NIH reports that in the state, 65% of drug overdose deaths involved opioids in 2018—a total of 2,866 fatalities at a rate of 23.8. This is despite the fact that Pennsylvania providers wrote 49.9 opioid prescriptions for every 100 persons compared to the average U.S. rate of 51.4 prescriptions. Opioid addiction has been characterized as a chronic disease with health, social and economic implications. Opioids’ mechanism of action is by acting on the nervous system to produce feelings of pleasure and pain relief. However, misuse of opioids alters the chemistry of the brain and lead to drug tolerance. Long-term misuse leads to dependence, which on withdrawal results in withdrawal symptoms such as muscle cramping, diarrhea, and anxiety. A significant number of opioid dependent individuals progress to an opioid addiction, which is classified with a higher risk of overdose and death as well as fatal interactions with other legal and illegal medications. The opioid epidemic affects all demographics. The wide range makes the problem a significant health problem with extensive ramifications on communities and the state at large. The position of nurses at the front lines of care can be used to fight against the epidemic and helping patients battling the addiction.
Idea for Addressing Solution In no more than 250 words, outline your idea for addressing the issue and explain why legislation is the best course for advocacy.
At an organizational level, identifying and treating individuals with opioid use disorder (OUD) at critical care areas such as ED can help address the problem. In the ED, clinicians can screen for opioid use disorder, provide interventions and facilitate referral to ongoing treatment. Medication initiation in the ED, and treatment of withdrawal symptoms has been cited as an opportunity for harm reduction and decreasing the use of illegal opioids. This entails the use of opioid agonist treatment, including methadone and buprenorphine/naloxone on individuals with OUD in ED. Initiating treatment upon diagnosis should include the identification of treatment goals, the conditions for changing or stopping treatment and the contingencies for non-adherence such as reassessments for addiction, and more intensive treatment. The benefits include low costs of intervention compared to community based interventions and increased engagement in addiction treatment.
Research the Issue Perform research and compile information for your idea. Present substantive evidence-based findings that support your idea for addressing the problem (studies, research, and reports). Include any similar legislation introduced or passed in other states.
Evidence 1	According to D’Onofrio et al. (2015) among opioid dependent patients’ ED-initiated buprenorphine treatment vs brief intervention and referral significantly increased engagement in addiction treatment, reduced self-reported illicit opioid use, and decreased use of inpatient addiction treatment services.
Evidence 2	According to Busch et al. (2017) emergency department-initiated buprenorphine intervention for patients with opioid dependence provides high value compared with referral to community-based treatment or combined brief intervention and referral.
Evidence 3	In Massachusetts, OUD treatment and medication initiation in ED is a standard of care is already required by law.
Stakeholder Support Discuss the stakeholders who would support the proposed idea and explain why they would be in support.
Stakeholder(s) Supporting 1	Nursing organizations such as ANA, support the incorporation of screening at the point of care for drug dependence and the initiation of treatment.
Stakeholder(s) Supporting 2	Internal stakeholders, focused on reducing the costs of OUD treatment and enhance its effectiveness. Includes clinicians, nurses and physicians. This is because the approach would help reduce readmissions and contribute to lower cases of OUD related deaths in the community.

Stakeholder Opposition Discuss the stakeholders who would oppose the proposed idea. Explain why they would be in opposition and how you would prepare to debate or converse about these considerations.
Stakeholder(s) Opposed 1	Some clinicians may oppose the proposal as it necessitates the expansion of practice to include the treatment of opioid addiction is that the emergency department.
Stakeholder(s) Opposed 2	Emergency provider who might cite increased admissions by more difficult patients who may want to abuse Buprenorphine or take part in prescribed buprenorphine diversion.

Financial Incentives/Costs In no more than 250 words, summarize the financial impact for the issue and the idea (added costs, cost savings, increased revenue, etc.). Provided support.
The initiative may require the training on ED-initiated buprenorphine and have decision support during the initial stages. The costs of the interventions will be low due to the minimal health care resources used in the ED-based component of the intervention. Busch et al. (2017) highlights that ongoing investment for EDs to provide the ED-initiated buprenorphine strategy will be minimal. Further, the approach would reduce patient time costs as well as the crime costs associated with substance use disorders. The long-term implications of the intervention will have a high value in addressing the highly prevalent opioid crisis in Pennsylvania.
Legislature: Information Needed and Process for Proposal Discuss the how to advocate for your proposal using legislation. Include the following:
Provide the name and complete contact information for the legislator.	Name, Contact
Describe the steps for how you would present this to your legislator.	Define the main message of the proposal, which is to address rampant opioid addictions and crisis in the state. Establish credibility, by underlining qualification related to the crisisProvide a brief yet accurate description of the proposal, use simple language and adopt visuals where appropriate. Make a connection by underlining how the approach will lead to better outcomes in the legislators’ district.
Outline the process if your legislator chooses to introduce your idea as a bill to congress.	Begins with the creation of the Bill and assigning of a legislative number, followed by the development of a committee where expert input is heard from all stakeholders. The bill is then returned to the floor for further debate and approval. This is followed by a vote on the proposed bill.
Christian Principles and Nursing Advocacy In no more than 250 words, discuss how principles of a Christian worldview lend support to legislative advocacy in health care without bias. Be specific as to how these principles help advocate for inclusiveness and positive health outcomes for all populations, including those more vulnerable, without regard to gender, sexual orientation, culture, race, religion/belief, etc.
Christianity principles calls for advocates for those in need, by utilizing the resources we have to serve and help others. Hence at a position of influence, one should adopt the belief that they are ambassadors for God. This would guide our belief on speaking up for others and finding solutions that would help those in need. The principle guides on the adoption of perspectives that approach each individual with respect and dignity and championing for inclusiveness as we are all made in the image and likeness of God. Besides we are required to take a proactive role in protecting the more vulnerable members of our society, as captured in Proverbs 31:8-9 “Speak up for those who cannot speak for themselves, for the rights of all who are destitute. Speak up and judge fairly; defend the rights of the poor and needy.” I believe this perspective and understanding should lead each nurse to legislation advocacy with the intention of helping those in need through the best way possible.

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References

Busch, S. H., Fiellin, D. A., Chawarski, M. C., Owens, P. H., Pantalon, M. V., Hawk, K., Bernstein, S. L., O’Connor, P. G., & D’Onofrio, G. (2017). Cost-effectiveness of emergency department-initiated treatment for opioid dependence. Addiction (Abingdon, England), 112(11), 2002–2010. https://doi.org/10.1111/add.13900

D’Onofrio, G., Chawarski, M. C., O’Connor, P. G., Pantalon, M. V., Busch, S. H., Owens, P. H., Hawk, K., Bernstein, S. L., & Fiellin, D. A. (2017). Emergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: Outcomes During and After Intervention. Journal of general internal medicine, 32(6), 660–666. https://doi.org/10.1007/s11606-017-3993-2

D’Onofrio, G., Edelman, E. J., Hawk, K. F., Pantalon, M. V., Chawarski, M. C., Owens, P. H., Martel, S. H., VanVeldhuisen, P., Oden, N., Murphy, S. M., Huntley, K., O’Connor, P. G., & Fiellin, D. A. (2019). Implementation facilitation to promote emergency department-initiated buprenorphine for opioid use disorder: protocol for a hybrid type III effectiveness-implementation study (Project ED HEALTH). Implementation science : IS, 14(1), 48. https://doi.org/10.1186/s13012-019-0891-5

Question

Nurses often become motivated to change aspects within the larger health care system based on their real-world experience. As such, many nurses take on an advocacy role to influence a change in regulations, policies, and laws that govern the larger health care system.

For this assignment, identify a problem or concern in your state, community, or organization that has the capacity for advocacy through legislation. Research the issue and use the \”Advocacy Through Legislation\” template to complete this assignment.

You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

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May 12, 2022

4 Best Nursing Care Plans for Thrombocytopenia

This article discusses Nursing Care Plans for Thrombocytopenia plus its causes, symptoms, preventions, treatments, and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Introduction

Thrombocytopenia is a condition in which a person has a low blood platelet count. This condition means a person has fewer than 150,000 platelets per microliter of circulating blood. Platelets are colourless blood cells that facilitate blood clotting. Platelets stop bleeding by clumping and forming plugs in blood vessel injuries.

Thrombocytopenia might occur due to a bone marrow disorder such as leukemia or an immune system problem. Or it can be a side effect of taking certain medications. It affects both children and adults.

Thrombocytopenia can be mild and cause few signs or symptoms. In rare cases, the number of platelets can be so low that dangerous internal bleeding occurs. Treatment options are available.

Symptoms of Thrombocytopenia

Thrombocytopenia signs and symptoms may include:

Easy or excessive bruising (purpura)
Blotches and bruises – A person might have large areas of bleeding under the skin that don’t turn white when you press on them. You also might see what look like the bruises you get from a bump or being hit. They could be blue or purple and change to yellow or green over time. These are caused from the inside by the sudden leaking from tiny blood vessels. The medical name for these is purpura.
Prolonged bleeding from cuts
Bleeding from your gums or nose
Blood in urine or stools
Hefty menstrual flows
Fatigue
Enlarged spleen

Causes of Thrombocytopenia

Platelets live about 10 days in the body, making it renew the platelet supply continually by producing new platelets in the bone marrow.

Thrombocytopenia rarely is inherited. Several medications or conditions can cause it. Whatever the cause, circulating platelets are reduced by one or more of the following:

Trapped platelets

The spleen is a small organ about the size of a fist situated just below the rib cage on the left side of the abdomen. Normally, the spleen works to fight infection and filter unwanted material from the blood. An enlarged spleen, which a number of disorders can cause, can harbour too many platelets, which decreases the number of platelets in circulation.

Decreased production of platelets

Platelets are produced in the bone marrow. Factors that can decrease platelet production include:

Leukemia and other cancers
Some types of anemia
Viral infections, such as hepatitis C or HIV
Chemotherapy drugs and radiation therapy
Heavy alcohol consumption

Increased breakdown of platelets

Some conditions can cause the body to use up or destroy platelets faster than they’re produced, leading to a shortage of platelets in the bloodstream. Examples of such conditions include:

Pregnancy – Thrombocytopenia caused by pregnancy is usually mild and improves soon after childbirth.

Immune thrombocytopenia – Autoimmune diseases like lupus and rheumatoid arthritis cause this type. The body’s immune system mistakenly attacks and destroys platelets. If the exact cause of this condition isn’t known, it’s called idiopathic thrombocytopenic purpura. This type more often affects children.

Bacteria in the blood – Severe bacterial infections involving the blood (bacteremia) can destroy platelets.

Thrombotic thrombocytopenic purpura is a rare condition that occurs when small blood clots suddenly form throughout the body, using up large numbers of platelets.

Hemolytic uremic syndrome – This rare disorder causes a sharp drop in platelets, destruction of red blood cells and impairs kidney function.

Medications – Certain medications can reduce the number of platelets in the blood. Sometimes a drug confuses the immune system and causes it to destroy platelets. Examples include heparin, quinine, sulfa-containing antibiotics and anticonvulsants.

Complications of Thrombocytopenia

Dangerous internal bleeding can occur when your platelet count falls below 10,000 platelets per microliter. Though rare, severe thrombocytopenia can cause bleeding into the brain, which can be fatal.

Diagnosis of Thrombocytopenia

Physical examination

If a doctor suspects a low platelet count, they will first do a physical exam. The doctor will check a patient’s body for unusual bruising or evidence of petechiae (small red and purple dots), which is a sign of capillary bleeding that often accompanies a low platelet count.

The doctor may also feel the abdomen to check for an enlarged spleen or liver.

Medical history

A doctor may also ask about the following:

A family history of bleeding disorders
Medications taken
Herbal supplements taken
Patient’s eating patterns
Alcohol intake and IV drug use
Current sex protection methods

Tests

Multiple blood, bone marrow, and ultrasound tests can help a doctor diagnose this condition and determine the underlying cause. The tests are discussed below.

Blood tests

A doctor will need to do a complete blood count (CBC) test to diagnose low platelet count. This test is often performed with a simple blood draw in the arm.

A CBC test looks at the number of blood cells in the blood. It will tell a doctor if the platelet count is lower than it should be. A typical platelet count will range between 150,000 and 450,000 platelets per millilitre of blood.

A doctor may also choose to perform a blood smear test, which looks at the blood under a microscope to see how the platelets look.

A patient’s blood may also be tested for platelet antibodies. These are proteins that destroy platelets. Platelet antibodies can be produced as a side effect of certain drugs, such as heparin, or for unknown reasons.

Blood-clotting tests may also be ordered, including partial thromboplastin time and prothrombin time. Certain chemicals are added to a blood sample to determine how long it takes the blood to clot.

Ultrasound

If a doctor suspects that a patient’s spleen is enlarged, they may order an ultrasound. This test uses sound waves to make a picture of the spleen.

Bone marrow aspiration and biopsy

A bone marrow test may also be performed. There are two types of bone marrow tests: a biopsy and an aspiration. In some cases, both tests may be performed at the same time.

A small amount of bone marrow is removed from one of the bones

during a bone marrow aspiration.

A sample of the core bone marrow is removed in a bone marrow biopsy, usually from the hipbone.

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**Nursing Care Plans for Thrombocytopenia**

Treatment of Thrombocytopenia

The treatment options for a low platelet count can vary. A doctor or specialist will determine the appropriate treatment for low platelet counts based on the underlying cause and severity of the condition.

If the condition is mild, a doctor may choose to monitor a patient.

If the low platelet count is more severe, a patient may need medical treatment.

Treatment options may include:

Blood or platelet transfusions
Changing medications that are causing a low platelet count
Prescribing steroids, immune globulin, or other medicines that suppress your immune system
Spleen removal surgery

Management of Thrombocytopenia

If a patient is at risk of developing a low platelet count, scheduling regular doctor’s visits will help pay attention to potential signs and symptoms.

The patient should let the doctor know about any supplements or medications they are taking.

The patient should avoid activities like contact sports that put you at risk for bleeding injuries or talk to a doctor about safety measures when possible.

If a patient’s spleen has been removed, they should watch for potential signs of infection — as the removal of the spleen can increase the risk — and seek medical attention if they start to feel ill or have a fever.

Screening and Prevention of Thrombocytopenia

There are many reasons that a doctor may screen for low platelet count. In some cases, a routine blood test may indicate low levels.

If a patient is at risk of developing a low platelet count due to an underlying condition or medical history, the healthcare professional may recommend taking prevention measures. These may include:

Avoiding activities with a high risk of bleeding or bruising (i.e., contact sports)
Limiting alcohol consumption
Making dietary changes
Stopping or switching medications that affect platelets, including aspirin and ibuprofen
Getting certain types of vaccinations
Avoiding toxic chemicals

Nursing Care Plans for Thrombocytopenia Based on Nursing Diagnosis

Nursing Care Plan 1: Diagnosis -Risk for Bleeding related to low platelet count

Desired Outcome

To prevent any bleeding episode and improve platelet count.

Interventions	Rationales
Assess the patient’s vital signs and perform a focused physical assessment, looking for any signs of bleeding.	Anticoagulants put the patient at risk for bleeding. Early signs of bleeding include gum bleeding, epistaxis, and unexplained bruises. Low blood pressure, low temperature, and dizziness may result from excessive bleeding.
Obtain blood samples and monitor platelet counts as well as coagulation levels (INR, PT, and PTT).	To measure the risk of bleeding by knowing the patient’s platelet counts and coagulation levels. To check for the need for platelet transfusion.
Administer blood or platelet transfusion as prescribed.	A platelet or whole blood transfusion is administered if the platelet level is too low and immediate correction is warranted.
Prepare the patient for splenectomy as indicated.	This is mostly recommended in cases of splenomegaly if it is the cause of thrombocytopenia.

Nursing Care Plan 2: Diagnosis – Fluid Volume Deficit related to blood volume loss secondary to bleeding

Evidenced by:

Hematemesis
Low platelet count
HB of 70
Skin pallor
A blood pressure level of 85/58
Lightheadedness

Desired Outcome

The patient will have an absence of bleeding, a hemoglobin (HB) level of over 100, blood pressure level within normal range, full level of consciousness, and normal skin colour.

Interventions	Rationales
Assess vital signs, particularly blood pressure level.	Hypovolemia due to bleeding may lower blood pressure levels and put the patient at risk for hypotensive episodes that lead to shock.
Commence a fluid balance chart, monitoring the input and output of the patient. Include episodes of vomiting, gastric suctioning, and other gastric losses in the I/O charting.	To monitor the patient’s fluid volume accurately.
Start intravenous therapy as prescribed. Electrolytes may need to be replaced intravenously. Encourage oral fluid intake of at least 2000 mL per day if not contraindicated.	To replenish the fluids and electrolytes lost and promote better blood circulation around the body.
Educate the patient (or guardian) on how to fill out a fluid balance chart at the bedside.	To help the patient or the guardian take ownership of the patient’s care, encourage them to drink more fluids as needed, or report any changes to the nursing team.
Administer blood transfusion as prescribed.	To increase the platelet count and hemoglobin level and treat thrombocytopenia, anemia and hypovolemia related to bleeding.

Nursing Care Plan 3: Diagnosis – Risk for Injury related to abnormal blood profile

Desired Outcome

The patient will be able to prevent injury by means doing activities that can be done without spending too much energy and by modifying the environment to adapt to the current capacity.

Intervention	Rationale
Assess the patient’s energy level and fatigability, as well as their usual activities of daily living (ADLs).	To explore the patient’s energy levels and how these can affect ADLs. To gain useful information before modifying the patient’s environment.
Place the bed in the lowest position. Place the call bell within reach (if there’s any), and keep the visual aids, patient’s phone, and other devices within reach.	To prevent or minimize injury of the patient.
Promote adequate lighting in the patient’s room.	To promote safety measures and support to the patient in doing ADLs optimally.
Ensure that the floor is free of objects that can cause the patient to slip or fall.	To promote safety measures and support to the patient in doing ADLs optimally.
Advise the patient to wear sunglasses, especially when going outdoors.	To reduce glare and help protect the eyes.

Nursing Care Plan 4: Diagnosis – Fatigue related to post-surgical removal of spleen secondary to thrombocytopenia and splenomegaly Evidenced by:

Verbalization of lack of energy
Verbalization of tiredness
Generalized weakness

Desired Outcome

Post-surgery, the patient will verbalize improved energy levels and will demonstrate active participation in necessary and desired activities.

Interventions	Rationales
Ask the patient to rate fatigue level (mild, moderate, or severe fatigue). Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that they used to do or wants to try.	To create a baseline of activity levels, degree of fatigability, and mental status related to fatigue and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media for long periods. Alternate periods of physical activity with rest and sleep.	To gradually increase the patient’s tolerance to physical activity.
Encourage the patient to follow low cholesterol, high caloric diet. Refer to the dietitian as needed.	To increase energy levels.
Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.	To allow the patient to relax while at rest. To allow enough oxygenation in the room.
Refer the patient to the physiotherapy / occupational therapy team as required.	To provide more specialized care for the patient in terms of helping them build confidence in increasing daily physical activity.

Related FAQs

1. What is a nursing diagnosis for thrombocytopenia?

Based on the assessment data, the major nursing diagnoses for idiopathic thrombocytopenic purpura are: Risk for bleeding related to decreased platelet count. Risk for injury related to abnormal blood profile.

2. What are nursing interventions for thrombocytopenia?

Nursing interventions. Nursing interventions include prevention, early identification, and management of thrombocytopenia and its complications. Take steps to minimize the patient’s risk of injury, as by preventing falls, reducing the bleeding risk, and preventing infection

3. What are the interventions for thrombocytopenia?

How is thrombocytopenia managed or treated?

Blood transfusion to temporarily increase platelet levels in your blood. …
Splenectomy or removal of the spleen.
Steroids (prednisone or dexamethasone), immunoglobulins (antibody proteins), and other medications that reduce platelet destruction and stimulate platelet production.

4. When should thrombocytosis be treated?

Treatment of essential thrombocythemia depends on your risk of blood clots or bleeding episodes. If you’re younger than 60 and have had no signs or symptoms, you may simply need periodic medical checkups. Your doctor may prescribe medication if: You’re older than 60 and have had previous blood clots or TIAs.

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May 11, 2022

2 Best Nursing Care Plans for Type 1 Diabetes

This article discusses Nursing Care Plans for Type 1 Diabetes plus its causes, symptoms, preventions, treatments, and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Introduction

When considering nursing diagnosis for type 1 diabetes, you must understand and take these complications into account. Because there is no singular diabetes nursing diagnosis, we’ll go over the many NANDA for diabetes and concerns that necessitate nursing intervention. Elevated blood sugars, difficulty with fluid balance, difficulty with nutritional regimens, skin and healing problems, and problems with feeling are all risk factors for diabetes. While not all of these diagnoses may apply to your patient, other factors, including education level, history, and social supports, should always be considered when selecting a nursing diagnosis.

Type 1 Diabetes mellitus is a chronic condition characterised by insufficient insulin synthesis in the pancreas or inefficient insulin utilisation by the body. As a result, the concentration of glucose in the bloodstream rises (hyperglycemia). Disturbances in carbohydrate, protein, and lipid metabolism characterise it. Sustained hyperglycemia has been demonstrated to affect nearly all of the body’s tissues. It is associated with significant complications of multiple organ systems, including the eyes, nerves, kidneys, and blood vessels.

The deficit is thought to occur in persons who are genetically predisposed to the condition and have had a precipitating event, such as a viral infection or a change in their environment that triggers an autoimmune reaction that affects the pancreas’ insulin-producing cells (beta cells).

Insulin injections and dietary and physical activity management are used to keep physiological functions in check. Hypoglycemia and hyperglycemia, which, if left untreated, can lead to insulin shock or ketoacidosis, are complications of incorrect coordination of these. Neuropathy, nephropathy, retinopathy, atherosclerosis, and microangiopathy are only a few of the long-term repercussions of the condition.

Diabetes Warning Signs

Vision is hazy
Fatigue
Feet and hands are numb or tingling.
bladder infections on a regular basis
The time it takes for wounds to heal is excessively long.
Gaining or losing weight is a common occurrence in both men and women.
Irritability
Vomiting, nausea
Itching

Clinical Manifestations

Hyperglycemia. Although some children describe general malaise, headache, and weakness, hyperglycemia alone may not create noticeable symptoms; children may also appear angry and ill-tempered.

Glycosuria. This disorder causes increased urine frequency and volume (polyuria), which is especially bothersome at night (nocturia) and frequently leads to enuresis in previously continent children.

Polydipsia. Increased thirst, which can be insatiable, is a side effect of dehydration caused by osmotic diuresis.

Polyuria. Urinary production rises dramatically, most likely due to enuresis.

Polyphagia. Hunger is on the rise, as is food consumption.

Loss of weight. Failure to thrive and wasting may be the first symptoms noticed in an infant or toddler and may precede frank hyperglycemia. Insulin deficiency causes uninhibited gluconeogenesis, which causes protein and fat breakdown; weight loss may be dramatic, though the child’s appetite usually remains good; failure to thrive and wasting may be the first symptoms noted in an infant or toddler and may precede frank hyperglycemia.

Malaise without a specified cause. Although this condition may exist prior to the onset of hyperglycemia symptoms or as a separate symptom of hyperglycemia, it is frequently only noticed after the fact.

Diabetic ketoacidosis. DKA is characterised by tiredness, dry skin, flushed cheeks, and cherry-red lips, as well as fruity acetone breath and Kussmaul breathing.

Pathophysiology

The following is a possible mechanism for the occurrence of type 1 diabetes:

Insulin is required for the metabolism of carbohydrates, fats, and proteins; it lowers blood glucose levels by allowing glucose to enter muscle cells and stimulating the conversion of glucose to glycogen (glycogenesis) as a carbohydrate store; it also inhibits the release of stored glucose from liver glycogen (glycogenolysis) and slows the breakdown of fat into triglycerides, free fatty acids, and ketones; and it promotes fat storage.
An insulin insufficiency causes unregulated gluconeogenesis, which limits the use and storage of circulating glucose, resulting in hyperglycemia (a random blood glucose concentration of more than 200 mg/dL or 11 mmol/L).
Increased fat and protein breakdown leads to ketone generation and weight loss; the kidneys are unable to reabsorb the excess glucose load, resulting in glycosuria, osmotic diuresis, thirst, and dehydration.
When glucose levels fall below 65 mg/dL (3.2 mmol/L), counterregulatory hormones (such as glucagon, cortisol, and adrenaline) are produced, and hypoglycemia symptoms appear.
The glucose level at which symptoms appear varies widely from person to person (and from time to time within the same person) and is influenced by factors such as the duration of diabetes, the frequency of hypoglycemia episodes, the rate of glycemia decline, and overall control.

Assessment and Diagnostic Findings

Diabetes consequences can be delayed or minimised by detecting and controlling the disease early on.

Glucose test by fingerstick – A fingerstick glucose test should be used to monitor glucose levels in children who have a family history of diabetes.
Dipstick urine test – The child should have a urine dipstick test to check for ketones in the urine.
Blood sugar levels after a fast (FBS) – A fasting blood sugar test is performed if the blood glucose level is increased or if ketonuria is present; an FBS result of 200 mg/dl or higher usually always indicates diabetes when other symptoms are present.
Profile of lipids – Increased circulating triglycerides caused by gluconeogenesis typically cause aberrant lipid profiles at diagnosis.
Glycated haemoglobin – Glycosylated haemoglobin derivatives result from a nonenzymatic interaction between glucose and haemoglobin; there is a substantial link between average blood glucose levels over an 8- to 10-week period and the amount of glycated haemoglobin.
Microalbuminuria – Microalbuminuria is the first sign of nephropathy; the exact definition varies by country, but an increased AER is commonly defined as a ratio of first morning-void urinary albumin levels to creatinine levels greater than 10 mg/mmol, or as a timed, overnight AER greater than 20 mcg/min but less than 200 mcg/min.

Nursing Diagnoses

Based on the assessment data, the major nursing diagnoses for diabetes mellitus type 1 are:

Imbalanced nutrition: less than body requirements related to insufficient caloric intake to meet growth and development needs and the inability of the body to use nutrients.

Risk for impaired skin integrity related to slow the healing process and decreased circulation.

Risk for infection related to elevated glucose levels.

Deficient knowledge related to complications of hypoglycemia and hyperglycemia.

Deficient knowledge related to appropriate exercise and activity.

Medical Management

Insulin therapy is a treatment for diabetes. Insulin therapy is an important aspect of the treatment of diabetes in children; the dosage of insulin is adjusted based on blood glucose levels to keep them close to normal; many children have been prescribed an insulin regimen that is given twice a day, once before breakfast and once before dinner.

Diet. The current diabetes dietary management stresses a healthy, balanced diet high in carbohydrates and fibre and low in fat.

Activity. Type 1 diabetes necessitates no activity limitations; exercise provides genuine benefits for a child with diabetes; and current rules are becoming increasingly complex, allowing youngsters to compete at the highest levels in sports.

Continuous glucose monitoring. Continuous glucose monitoring is recommended for children and adolescents with type 1 diabetes, whether they are receiving injections or a continuous subcutaneous insulin infusion, according to the American Diabetes Association’s Standards of Medical Care in Diabetes-2018.

Pharmacologic Management

Insulin is always needed to treat type 1 diabetes and is also used to treat type 2 diabetes that hasn’t responded to medication with diet and/or oral hypoglycemics.

Insulin deficiency. Insulin aspart is a rapid-acting insulin that has been approved by the FDA for use in children aged two years and older with type 1 diabetes for SC daily injections and SC continuous infusion by external insulin pump; however, it has not been studied in children with type 2 diabetes; onset of action is 10-30 minutes, peak activity is 1-2 hours, and duration of action is 3-6 hours; onset of action is 10-30 minutes, peak activity is 1-2 hours, and duration of action is 3-6 hours.

**Nursing Care Plans for Type 1 Diabetes**

Glulisine is a kind of insulin. Rapid-acting insulin; the safety and effectiveness of SC injections of insulin glulisine in pediatric patients (aged 4-17 years) with type 1 diabetes have been established; however, it has not been studied in pediatric patients with type 2 diabetes; onset of action is 20-30 minutes, peak activity is 1 hour, and duration of action is 5 hours; onset of action is 20-30 minutes, peak activity is 1 hour, and duration of action is 5 hours.

Insulin lispro. Only lispro U-100 has been approved by the FDA to improve glycemic control in children aged >3 years with type 1 diabetes; however, it has not been studied in children with type 2 diabetes; onset of action is 10-30 minutes, peak activity is 1-2 hours, and duration of action is 2-4 hours; onset of action is 10-30 minutes, peak activity is 1-2 hours, and duration of action is 2-4 hours.

Insulin how it should be. Insulin that works quickly. The FDA has approved Novolin R to improve glycemic control in pediatric patients with type 1 diabetes aged 2 to 18 years; however, it has not been studied in pediatric patients with type 2 diabetes. Humulin R is indicated to improve glycemic control in pediatric patients with diabetes mellitus requiring more than 200 units of insulin per day.

Insulin NPH. Intermediate-acting insulin is used to enhance glycemic control in children with type 1 diabetes. Its onset is 3-4 hours, the peak effect is 8-14 hours, and the average duration of action is 16-24 hours.

Insulin glargine is a kind of insulin that is used to treat diabetes. Long-acting insulin; the safety and efficacy of glargine U-100 in pediatric patients (6-15 years old) with type 1 diabetes have been established; however, it has not been investigated in pediatric patients with type 2 diabetes.

Insulin detemir. Long-acting insulin. Insulin detemir is approved for once- or twice-daily SC delivery in pediatric patients with type 1 diabetes (aged 6-17 years).

Nursing Care Plans for Type 1 Diabetes

When caring for a client with diabetes, nurses play an important role in educating the child and family about hyperglycemia and hypoglycemia management, including insulin administration, dietary regimen, and exercise requirements for the child, assisting the family in adjusting to having a chronic disease and preventing short- and long-term complications of diabetes.

Nursing Care Plans based on Diagnosis include:

Deficient Knowledge
Compromised Family Coping
Risk for Injury
Risk for Unstable Blood Glucose

Nursing Care Plan 1 : Diagnosis : Deficient Knowledge

Evidence of Deficient Knowledge include:

New diagnosis of IDDM
Request for information regarding the pathology, blood and urine testing, insulin therapy, activity/exercise needs, dietary regimen, personal hygiene and health promotion

Desired Outcomes

The client will verbalise understanding of IDDM.
Client and parents will demonstrate appropriate blood-glucose monitoring, insulin administration, dietary management, and exercise plan.
Client and parents will identify signs and symptoms of hypoglycemia and hyperglycemia and correct response.

Nursing Interventions	Rationale
Assess parents and child understanding of disease and ability to perform procedures and care, for educational level and learning capacity, and for developmental level.	Provides information essential to develop a learning program; children ages 8 to 10 may be able to take responsibility for some of the care.
Provide a quiet, comfortable environment; allow time for teaching small amounts at a time and for reinforcement, demonstrations and return demonstration; start educating one day following diagnosis and limit sessions to 30 to 60 minutes.	It prevents distractions and facilitates learning.
Include as many family members in teaching sessions as possible.	Promotes understanding and support of family and feeling of security for the child.
Teach about the cause of disease, disease process and pathology; use pamphlets , and other aids appropriate for the age of child and level of comprehension of parents.	Provides basic information that may be used as a rationale for treatments and care and allows for different teaching strategies.
Instruct parents and children in insulin administration including drawing up insulin into the syringe, rotating vial instead of shaking, drawing clear insulin first if mixing two types in the same syringe, injecting SC, storing insulin, rotating sites, adjusting dosages, reusing a syringe and needle and disposing of them.	Promotes proper technique of insulin administration to avoid complications.
Instruct in use of a syringe-loaded injector.	Provides an alternative method of insulin administration if the child is afraid of skin puncture.
Teach parents and child on how to operate a portable insulin pump to regulate insulin delivery.	Provides continuous subcutaneous insulin infusion.
Instruct parents and children to monitor blood glucose levels four times a day (before meals and before bed), with a lancet and blood-testing meter or a reagent strip compared to a colour chart; collection and testing of urine with ketostix or Clinitest.	Monitors blood and urine for the presence of glucose and ketone.
Teach parents and children about dietary planning with importance on proper meal times and adequate caloric intake according to age as ordered. Teach that food intake depends on activity, and describe methods to judge amounts of foods; provide a list of acceptable food items from “fast food” restaurants.	Provides information about an important aspect of the total care of the child with diabetes.
Teach parents and children about the role of exercise and changes needed in food and insulin intake with increased or decreased activity.	Provides information about common activity patterns and effects on dietary intake and insulin needs.
Teach parents and children about skin problems associated with diabetes, need for regular dental examinations, foot care, protection of and proper care of nails, prevention of infections and exposure to infections, eye examinations, immunisations.	Provides information about common complications as a result of chronic effects of the disease.
Instruct parents and children to keep a record of insulin administration, glucose monitoring, responses to diet and exercise, noncompliance in medical regimen and effects.	Provides a method to improve self-care and demonstrates the need to notify the physician for treatment evaluation and possible modification.
Instruct the child to wear or carry identification and information about the disease, treatment, and physician name.	Provides information in case of an emergency.

Nursing Care Plan 2 : Diagnosis : Compromised Family Coping

Evidence of Compromised Family Coping include:

Expression and/or confirmation of concern and inadequate knowledge about long-term care needs, problems and complications

Anxiety and guilt

Overprotection of child

Desired Outcomes

The family will talk about their feelings about the child’s long-term requirements.

The family will decide on the best support networks and coping techniques for them.

Nursing Interventions	Rationale
Assess family coping mechanisms and its effectiveness, family dynamics and expectations related to long-term care, developmental level of family, the response of siblings, knowledge, and use of support systems and resources, presence of guilt and anxiety, overprotection and overeating behaviours.	Recognises coping methods that work and the need to develop new coping skills and behaviours, family attitudes; child with special long-term needs may tighten or strain family relationships, and that over-protection may be deleterious to child’s growth and development.
Allow family members and child to express difficult areas, anxiety and explore solutions responsibly.	Lessens anxiety and improves understanding; provides the family with an opportunity to recognise problems and generate problem-solving methods.

Assist family in establishing short- and long-term goals for the child and to involve the child in the activities of the family; include the participation of all family members in care routines.	Promotes engagement in and control over situations and keeps the role of family members and parents.
Encourage family members to verbalise feelings, to tell how they handle the chronic needs of the family member, and to define coping patterns that support or inhibit adjustment to the problems.	Encourages expression of feelings to identify the need for information and support and to dismiss guilt and anxiety.
Provide support to social worker, counselor, clergy, or other as needed.	Provides assistance to the family dealing with the long-term care of a child with chronic illness.
Teach family about long-term care and treatments.	Improves family’s understanding of treatment regimen and responsibilities of family.
Teach family that overprotective behavior may inhibit growth and development so they should treat the child as normally as possible.	Facilitates understanding of the significance of making the child a part of the family and illustrates the unfavorable effects of being overprotective.
Explain the importance of attending follow-up appointments for physical examinations, laboratory tests.	Promotes positive outcome when family collaborates with the physician and health team to monitor disease.

Related FAQs

1. What is difference between type 1 and type 2 diabetes?

The main difference between the type 1 and type 2 diabetes is that type 1 diabetes is a genetic condition that often shows up early in life, and type 2 is mainly lifestyle-related and develops over time. With type 1 diabetes, your immune system is attacking and destroying the insulin-producing cells in your pancreas.

2. How does a person get type 1 diabetes?

Type 1 diabetes occurs when your immune system, the body’s system for fighting infection, attacks and destroys the insulin-producing beta cells of the pancreas. Scientists think type 1 diabetes is caused by genes and environmental factors, such as viruses, that might trigger the disease.

3. Is type 1 diabetes serious?

Type 1 diabetes is a serious condition where your blood glucose (sugar) level is too high because your body can’t make a hormone called insulin. This happens because your body attacks the cells in your pancreas that make the insulin, meaning you can’t produce any at all. We all need insulin to live.

4. Can type 2 diabetes be cured?

There’s no cure for type 2 diabetes, but losing weight, eating well and exercising can help you manage the disease. If diet and exercise aren’t enough to manage your blood sugar, you may also need diabetes medications or insulin therapy.

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May 11, 2022

4 Best Nursing Care Plans for Ulcerative Colitis

This article discusses Nursing Care Plans for Ulcerative Colitis plus its causes, symptoms, preventions, treatments, and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Introduction

Ulcerative colitis (UC) is an inflammatory bowel disease. It causes irritation, inflammation, and ulcers in the lining of your large intestine/colon.

There’s no cure, and people usually have symptoms off and on for life. But the right treatments can help keep a handle on the disease.

Nursing Care Plans for Ulcerative Colitis – Causes of Ulcerative colitis

Ulcerative colitis happens when the immune system makes a mistake. Normally, it attacks invaders in the body, like the common cold. But when one has UC, the immune system thinks food, good gut bacteria, and the cells that line the colon are the intruders. White blood cells that usually protect the body attack the colon’s lining instead. They cause inflammation and ulcers.

Doctors aren’t sure why people get the condition. Genes may play a role; the disease sometimes runs in families. Other things in the world around may make a difference too.

Nursing Care Plans for Ulcerative Colitis – Risk Factors of Ulcerative colitis

Things that can affect one’s risk of getting ulcerative colitis include:

Age

It’s most likely to get ulcerative colitis if one is between 15 and 30 years old or older than 60.

Ethnicity

The risk is highest in people of Ashkenazi Jewish descent.

Family history

A person’s risk could be up to 30% higher if they have a close relative with the condition.

Food and stress don’t cause it, but they can trigger a flare of symptoms.

Nursing Care Plans for Ulcerative Colitis – Types of Ulcerative Colitis

The type of ulcerative colitis depends on where it is in the body:

Ulcerative Proctitis

Ulcerative Proctitis is usually the mildest form. It’s only in the rectum, the part of the colon closest to the anus. Rectal bleeding may be the only sign of the disease.

Proctosigmoiditis

Proctosigmoiditis happens in the rectum and the lower end of the colon. Bloody diarrhea, belly cramps, and pain are the likely symptoms of this condition. A patient with this condition usually has the urge to poop but can’t be able to.

Left-sided colitis

Left-sided colitis causes cramps on that side of the belly. A patient also has bloody diarrhea and might lose weight without trying. A patient will have inflammation from the rectum up through the left side of the colon.

Pancolitis

Pancolitis often affects the entire colon. It can cause severe bouts of bloody diarrhea, belly cramps, pain, fatigue, and major weight loss.

Acute severe ulcerative colitis

Acute severe ulcerative colitis is rare. It affects the entire colon and causes severe pain, heavy diarrhea, bleeding, and fever.

Nursing Care Plans for Ulcerative Colitis – Symptoms of Ulcerative Colitis

The main symptom of ulcerative colitis is bloody diarrhea. There might be some pus in the stools too.

Nursing Care Plans for Ulcerative Colitis – Diagnosis of Ulcerative Colitis

A doctor will use tests to tell if a patient has UC instead of another gut disease.

Blood tests can show if a patient has anemia or inflammation.

Stool samples can help the doctor rule out an infection or parasite in the colon. They can also show if there’s blood in the stool.

Flexible sigmoidoscopy lets the doctor look at the lower part of the colon. They’ll put a bendable tube into the lower colon through the bottom. The tube has a small light and camera on the end. A doctor might also use a small tool to take a piece of the lining of the lower colon. This is called a biopsy. A doctor in a lab will look at the sample under a microscope.

Colonoscopy is the same process as flexible sigmoidoscopy, only the doctor will look at the whole colon, not just the lower part.

X-rays are less common for diagnosing the disease, but a doctor may want a patient to have one in special cases.

Nursing Care Plans for Ulcerative Colitis – Treatment of Ulcerative Colitis

UC treatment has two main goals. The first is to make a patient feel better and give the colon a chance to heal. The second is to prevent more flare-ups. A patient may need a combination of diet changes, medication, or surgery to reach those goals.

Diet

Some foods can make the symptoms worse. Soft, bland food doesn’t bother as much as spicy or high-fiber dishes. If a patient can’t digest the sugar in milk called lactose, a doctor may tell him or her to stop eating dairy products. A balanced diet with plenty of fiber, lean protein, fruits, and veggies should provide enough vitamins and nutrients.

Medicine

A doctor may prescribe a few different kinds of drugs, including:

Antibiotics. These fight infections and let your large intestine heal.
Aminosalicylates. These drugs have something called 5-aminosalicylic acid (5-ASA) that fights inflammation and helps control symptoms.
Corticosteroids. If aminosalicylates don’t work or the symptoms are severe, a doctor might give these anti-inflammatory drugs for a short time.
Immunomodulators. These help stop the immune system’s attack on the colon. They can take a while to take effect. A patient might not notice any changes for up to 3 months.
Biologics. These are made from proteins in living cells instead of chemicals. They’re for people with severe ulcerative colitis.
Janus kinase inhibitors (JAK inhibitors). These are oral medicines that can work quickly to get and maintain remission in ulcerative colitis.
Sphingosine 1-phosphate (S1P) receptor modulators. This is an oral medication for patients with moderately to severely active UC.
Loperamide. This can slow or stop diarrhea.

Surgery. If other treatments don’t work or UC is severe, a patient might need surgery to remove the colon (colectomy) or colon and rectum (proctocolectomy). If a patient has a proctocolectomy, a doctor might make a small pouch out of the small intestine and attach it to the anus. This is called ileal pouch-anal anastomosis (IPAA). It lets the body expel waste normally, so a patient doesn’t need to wear a bag to collect stool.

Nursing Care Plans for Ulcerative Colitis – Complications of Ulcerative Colitis

Complications of ulcerative colitis can include:

Bleeding. This can lead to anemia.

Osteoporosis. Patients’ bones might become weak because of the diet or if they take a lot of corticosteroids.

Dehydration. A patient might need to get fluids through a vein (intravenous or IV) if the large intestine can’t absorb enough.

Inflammation. This can affect the joints, skin, or eyes.

Fulminant colitis. If UC attack is severe, the colon might burst, or infection could spread through the body. The intestines stop moving waste, and the belly swells.

Megacolon. Fulminant colitis can cause the large intestine to swell or burst. This is a dangerous complication, and a patient will probably need surgery.

Liver disease. The bile ducts or liver could become inflamed or could get scar tissue.

Colon cancer. Ulcerative colitis puts a patient at higher risk of getting colon cancer, especially if the whole large intestine is affected or if UC persists for a long time.

Nursing Care Plans for Ulcerative Colitis Based on Diagnosis

Nursing Care Plans for Ulcerative Colitis: Care Plan 1 – Diagnosis: Diarrhea related to inflammation of the bowel

Evidenced by:

Loose, watery stools, abdominal cramping, and pain
Increased urgency to defecate
Tenesmus
Increased bowel sounds

**Nursing Care Plans for Ulcerative Colitis**

Desired Outcome

The patient will be able to return to more normal stool consistency and frequency.

Interventions	Rationales
1. Commence a stool chart. Use a standardized stool assessment tool such as the Bristol stool chart.	To monitor the patient’s bowel pattern.
2. Administer medications for ulcerative colitis as prescribed.	To help decrease the frequency of stools and alleviate diarrhea, the doctor may prescribe: Anti-inflammatory drugs- the first line of treatment for people with ulcerative colitis Immune system suppressors- work by prohibiting inflammatory response through suppressing the immune system Biologics- work by stopping proteins in the body from causing inflammation anti-diarrheal and antispasmodics.
Encourage to increase oral fluid intake as tolerated, ideally at least 2L per day. Avoid cold drinks. Check if the patient is in any fluid restriction before doing so.	To help ensure that the patient will not have dehydration due to severe diarrhea. Cold drinks can increase intestinal motility.
Help the patient to select appropriate dietary choices to reduce the intake of milk products, caffeinated drinks, alcohol and avoid high fiber, high-fat foods.	To relieve abdominal pain and cramping, alleviate diarrhea, and promote healthy food habits. To avoid flare-ups of ulcerative colitis. High fiber and high-fat foods can irritate the intestines.
Start the patient on a nothing by mouth status and gradually progress to clear liquids, followed by a bland and low residue diet. The patient can then have a low fat/residue, low fiber diet long-term, as recommended by the dietitian.	Nothing by mouth (NBM) status can help rest the bowel by decreasing peristalsis. Gradual progression from NBM up to low fat and low fiber diet can help manage the symptoms of Ulcerative colitis.

Nursing Care Plans for Ulcerative Colitis: Care Plan 2 – Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to altered absorption of nutrients secondary to Ulcerative Colitis

Evidenced by:

Diarrhea
Abdominal pain and cramping
Weight loss
Nausea and vomiting
Loss of appetite

Desired Outcome

The patient will be able to achieve weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.

Intervention	Rationale
Explore the patient’s daily nutritional intake and food habits (e.g., mealtimes, duration of each meal session, snacking, etc.)	To create a baseline of the patient’s nutritional status and preferences.
Create a daily weight chart and a food and fluid chart. Discuss the short-term and long-term nutrition and weight goals related to Ulcerative colitis with the patient.	To effectively monitor the patient’s daily nutritional intake and progress in weight goals.
Help the patient to select appropriate dietary choices to reduce the intake of milk products, caffeinated drinks, alcohol, and high fiber, high-fat foods.	To relieve abdominal pain and cramping, alleviate diarrhea, and healthy food habits. Caffeine is a stimulant of gastric acid production, which can worsen the condition.
Refer the patient to the dietitian.	To provide more specialized care for the patient in terms of nutrition and diet in relation to newly diagnosed Ulcerative colitis.
Start the patient on a nothing by mouth status and gradually progress to clear liquids, followed by a bland and low residue diet. The patient can then have a low-fat, low-fiber diet on a long-term basis.	Nothing by mouth (NBM) status can help rest the bowel by decreasing peristalsis. Gradual progression from NBM up to low fat and low fiber diet can help manage the symptoms of Ulcerative colitis.

Nursing Care Plans for Ulcerative Colitis: Care Plan 3 – Diagnosis: Acute Pain

May be related to:

Hyperperistalsis
Prolonged diarrhea
Skin/tissue irritation
Perirectal excoriation
Fissures
Fistulas

Possibly evidenced by:

Reports of colicky/cramping abdominal pain/referred pain
Guarding/distraction behaviors, restlessness
Facial mask of pain; self-focusing

Desired Outcomes

Report pain is relieved/controlled.
Appear relaxed and able to sleep/rest appropriately.

Nursing Interventions	Rationale
Encourage the patient to report pain.	May try to tolerate pain rather than request analgesics.
Assess abdominal cramping or pain reports, noting location, duration, and intensity (0–10 scale). Investigate and report changes in pain characteristics	Colicky intermittent pain occurs with Crohn’s disease
Note nonverbal cues (restlessness, reluctance to move, abdominal guarding, withdrawal, and depression). Investigate discrepancies between verbal and nonverbal cues.	Body language or nonverbal cues may be both physiological and psychological and may be used in conjunction with verbal cues to determine the extent and severity of the problem.
Review factors that aggravate or alleviate pain.	May pinpoint precipitating or aggravating factors (such as stressful events, food intolerance) or identify developing complications.
Encourage the patient to assume a position of comfort (knees flexed).	Reduces abdominal tension and promotes a sense of control.
Provide comfort measures (back rub, reposition) and diversional activities.	Promotes relaxation refocuses attention, and may enhance coping abilities.
Cleanse the rectal area with mild soap and water or wipes after each stool and provide skincare (A&D ointment, Sween ointment, karaya gel, Desitin, petroleum jelly).	Protects skin from bowel acids, preventing excoriation.
Provide sitz bath as appropriate.	Enhances cleanliness and comfort in the presence of perianal irritation or fissures.
Observe for ischiorectal and perianal fistulas.	Fistulas may develop from erosion and weakening of the intestinal bowel wall.
Observe and record abdominal distension, increased temperature, decreased BP.	May indicate developing intestinal obstruction from inflammation, edema, and scarring.
Implement prescribed dietary modifications (commence with liquids and increase to solid foods as tolerated).	Complete bowel rest can reduce pain cramping.

Nursing Care Plans for Ulcerative Colitis: Care Plan 4 –Diagnosis: Ineffective Coping

May be related to:

Multiple stressors, repeated over a period of time; situational crisis
Unpredictable nature of disease process
Personal vulnerability; inadequate coping method; lack of support systems
Severe pain
Lack of sleep, rest

Possibly evidenced by:

Verbalization of inability to cope, discouragement, anxiety
Preoccupation with the physical self, chronic worry, emotional tension, poor self-esteem
Depression and dependency

Desired Outcomes

Assess the current situation accurately.
Identify ineffective coping behaviors and consequences.
Acknowledge own coping abilities.
Demonstrate necessary lifestyle changes to limit/prevent recurrent episodes.

Nursing Interventions	Rationale
Assess patient’s and SO’s understanding and previous methods of dealing with the disease process.	Enables the nurse to deal more realistically with current problems. Anxiety and other problems may have interfered with previous health teaching and patient learning.
Determine outside stressors (family, relationships, social or work environment).	Stress can alter the autonomic nervous response, affecting the immune system and contributing to the exacerbation of the disease. Even the goal of independence in the dependent patient can be an added stressor.
Provide an opportunity for the patient to discuss how illness has affected the relationship, including sexual concerns.	Stressors of illness affect all areas of life, and a patient may have difficulty coping with feelings of fatigue and pain in relation to relationship and sexual needs.
Help patient identify individually effective coping skills.	Use of previously successful behaviors can help a patient deal with the current situation and plan for the future.
Provide emotional support: Active-Listen in a nonjudgmental manner; Maintain nonjudgmental body language when caring for the patient; Assign the same staff as much as possible.	Aids in communication and understanding patient’s viewpoint. Adds to patient’s feelings of self-worth. It prevents reinforcing the patient’s feelings of being a burden (frequent need to empty bedpan or commode). Provides a more therapeutic environment and lessens the stress of constant adjustments.
Provide uninterrupted sleep and rest periods.	Exhaustion brought on by the disease tends to magnify problems, interfering with the ability to cope.
Encourage the use of stress management skills (relaxation techniques, visualization, guided imagery, deep-breathing exercises).	Refocuses attention, promotes relaxation, and enhances coping abilities.
Include patient and SO in team conferences to develop an individualized program.	Promotes continuity of care and enables patients and SO to feel a part of the plan, imparting a sense of control and increasing cooperation with the therapeutic regimen.
Administer medications as indicated: antianxiety agents, such as lorazepam (Ativan) Alprazolam (Xanax).	Aids in psychological and physical rest. Conserves energy and may strengthen coping abilities.
Refer to resources as indicated (local support group, social worker, psychiatric clinical nurse specialist, spiritual advisor).	Additional support and counseling can assist patients and SO in dealing with specific stress and problem areas.

Related FAQs

1. What is the main cause of ulcerative colitis?

Abnormal immune response, genetics, microbiome, and environmental factors all contribute to ulcerative colitis. Research suggests that ulcerative colitis could be triggered by an interaction between a virus or bacterial infection in the colon and the body’s immune response.

2. How serious is ulcerative colitis?

Ulcerative colitis is a lifelong condition that you have to manage, rather than a life-threatening illness. Still, it’s a serious disease that can cause some dangerous complications, especially if you don’t get the right treatment. Ulcerative colitis is one form of inflammatory bowel disease (IBD).

3. Can you live a long life with ulcerative colitis?

If you have ulcerative colitis (UC), your life expectancy is pretty much the same as someone without it. Getting the right medical care is the key to preventing complications, including some that could be life-threatening. Medicine, changes to your diet, and surgery can help you stay well.

4. What were your first symptoms of ulcerative colitis?

Diarrhea and bloody stools are the two most common initial symptoms of ulcerative colitis. People also often experience abdominal or rectal pain, weight loss, and fever.

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May 11, 2022

Nursing Care Plans for Urinary Tract Infection – Best Nursing Care Plans(2022)
This article discusses Nursing Care Plans for Urinary Tract Infection plus its causes, symptoms, preventions, treatments, and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.
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Introduction

Nursing interventions for UTI are actions nurses takes to implement their patient care plan, including any treatments, procedures, or teaching moments intended to improve the patient’s comfort and health.

Urinary Tract Infection

A urinary tract infection is an infection of the lower respiratory tract caused by bacteria travelling from the anus to the urethra and bladder. Because germs may travel a shorter distance in women, UTIs are more common than in men.

The urinary system provides a pathway for urine created by the kidneys to be drained. It should be fully functional because injury to this system could quickly influence other body systems.

The kidneys, bladder, ureters, and urethra make up the urinary tract. The kidneys filter waste from the bloodstream and excrete it in urine. Urine travels through the ureter to reach the bladder shortly after leaving the kidney. Urine will stay in the bladder until it is time to urinate.

The bacterium Escherichia coli (E. coli), which is generally prevalent in the digestive system, is responsible for most UTIs. The body usually eliminates bacteria that enter the urinary tract before causing symptoms. However, bacteria can sometimes overwhelm the body’s natural defences, resulting in illness. Infections in the upper or lower urinary tract are commonly referred to as UTIs. Urethritis is an infection of the urethra. Cystitis is the medical term for a bladder infection. Bacteria may enter the ureters and multiply, resulting in kidney infection (pyelonephritis). Fever, chills, a strong, continuous urge to urinate, burning sensation when urinating, murky, foul-smelling urine, and pelvic pain in women are all signs and symptoms of urinary tract infections.

Classification of UTIs

UTIs are categorised based on their location and then further classified based on other characteristics and situations.
1. Lower UTIs – Bacterial cystitis, prostatitis, and urethritis are examples of lower UTIs.
2. Upper urinary tract infections (UTIs) – Upper UTIs, including acute and chronic pyelonephritis, interstitial nephritis, and renal nephritis, are far less prevalent.
3. Uncomplicated Lower or Upper UTIs – Most simple UTIs are acquired in the community and are frequent in young women, but they are rarely recurrent.
4. Lower or upper urinary tract infections that are complicated. Complicated UTIs are most commonly acquired in persons with urologic abnormalities or recent catheterisation after hospitalisation.
Causes of UTIs
- Bacteria that have infiltrated the urinary tract are the primary cause of UTIs. Frequent sexual intercourse, poor hygiene or wiping from back to front, and the use of spermicidal foams are all common risk factors.
- The most common causes include:
- Failure or inability to empty the bladder. Stasis of urine in the urinary bladder stimulates microorganisms to enter the tract.
- The urinary tract’s instrumentation. Bacteria could be introduced into the urinary tract during catheterisation or cystoscopy.
- Urinary flow is obstructed. Anomalies in the urinary tract’s anatomy might restrict urine flow, making it impossible to empty the bladder.
- Natural host defences are weakened. Immunosuppression, or the body’s inability to produce its own defences, makes the patient vulnerable to UTI.
- Unprotected sexual intercourse
- Constipation
- A recent pregnancy, a miscarriage, an abortion, or labour and delivery
- Having a history of urinary tract infections (UTIs), diabetes, or any other ailment that compromises your immune system
Pathophysiology

Bacteria must obtain entry into the system to infect it.
- Access – The bacteria get entrance to the urinary tract and cause infection.
- Attachment – To avoid being rinsed away by voiding, the bacteria cling to the epithelium of the urinary system and colonise it.
- Evasion – The host then eludes the defence mechanisms.
- Inflammation – As the body’s defensive mechanisms react to the bacteria, inflammation and other symptoms of infection emerge.
Signs and Symptoms of Urinary Tract Infections

The following are some of the most common signs and symptoms:
1. Fever (elevated body temperature)
2. Urinary tract pain, both lower and upper
3. Urinating with a burning sensation
4. Urination regularly
5. Having trouble initiating urine flow or experiencing painful spasms during ejaculation (in men)
6. Cloudy urine
7. Urine with a strong odour
8. Feeling feverish for no apparent reason
9. Urine with blood
Clinical Manifestations
- Urination causes a burning sensation. The patient may have pain while urinating, which they describe as a burning sensation.
- Frequency. Every three hours, the patient voids more than usual.
- Nocturia. Urinating in the middle of the night is also an indication of a UTI.
- Suprapubic or pelvic pain is a common complaint. The patient may have pain in the suprapubic or pelvic area.
- Urgency. There is also a fear that the patient will no longer be able to control the urge and will rush to expel it.
Preventions

Bathtubs should be avoided. Because bacteria in bath water can enter the urethra, it’s best to shower rather than bathe.

Perineal hygiene. Clean the perineum and urethral meatus from front to back after each bowel movement to lower pathogen concentrations near the urethral aperture.

Increase your water consumption. To flush out bacteria, drink enough water on a daily basis.

Avoid urinary tract irritants. UTI is caused by beverages such as coffee, tea, colas, alcohol, and others.

Voiding habit. During the day, void at least every 2 to 3 hours and totally empty the bladder.

Medications. Follow the directions on your prescription carefully.

Don’t drink fluids instantly before or after intercourse. Instead, it is advised that you urinate first. Bacteria can migrate up the urethra (which goes to the bladder) more easily than bacteria can flow down it (from your bladder).

Urinate as soon as possible after having sex. The same logic applies here: bacteria have more time to proliferate inside your urinary tract if you wait too long between having sex and urinating.

Get gynaecological screenings regularly. Make an appointment with your doctor at least once a year or if you have any symptoms that could indicate a UTI infection. Your doctor will do tests to determine the root of the problem and prescribe medication.

Nursing Diagnosis for UTI

Urine cultures.

Urine cultures are the definitive diagnostic test for UTIs and are valuable in identifying the organism present.

A urine culture is the most reliable approach to check for a bladder infection. This entails sending a sample of your urine to the lab, where it will be put in a particular nutrient solution to allow bacteria to grow and be identified.

The lab technician will examine how bacteria react to specific dyes that allow them to be seen under a microscope. The germs will then be examined under a microscope by the technician, who will compare your sample to samples from other people who have the condition. This can assist you to figure out if you have a UTI or not.

STD tests

Because UTIs can be spread sexually, STD tests may be conducted.

Urinalysis

Girls who are prone to UTI should have a urinalysis done. It involves testing bacteria, white blood cells, and pH levels in a urine sample. Protein levels in the urine are also measured since too much protein can harm the kidneys.

Doctors frequently test for a protein called albumin as part of a urinalysis. When we have an illness, albumin is found in our blood and naturally makes its way into our urine. A dipstick test, which is performed on a little sample of your urine, can reveal this. The presence of albumin in your urine is vital to know since high albumin levels can signal renal impairment.

CT scan.

This scan produces two-dimensional images that help you understand the size and structure of your organs, as well as any anomalies that may be present. The key advantage is that no X-rays are required, and you are not exposed to radiation.

A CT scan can detect abscesses or pyelonephritis.

Retention of Urine

Urinary retention can be caused by abruptly terminating ureteral catheters without a gradual decline in flow rate or by using a ureteral catheter with a clogged drainage system.

MRI

It’s used to see the parts of your body that aren’t working properly. The MRI scan creates images of organs using a magnetic field and radio waves, and it can be used to inspect the inside of your bladder. However, because it needs you to lie still for an extended amount of time, it may not be realistic in some instances.

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Nursing Care Plans for Urinary Tract Infection

Ultrasonography

Sound waves are used in a new imaging technique to create a three-dimensional image of the kidneys, ureters, and bladder (called ultrasound). It enables a doctor to see any anomalies inside these structures. This can assist your doctor in determining whether a patient has a urinary tract infection creating inflammation.

Obstacles, abscesses, tumours, and cysts can be detected with remarkable sensitivity using ultrasound.

Cystoscopy

A cystoscope is a small, flexible tool with a light source at the end that a doctor might use to check the bladder. This allows them to see any irregularities in the bladder and look directly at the locations where urine is coming from (ureters). The doctor can reach into the bladder or ureters and remove the infected area if there are abnormal spots there.

Medical Management

Management of UTIs typically involves pharmacologic therapy and patient education.

Acute pharmacologic therapy – is a type of treatment used for a short period of time. An antibiotic drug that eliminates germs from the urinary system while having little effect on faecal and vaginal flora is the best treatment for UTI.

Long-term pharmacologic therapy -recurrence is caused by reinfection with new germs. Patients with recurrence are told to start therapy independently as soon as symptoms appear and to call their doctor only if symptoms persist.

Nursing Care Plans for Urinary Tract Infection Based on Diagnosis

Nursing diagnoses include:
1. Acute Pain
2. Impaired Urinary Elimination
3. Hyperthermia
4. Deficient Knowledge
Acute Pain

Evidence of acute pain include:
- Burning on urination.
- Facial grimace.
- Guarding behaviour.
- Protective decreased physical activity.
- Spasm in the lower back and bladder area.
Desired goals and outcomes
- The client will employ both pharmaceutical and nonpharmacological pain management techniques.
- On a scale of 0 to 10, the client will report good pain control at a level less than 3 to 4.
- The client will report the absence of pain.
Nursing Evaluation and Rationale

1. Evaluate the client’s pain description, including the pain’s quality, nature, and severity.

Burning when urinating, flank pain, lower abdominal or suprapubic pain are all symptoms of a UTI. Some clients with persistent infections, on the other hand, are asymptomatic. This information will aid in the selection of an intervention. For a more detailed nursing assessment of pain, see our Acute Pain nursing diagnostic.

2. Examine for urinary tract infection signs and symptoms.

Dysuria, urine frequency and urgency, and nocturia are all common indications and symptoms of a urinary tract infection. Excess white cells in the urine and bleeding of the irritated bladder wall can also cause pyuria (bad-smelling or murky urine) or hematuria (bloody urine).

3. Check for UTI risk factors.

UTIs are more likely to occur if you have a history of sexually transmitted infections, catheter use, or past genitourinary tract surgery. Urinary tract blockages, such as those produced by a kidney stone or an enlarged prostate, can reduce urine flow and raise UTI risk. (2019, Storme, Saucedo, and Garcia-Mora).

4. Monitor laboratory and diagnostic studies, as indicated:
- WBC count (number of white blood cells)
An increase in WBC count shows a response to a systemic infection.
- Urinalysis
To assess for pyuria, bacteria and blood cells in the urine are signs of inflammation during infection.
- Bacteria in the urine
Infection is indicated by a colony count of more than 100,000 CFU/mL of urine during a clean-catch midstream or catheterised specimen, while lower counts may potentially suggest UTI.
- Urine culture and sensitivity
Used to find the most effective and appropriate antibiotic after identifying the infecting bacteria. If acute urethritis is suspected, a test for sexually transmitted infections is also conducted.
- CT (computed tomography)
Renal calculi, pyelonephritis, and abscesses can all be detected with this test.
- Ultrasound and kidney scans
Obstructions, abscesses, tumours, and cysts can all be detected with this technique.

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Nursing Care Plans for Urinary Tract Infection

Nursing Interventions and Rationales

1. Apply a heating pad on your lower back or suprapubic area.

Heat applied to the perineum helps reduce pain and spasms.

2. Administer analgesics (such as acetaminophen) or antispasmodics (such as phenazopyridine).

Bladder irritation, spasm, and discomfort can be relieved using antispasmodic and analgesic medications.

3. Unless contraindicated, encourage the patient to increase their oral fluid intake.

Increasing fluid consumption to 2 to 3 litres per day aids urine production, dilutes urine, relieves bladder irritation, improves renal blood flow, and flushes microorganisms from the urinary system.

4. Advise them to stay away from coffee, tea, spices, alcohol, and soft drinks.

These foods irritate the urinary system and are classified as urinary tract irritants.

5. Encouraged the client to go to the bathroom often.

To avoid bladder distention, lower bacterial urine counts, reduce urine stasis and prevent reinfection, frequent voiding every 2 to 3 hours to empty the bladder is recommended.

6. When appropriate, non-pharmacological pain management approaches are used.

Relaxation, massage, guided imagery, and diversion are examples of alternative therapies that can help to relieve pain and bring comfort.

7. As needed, administer antimicrobial agents.

Antibiotics such as trimethoprim (TMP) or cephalexin are usually the initial choices. Short-course therapy with a single antibiotic or a three-day course lowers treatment costs, improves adherence, and reduces adverse effects.

Impaired Urinary Elimination

Evidence of Impaired Urinary Elimination include:
- Dysuria.
- Urinary frequency; urge.
- Urinary hesitancy.
Desired Outcomes
- The client’s urine elimination pattern will return to normal, as shown by the lack of signs of urinary problems (urgency, oliguria, dysuria).
- The client will exhibit behavioural approaches for avoiding urine infections.
Nursing Interventions and Rationales

1. Examine the patient’s elimination pattern.

It can assist in identifying characteristics that may predispose a patient to a urinary tract infection (UTI) and serve as a foundation for choosing appropriate therapies. The following items may be included in an assessment and physical examination:
- Inquiring about symptoms such as frequency, urgency, dysuria, and nocturia in the client.
- Identifying whether or not there is a pain in the bladder area.
- Identifying the urine’s properties. Take note of the colour, cloudiness, and foul odour.
- Identifying the frequency and volume of urine.
2. Note the client’s age and gender.

UTI is more common in women than in males while younger, but the difference narrows as they get older. A UTI affects about one in every five women at some point in their lives. Because of anatomical defects and decreased bladder tone, older persons are more likely to get UTI caused by inadequate bladder emptying.

3. Have the female client clean her face from front to back.

This method prevents bacteria from spreading from the anal region to the vagina and, eventually, the urethra. Perineal hygiene helps to reduce the risk of contamination and reinfection.

4. Encourage the consumption of cranberry juice.

Cranberry juice helps prevent and control UTI symptoms. Bacterial adhesion to uroepithelial cells in the urine system has been demonstrated to be reduced.

5. To treat incontinence, limit the use of indwelling bladder catheters.

The use of a catheter greatly raises the risk of a urinary tract infection (UTI). Each day that a urinary catheter is inserted, the risk of catheter-associated urinary tract infection rises. Regular toileting, for example, can help avoid illness. If an indwelling catheter is required, adhere to stringent guidelines to avoid infection and urosepsis.

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Nursing Care Plans for Urinary Tract Infection

Hyperthermia

Evidence of Hyperthermia include:
- Increase body temperature above the normal range.
- Flushed skin; warm to touch.
Desired Outcomes
- The client’s core temperature will remain within normal limits.
Nursing Assessment and Rationales

1. Assess for any indicators of a rise in body temperature.

Sweating, shivering, headaches, heated skin, and general malaise are all signs of an elevated body temperature.

2. Monitor vital signs, particularly fever, to determine the best course of action.

Nursing Interventions and Rationales

1. Provide a tepid sponge bath. To lower fever, take a tepid sponge bath.

2. Encourage sufficient fluid intake to avoid dehydration brought on by a rise in temperature.

3. Encourage using a hypothermia blanket and the use of bath towels to wrap the extremities. It aids in the prevention of shivering.

4. Stay in bed as much as possible to cut down on metabolic demands and oxygen usage.

5. Use antipyretic medications to lower body temperature.

Deficient Knowledge

Evidence of Deficient Knowledge include:
- Lack of questions.
- Multiple questions.
- Recurrent UTI.
- Verbalising inaccurate information.
Desired Outcomes
- The client verbalises knowledge of UTI causes and treatments, manages risk factors, and completes UTI medical therapy.
Nursing Interventions and Their Rationale
1. Educate the client on the causes, prevention, and treatment of urinary tract infections. UTI recurrences regularly could suggest that the client has trouble understanding the ailment and adhering to the prescribed treatment plan.
2. Instruct the client on how to avoid urinary tract infections.

The purpose of client education is to get rid of the current infection and prevent it from coming again. Interventions may include the following:
- Hygiene precautions (showering rather than bathing in a tub).
- Bacteria in the bathwater can get into the urethra and cause infection.
- Encourage people not to ignore the need to go to the bathroom.
- Urine stasis is a possibility.
- After a bowel movement, perform perineal hygiene.
- This will assist in preventing the infection from migrating into the urethral and vaginal openings in women.
- The significance of bladder emptying regularly.
- Bladder distention and a weakened blood supply to the bladder wall can be avoided by completely emptying the bladder. The consumer is predisposed to UTI as a result of these factors.
- Tampons should be used for periods. Tampons are preferred over sanitary napkins during menstruation because they keep the bladder opening area dry, preventing bacteria growth.
- Wearing non-breathing undergarments that are too tight or restrictive is not a good idea. Such textiles can absorb moisture and offer a breeding ground for bacteria. Cotton fabrics and clotting with a loose fit are preferred.
Related FAQs

1. What is a nursing diagnosis for infection?

Risk for infection is a NANDA nursing diagnosis that involves the alteration or disturbance in the body’s inflammatory response, which allows microorganisms to invade the body and cause infection. It is a common problem in people with low immune system.

2. What are the priority nursing diagnosis related to urinary elimination?

Impaired Urinary Elimination is a NANDA diagnosis that refers to any disturbance to the urine elimination. It is commonly used to create a nursing care plan for patients with genito-urinary disorders, such as urinary tract infections or UTIs, and renal diseases, such as acute kidney injury and chronic renal failure.

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Nursing Care Plans for Urinary Tract Infection

3. Is UTI a nursing or medical diagnosis?

Urinary tract infection (UTI) is a medical condition that results from the invasion and multiplication of pathogens in the urinary tract. The urinary tract system involves the kidneys, bladder, and urethra.

4. What would you educate to decrease the risk of UTI?

Practice good personal hygiene. Always wipe from front to back. Drink plenty of fluids (at least three to four glasses of water each day) to help flush bacteria out of the urinary tract. Empty your bladder completely as soon as you feel the urge, or at least every three hours.

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