ago and has slept poorly because of nocturia. The nurse takes Ms. Lansdale’s vital signs, which are within normal limits, and acquires a clean urine specimen for culture and sensitivity. The health care provider prescribes trimethprim/sulfamethoxazole 160/800 (Trimethprim with Sulfamethoxazole DS) every 12 hours for 10 days. A follow-up urine specimen is needed in 2 weeks.

NursiNg Care PlaN 8-aA Client with Urinary Tract Infection Taking Trimethoprim/SulfamethoxazoleAbby Lansdale, 38 years old, visits her health care provider with complaints of burning on urination and urinary frequency and urgency she first experienced these symptoms 2 days

Chapter 8 Antimicrobial Agents

Section 2: Agents That Interfere with Microbial Growth

Assessment nursing diAgnosis PlAnning/goAls imPlementAtion evAluAtion

Vital signs Risk for hyperthermia related to infection

The client will recognise signs of infection and begin treatment.

Ask client to report temperature elevations. Remind her about follow-up visits and laboratory study appointments.

Vital signs have returned to normal limits as a result of treatment.

Report of frequency, urgency, dysuria, and nocturia

Impaired urinary elimination patterns related to lower urinary tract infection (UTI).

The client will return to her normal urination patterns within 1 week of treatment.

Explain the importance of compliance with treatment program for full length of time medication is prescribed.

Infection subsided with treatment. UTI will not recur because of inadequate treatment.

Nocturia Disturbed sleep pattern related to nocturia from UTI

The client will be able to have 6–8 hours of uninterrupted sleep within 2 days.

Explain to client the need to void before bedtime.

Client has returned to normal sleep patterns.

Dysuria Pain: Acute related to infectious process

The client will have relief of pain within 48 hours.

Review frequency of administration and advise client to take medications with meals.

Client has become pain-free. Gastrointestinal (GI) upset did not occur.

General hygiene practices

Risk for infection due to poor hygienic practices

Client will demonstrate understanding of good hygienic practices.

Explain relationship between poor hygiene and UTIs. Review proper postelimination hygiene.

Client verbalises how to control and prevent any UTI.

Current fluid intake Risk for deficient fluid volume related to increased need for fluid secondary to infectious process

Client will increase fluid intake to 200 mls. per hour while awake.

Explain that fluids are needed to dilute urine and flush out infectants. Also, adequate fluids increase comfort. Encourage client to drink cranberry juice.

Client drinks 200 mls of fluid per hour. Increased fluid intake leads to pain-free elimination.

Sexual history Deficient knowledge (relationship between sexual activity and UTI)

Client will demonstrate understanding of relationship of sexual activity and UTI.

Explain that most UTIs in women occur within 48 hours of intercourse. Altering type of intercourse and urinating immediately after intercourse may decrease frequency of infections.

Client demonstrates understanding of relationship between sexual activity and UTIs.

Knowledge of illness and its treatment

Deficient knowledge (cause of this health problem and its treatment)

Client will demonstrate understanding of treatment regimen.

Explain common causes of UTIs. Explain the complete course of each medication as ordered. Follow-up urine specimen needed.

Compliance with treatment regimen. Adequate treatment of this episode of UTI as indicated by sterile urine and absence of symptoms. Occurrence of future UTIs is decreased.

NursiNg Care PlaN 8-BA Client with Acquired Immunodeficiency SyndromeStephen Burt, 27 years old, is admitted to the hospital for treatment of multiple problems associated with acquired immunodeficiency Syndrome (AIDS), including a diagnostic

workup to determine the cause of his elevated temperature. On admission he is thin and fatigued with the following vital signs: T 39, P 94, R 14. He reports that he has been taking zidovudine (Retrovir) 200 mg every 4 hours for 6 months and atovaquone (Wellvone Suspension) 750 mg (5ml) twice daily for 21 days with a high fat meal.

Assessment nursing diAgnosis PlAnning/goAls imPlementAtion evAluAtion

Vital signs Hyperthermia related to infectious process

Client will recognise signs of infection and seek treatment.

Take vital signs every 4 hours. Request prescription for NSAID (not paracetamol as medication reaction alert) and administer NSAID 4 hourly PRN.

Temperature returns to normal as result of identifying cause of elevation, using antipyretic, and beginning appropriate treatment.

Current fluid intake

Risk for deficient fluid volume deficit related to increased perspiration and malnutrition

Client will increase fluid intake to 200 mls. per hour while awake.

Explain that fluids are needed to replace those lost by perspiration. Increased fluids also help to facilitate elimination of waste products of infection. Provide fluids client likes.

Client maintains adequate fluid volume as evidenced by absence of weight loss, normal urine specific gravity, and good skin turgor.

Medication history

Risk for ineffective health maintenance related to noncompliance with therapeutic regimen

Client will demonstrate understanding of therapeutic regimen and health behaviours needed to manage condition.

Review past and current medication schedules with client and importance of 24-hour schedule for administration of zidovudine.

Client adheres to therapeutic regimen. Client verbalises understanding of symptoms of zidovudine therapy. Physical condition improves. Zidovudine toxicity does not occur.

Medication history, respiratory rate, breath sounds

Risk for infection: recurrence of Pneumocystis carinii pneumonia (PCP) related to altered immune system.

Client will demonstrate understanding of medication regimen and list symptoms of recurrence.

Assess vital signs before beginning atovaquone and as indicated throughout and at the end of treatment. Auscultate lungs at 15 and 30 minutes for wheezing and dyspnoea.

Client verbalises symptoms of recurrence and knows when to call physician. Respirations are within normal limits. Breath sounds are present and clear.

Nutritional status

Nutrition, imbalanced: less than body requirements related to catabolic illness

Client’s nutritional status will improve, and client will maintain or gain weight.

Take a nutrition history. Obtain foods client likes. Schedule nutrition consult if necessary. Weigh client every other day. Ensure client understands of the need to take atovaquone with a high fat meal.

Client’s food intake improves, and client maintains or gains weight. Client is able to tolerate two meals per day of high fat content

Hygiene practices

Risk for infection transmission related to lack of knowledge of modes of transmission

Client will verbalise how AIDS is transmitted and a plan to avoid infecting others.

Determine what client knows about AIDS transmission and provide information about ways to avoid transmitting to others.

Client describes the means by which AIDS can be transmitted and takes measures to avoid transmission.

Knowledge of illness and its treatment

Deficient knowledge (course of this health problem and its treatment)

Client will verbalise understanding of treatment regimen, disease process, transmission, and complications.

Assess client’s knowledge about AIDS and its treatment. Provide additional information, if necessary. Explain purposes of zidovudine and atovaquone therapy.

Client is able to explain the purpose of zidovudine and atovaquone therapy and is compliant with medication regimen.

Activity tolerance sleep/rest pattern

Activity intolerance related to generalised weakness and malnourished state secondary to AIDS

Client will maintain an activity level within capabilities as evidenced by normal heart rate and blood pressure during activity.

Assist client in gradually increasing his daily activities. Provide uninterrupted time for rest and sleep. Schedule other procedures for times when zidovudine must be administered during the night.

Client’s tolerance for activities improves. He reports absence of shortness of breath, weakness, and fatigue.

Taste Disturbed sensory perception: Gustatory

Client will not experience bitter aftertaste resulting from treatment.

Tell client bitterness disappears in a few hours. Have client rinse mouth with baking soda paste and saline immediately after treatment. Sucking on hard lollies also may help to decrease the aftertaste.

Client reports minimal alteration in taste continues treatment as scheduled and dental hygiene is maintained