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This document provides guidelines for evaluating and managing hematuria (red blood cells in urine). It discusses:
1. The prevalence, causes, and differential diagnosis of hematuria depending on its origin from the glomerulus, kidneys, urologic structures, or adjacent organs.
2. The recommended evaluation of hematuria including a detailed history, physical exam, urine analysis, urine culture if infection is suspected, renal function tests, ultrasound, and cystoscopy.
3. The typical findings and management strategies for common hematuria causes like urinary tract infections (25%), malignancies (20%), and urinary stones (20%). Benign essential hematuria accounts for 15-20% and requires careful follow up
1. The document provides a nursing care plan for a patient with congestive heart failure and chronic renal failure, outlining various identified problems, objectives, interventions, and evaluations.
2. It addresses problems related to decreased cardiac output, excess fluid volume, disturbed sleep patterns, fatigue, risk for skin breakdown, activity intolerance, bathing self-care deficits, and situational low self-esteem.
3. For each problem, the care plan proposes short-term and long-term objectives, lists nursing interventions and rationales, and evaluates the outcomes.
1. A 52-year-old female patient was admitted to the hospital with a history of a fall at home and a past medical history of end stage renal disease, disseminated tuberculosis, and tracheostomy.
2. Examination found increased serum creatinine levels and a positive tuberculin skin test. She was diagnosed with disseminated tuberculosis.
3. Her treatment plan included anti-tuberculosis drugs and medications to treat her kidney disease and symptoms. She required counseling on properly taking her medications and managing symptoms.
The patient is a 50-year-old male presenting with severe abdominal pain radiating to his back. He has a fever of 101.3F and is vomiting. His history includes diabetes mellitus. On examination, his abdomen is distended and tender in the right upper quadrant. Initial management should include oxygen, IV fluids, analgesia and antiemetics to make the patient more comfortable. Bedside investigations including an ECG, ABG and urinalysis should be obtained. Laboratory tests including a CBC, coagulation screen, HbA1c, liver function tests and a renal profile are needed.
This document discusses acute pancreatitis, including:
- Definitions of mild and severe acute pancreatitis.
- Common causes like gallstones and alcohol.
- Presenting signs of abdominal pain, nausea, and elevated amylase/lipase levels.
- Imaging like CT scans can assess severity and complications.
- Treatment focuses on supportive care like fluid resuscitation, pain control, and enteral nutrition.
This document provides guidelines for evaluating and managing hematuria (red blood cells in urine). It discusses:
1. The prevalence, causes, and differential diagnosis of hematuria depending on its origin from the glomerulus, kidneys, urologic structures, or adjacent organs.
2. The recommended evaluation of hematuria including a detailed history, physical exam, urine analysis, urine culture if infection is suspected, renal function tests, ultrasound, and cystoscopy.
3. The typical findings and management strategies for common hematuria causes like urinary tract infections (25%), malignancies (20%), and urinary stones (20%). Benign essential hematuria accounts for 15-20% and requires careful follow up
1. The document provides a nursing care plan for a patient with congestive heart failure and chronic renal failure, outlining various identified problems, objectives, interventions, and evaluations.
2. It addresses problems related to decreased cardiac output, excess fluid volume, disturbed sleep patterns, fatigue, risk for skin breakdown, activity intolerance, bathing self-care deficits, and situational low self-esteem.
3. For each problem, the care plan proposes short-term and long-term objectives, lists nursing interventions and rationales, and evaluates the outcomes.
1. A 52-year-old female patient was admitted to the hospital with a history of a fall at home and a past medical history of end stage renal disease, disseminated tuberculosis, and tracheostomy.
2. Examination found increased serum creatinine levels and a positive tuberculin skin test. She was diagnosed with disseminated tuberculosis.
3. Her treatment plan included anti-tuberculosis drugs and medications to treat her kidney disease and symptoms. She required counseling on properly taking her medications and managing symptoms.
The patient is a 50-year-old male presenting with severe abdominal pain radiating to his back. He has a fever of 101.3F and is vomiting. His history includes diabetes mellitus. On examination, his abdomen is distended and tender in the right upper quadrant. Initial management should include oxygen, IV fluids, analgesia and antiemetics to make the patient more comfortable. Bedside investigations including an ECG, ABG and urinalysis should be obtained. Laboratory tests including a CBC, coagulation screen, HbA1c, liver function tests and a renal profile are needed.
This document discusses acute pancreatitis, including:
- Definitions of mild and severe acute pancreatitis.
- Common causes like gallstones and alcohol.
- Presenting signs of abdominal pain, nausea, and elevated amylase/lipase levels.
- Imaging like CT scans can assess severity and complications.
- Treatment focuses on supportive care like fluid resuscitation, pain control, and enteral nutrition.
Role of nurse in organ donation, retrievel and banking RakhiYadav53
Nurses play a vital role in organ donation, from facilitating potential donors to supporting families. They begin by identifying potential donors and managing their care until donation. Nurses guide families through the difficult process, obtain consent, and initiate the donor protocol according to hospital policy. After retrieval, organs are preserved and transported to recipients. Nurses coordinate multiple teams and care for donors and recipients through all stages of donation and transplantation. Their role is critical in this complex process.
This document provides guidance on preoperative care and assessment. It outlines the objectives of preoperative care, which include organizing care and the operating list, understanding surgical, medical and anesthetic assessments, optimizing the patient's condition, obtaining consent, and organizing the operating list. It describes evaluating the patient's history, examination, investigations, preoperative conditions and treatment, and documenting the assessments. Key areas of focus for the patient assessment include cardiovascular, respiratory, gastrointestinal, genitourinary, neurological, endocrine and metabolic conditions. The document provides guidance on identifying and managing preoperative problems, obtaining informed consent, conducting a pre-anesthetic airway assessment, and arranging the operating theater list.
A 45-year-old male presented with a 2-month history of dry cough and 1-week history of shortness of breath. He was diagnosed with disseminated tuberculosis involving the lungs and massive pericardial effusion. He was started on anti-tuberculosis medications and steroids. He developed lower limb deep vein thrombosis and was started on anticoagulation. He underwent pericardial drainage and window procedure. His treatment plan includes continuing anti-TB medications, increasing warfarin dose, and educating the patient about medication adherence and side effect monitoring.
CASE PRESENTATION ON RHEUMATOID ARTHRITISBinuja S.S
A 57-year-old female was admitted with non-healing ulceration of the left ankle, edema of both lower limbs, and joint pain with intermittent fever. Her history and examinations were consistent with rheumatoid arthritis. She was treated with aspirin, prednisolone, methotrexate, folic acid, and other medications. Her joint pain and edema improved over her 6-day hospital stay, and she was discharged on medications with follow-up planned.
1. The patient, a 65-year-old female, presented with complaints of dysuresis, low abdominal pain, fever, and rarely bloody urine. She was diagnosed with cystitis.
2. Objective findings included elevated pulse and temperature. Examination found systemic infection and a normal-sized right kidney but a left kidney with an upper pole renal cyst.
3. Treatment included antibiotics (ciprofloxacin), antacids (raniditine), analgesics (paracetamol), IV fluids (normal saline and Ringer's lactate), and antispasmodics (dicyclomine). The pharmacist noted some issues and interventions to address.
This document provides information about pleural effusion including its definition, causes, frequency, and outcomes. It begins with an introduction to the case study and defines pleural effusion as a collection of fluid in the pleural space caused by excessive filtration or defective absorption. Pleural effusions can be transudates or exudates depending on the underlying cause. Common causes discussed include infections, tuberculosis, and cancers. International frequencies are reported to be similar, with some developed countries seeing increasing rates possibly due to improved healthcare access. Complications and outcomes depend on specific causes, with viral infections often resolving spontaneously but empyema having higher mortality if not treated early.
This document provides details on a case presentation of a 57-year-old female patient admitted with nephrolithiasis. The summary includes:
1. The patient presented with right flank pain and was diagnosed with nephrolithiasis with hydronephrosis and hydroureter.
2. Her medical history includes hypertension and previous bilateral nephrolithiasis.
3. Laboratory results showed elevated creatinine, BUN, uric acid and blood sugar levels indicating kidney impairment and dehydration.
4. The patient received IV fluids, analgesics, antibiotics and underwent CVP insertion for monitoring and management of her condition.
This document provides information about peritoneal dialysis (PD), including:
- An overview of PD, how it works, and the components of PD fluid.
- Details on different PD modalities, principles of exchanges, and factors in patient selection.
- Complications of PD like peritonitis and their treatment, as well as non-infectious complications.
- The PD program at Mansoura International Hospital, including patient education, catheter insertion, and home visits.
Jack Daniels, a 75-year old male with a history of diabetes, hypertension and alcoholism, was admitted to the renal ward with acute kidney injury secondary to severe dehydration and ACE inhibitor use. He presented restless, anxious and in pain. Nurses performed initial assessments, administered IV fluids and medications, and monitored his condition over several hours. Blood work showed elevated creatinine levels indicating acute kidney injury. The senior nurse interpreted the results and conducted focused assessments while the student nurse provided routine care and education. Multidisciplinary teams were referred to assist with Jack's holistic care and discharge planning.
This document discusses peritonitis and exit site infections related to peritoneal dialysis. It provides statistics on the rates of these infections and their impact. Prevention is key and involves things like proper training, exit site care, antibiotic prophylaxis and monitoring infection rates. Symptoms, diagnosis, empirical antibiotic treatment and culture-specific treatment are outlined. Factors affecting exit site infections and appropriate pre-operative, operative and post-operative care are also covered.
The document discusses various aspects of critical care nursing. It begins by defining a critical care unit as a facility equipped to provide life support treatment to critically ill patients. It describes the role of critical care nurses in monitoring patients on life support equipment. Key aspects of patient care discussed include feeding/fluids, analgesia, sedation, thromboembolism prophylaxis, head elevation, ulcer prophylaxis, glycemic control, spontaneous breathing trials, bowel care, indwelling catheter removal, and drug de-escalation. The document emphasizes the importance of these aspects of care and outlines the roles and responsibilities of nurses in ensuring patients receive appropriate treatment and monitoring.
Capurso G. Le Pancreatiti Acute: quelle vere e quelle false. ASMaD 2014Gianfranco Tammaro
1. The document discusses the management of acute pancreatitis, noting that contrast-enhanced CT or MRI should be reserved for unclear diagnoses or patients who do not improve clinically within 48-72 hours of admission.
2. Early fluid resuscitation, with 2 ml/kg/hour and an initial bolus of 20 ml/kg within 30-45 minutes is recommended, preferably with crystalloids like lactated Ringer's solution.
3. For mild pancreatitis, early oral feeding is recommended once pain resolves, while for severe cases enteral nutrition within 48 hours is recommended to prevent infectious complications.
Colonoscopy is one of the most common procedures in medicine today. This lectures covers the complications associated with colonoscopy, including the risk factors and management.
A 33-year-old female patient presented with a 1-week history of abdominal pain in the lower abdomen, vomiting, burning urination, and fever for 2 days. On examination, she had a fever and left iliac fossa tenderness. Laboratory tests found an elevated white blood cell count. She was diagnosed with a urinary tract infection, renal calculi, and gastroesophageal reflux disease. She was treated with IV and oral antibiotics, antacids, and analgesics.
Bleeding Peptic Ulcer Disease - Does Practice Meet Evidence?Jarrod Lee
Bleeding peptic ulcer is a common medical emergency. Today many good studies and evidence based guidelines have provided doctors with a strong evidence based approach to manage this condition. However, how much of daily practice actually follows the evidence? The presentation goes through common scenarios in hospital medicine, and covers the latest evidence through a case based approach.
The document discusses various strategies for managing gastrointestinal bleeds in the emergency department, noting that identifying the bleed source is important but often challenging without endoscopy. While proton pump inhibitors are commonly used, the evidence does not clearly show they provide significant benefits and they may potentially increase mortality risk, so endoscopy should not be delayed for stable patients. Erythromycin and octreotide can help optimize endoscopy for identifying bleed sources when needed.
a case study on urinary tract infection ( UTI) martinshaji
A case study on urinary tract infection , which gives a detailed study about UTI , the case study details about the treatment options , diagnosis , patient counselling , pharmacist interventions etc
The document discusses complications of peritoneal dialysis, specifically peritonitis. It describes the typical presentation of peritonitis as abdominal pain and cloudy dialysate fluid. Causes include breaks in sterile technique or recent infections. Diagnosis requires abdominal pain and cloudy fluid with leukocytosis. Treatment involves empiric antibiotics targeting gram positive and negative organisms. Outcomes depend on causative organisms and whether the peritoneal catheter is infected.
Hello Sir
We are a premier academic writing agency with industry partners in UK, Australia and Middle East and over 15 years of experience. We are looking to establish long-term relationships with industry partners and would love to discuss this opportunity further with you.
Thanks & Regards
visit our website.
www.onlineassignmenthelp.com.au
www.freeassignmenthelp.com
www.btechndassignment.cheapassignmenthelp.co.uk
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www.cheapassignmenthelp.co.uk/
Hello Sir
We are a premier academic writing agency with industry partners in UK, Australia and Middle East and over 15 years of experience. We are looking to establish long-term relationships with industry partners and would love to discuss this opportunity further with you.
Thanks & Regards
visit our website.
www.onlineassignmenthelp.com.au
www.freeassignmenthelp.com
www.btechndassignment.cheapassignmenthelp.co.uk
www.cheapassignmenthelp.com
www.cheapassignmenthelp.co.uk/
Role of nurse in organ donation, retrievel and banking RakhiYadav53
Nurses play a vital role in organ donation, from facilitating potential donors to supporting families. They begin by identifying potential donors and managing their care until donation. Nurses guide families through the difficult process, obtain consent, and initiate the donor protocol according to hospital policy. After retrieval, organs are preserved and transported to recipients. Nurses coordinate multiple teams and care for donors and recipients through all stages of donation and transplantation. Their role is critical in this complex process.
This document provides guidance on preoperative care and assessment. It outlines the objectives of preoperative care, which include organizing care and the operating list, understanding surgical, medical and anesthetic assessments, optimizing the patient's condition, obtaining consent, and organizing the operating list. It describes evaluating the patient's history, examination, investigations, preoperative conditions and treatment, and documenting the assessments. Key areas of focus for the patient assessment include cardiovascular, respiratory, gastrointestinal, genitourinary, neurological, endocrine and metabolic conditions. The document provides guidance on identifying and managing preoperative problems, obtaining informed consent, conducting a pre-anesthetic airway assessment, and arranging the operating theater list.
A 45-year-old male presented with a 2-month history of dry cough and 1-week history of shortness of breath. He was diagnosed with disseminated tuberculosis involving the lungs and massive pericardial effusion. He was started on anti-tuberculosis medications and steroids. He developed lower limb deep vein thrombosis and was started on anticoagulation. He underwent pericardial drainage and window procedure. His treatment plan includes continuing anti-TB medications, increasing warfarin dose, and educating the patient about medication adherence and side effect monitoring.
CASE PRESENTATION ON RHEUMATOID ARTHRITISBinuja S.S
A 57-year-old female was admitted with non-healing ulceration of the left ankle, edema of both lower limbs, and joint pain with intermittent fever. Her history and examinations were consistent with rheumatoid arthritis. She was treated with aspirin, prednisolone, methotrexate, folic acid, and other medications. Her joint pain and edema improved over her 6-day hospital stay, and she was discharged on medications with follow-up planned.
1. The patient, a 65-year-old female, presented with complaints of dysuresis, low abdominal pain, fever, and rarely bloody urine. She was diagnosed with cystitis.
2. Objective findings included elevated pulse and temperature. Examination found systemic infection and a normal-sized right kidney but a left kidney with an upper pole renal cyst.
3. Treatment included antibiotics (ciprofloxacin), antacids (raniditine), analgesics (paracetamol), IV fluids (normal saline and Ringer's lactate), and antispasmodics (dicyclomine). The pharmacist noted some issues and interventions to address.
This document provides information about pleural effusion including its definition, causes, frequency, and outcomes. It begins with an introduction to the case study and defines pleural effusion as a collection of fluid in the pleural space caused by excessive filtration or defective absorption. Pleural effusions can be transudates or exudates depending on the underlying cause. Common causes discussed include infections, tuberculosis, and cancers. International frequencies are reported to be similar, with some developed countries seeing increasing rates possibly due to improved healthcare access. Complications and outcomes depend on specific causes, with viral infections often resolving spontaneously but empyema having higher mortality if not treated early.
This document provides details on a case presentation of a 57-year-old female patient admitted with nephrolithiasis. The summary includes:
1. The patient presented with right flank pain and was diagnosed with nephrolithiasis with hydronephrosis and hydroureter.
2. Her medical history includes hypertension and previous bilateral nephrolithiasis.
3. Laboratory results showed elevated creatinine, BUN, uric acid and blood sugar levels indicating kidney impairment and dehydration.
4. The patient received IV fluids, analgesics, antibiotics and underwent CVP insertion for monitoring and management of her condition.
This document provides information about peritoneal dialysis (PD), including:
- An overview of PD, how it works, and the components of PD fluid.
- Details on different PD modalities, principles of exchanges, and factors in patient selection.
- Complications of PD like peritonitis and their treatment, as well as non-infectious complications.
- The PD program at Mansoura International Hospital, including patient education, catheter insertion, and home visits.
Jack Daniels, a 75-year old male with a history of diabetes, hypertension and alcoholism, was admitted to the renal ward with acute kidney injury secondary to severe dehydration and ACE inhibitor use. He presented restless, anxious and in pain. Nurses performed initial assessments, administered IV fluids and medications, and monitored his condition over several hours. Blood work showed elevated creatinine levels indicating acute kidney injury. The senior nurse interpreted the results and conducted focused assessments while the student nurse provided routine care and education. Multidisciplinary teams were referred to assist with Jack's holistic care and discharge planning.
This document discusses peritonitis and exit site infections related to peritoneal dialysis. It provides statistics on the rates of these infections and their impact. Prevention is key and involves things like proper training, exit site care, antibiotic prophylaxis and monitoring infection rates. Symptoms, diagnosis, empirical antibiotic treatment and culture-specific treatment are outlined. Factors affecting exit site infections and appropriate pre-operative, operative and post-operative care are also covered.
The document discusses various aspects of critical care nursing. It begins by defining a critical care unit as a facility equipped to provide life support treatment to critically ill patients. It describes the role of critical care nurses in monitoring patients on life support equipment. Key aspects of patient care discussed include feeding/fluids, analgesia, sedation, thromboembolism prophylaxis, head elevation, ulcer prophylaxis, glycemic control, spontaneous breathing trials, bowel care, indwelling catheter removal, and drug de-escalation. The document emphasizes the importance of these aspects of care and outlines the roles and responsibilities of nurses in ensuring patients receive appropriate treatment and monitoring.
Capurso G. Le Pancreatiti Acute: quelle vere e quelle false. ASMaD 2014Gianfranco Tammaro
1. The document discusses the management of acute pancreatitis, noting that contrast-enhanced CT or MRI should be reserved for unclear diagnoses or patients who do not improve clinically within 48-72 hours of admission.
2. Early fluid resuscitation, with 2 ml/kg/hour and an initial bolus of 20 ml/kg within 30-45 minutes is recommended, preferably with crystalloids like lactated Ringer's solution.
3. For mild pancreatitis, early oral feeding is recommended once pain resolves, while for severe cases enteral nutrition within 48 hours is recommended to prevent infectious complications.
Colonoscopy is one of the most common procedures in medicine today. This lectures covers the complications associated with colonoscopy, including the risk factors and management.
A 33-year-old female patient presented with a 1-week history of abdominal pain in the lower abdomen, vomiting, burning urination, and fever for 2 days. On examination, she had a fever and left iliac fossa tenderness. Laboratory tests found an elevated white blood cell count. She was diagnosed with a urinary tract infection, renal calculi, and gastroesophageal reflux disease. She was treated with IV and oral antibiotics, antacids, and analgesics.
Bleeding Peptic Ulcer Disease - Does Practice Meet Evidence?Jarrod Lee
Bleeding peptic ulcer is a common medical emergency. Today many good studies and evidence based guidelines have provided doctors with a strong evidence based approach to manage this condition. However, how much of daily practice actually follows the evidence? The presentation goes through common scenarios in hospital medicine, and covers the latest evidence through a case based approach.
The document discusses various strategies for managing gastrointestinal bleeds in the emergency department, noting that identifying the bleed source is important but often challenging without endoscopy. While proton pump inhibitors are commonly used, the evidence does not clearly show they provide significant benefits and they may potentially increase mortality risk, so endoscopy should not be delayed for stable patients. Erythromycin and octreotide can help optimize endoscopy for identifying bleed sources when needed.
a case study on urinary tract infection ( UTI) martinshaji
A case study on urinary tract infection , which gives a detailed study about UTI , the case study details about the treatment options , diagnosis , patient counselling , pharmacist interventions etc
The document discusses complications of peritoneal dialysis, specifically peritonitis. It describes the typical presentation of peritonitis as abdominal pain and cloudy dialysate fluid. Causes include breaks in sterile technique or recent infections. Diagnosis requires abdominal pain and cloudy fluid with leukocytosis. Treatment involves empiric antibiotics targeting gram positive and negative organisms. Outcomes depend on causative organisms and whether the peritoneal catheter is infected.
Hello Sir
We are a premier academic writing agency with industry partners in UK, Australia and Middle East and over 15 years of experience. We are looking to establish long-term relationships with industry partners and would love to discuss this opportunity further with you.
Thanks & Regards
visit our website.
www.onlineassignmenthelp.com.au
www.freeassignmenthelp.com
www.btechndassignment.cheapassignmenthelp.co.uk
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www.cheapassignmenthelp.co.uk/
Hello Sir
We are a premier academic writing agency with industry partners in UK, Australia and Middle East and over 15 years of experience. We are looking to establish long-term relationships with industry partners and would love to discuss this opportunity further with you.
Thanks & Regards
visit our website.
www.onlineassignmenthelp.com.au
www.freeassignmenthelp.com
www.btechndassignment.cheapassignmenthelp.co.uk
www.cheapassignmenthelp.com
www.cheapassignmenthelp.co.uk/
Hello Sir
We are a premier academic writing agency with industry partners in UK, Australia and Middle East and over 15 years of experience. We are looking to establish long-term relationships with industry partners and would love to discuss this opportunity further with you.
Thanks & Regards
visit our website.
www.onlineassignmenthelp.com.au
www.freeassignmenthelp.com
www.btechndassignment.cheapassignmenthelp.co.uk
www.cheapassignmenthelp.com
www.cheapassignmenthelp.co.uk/
Hello Sir
We are a premier academic writing agency with industry partners in UK,
Australia and Middle East and over 15 years of experience. We are looking to
establish long-term relationships with industry partners and would love to
discuss this opportunity further with you.
Thanks & Regards
visit our website.
www.onlineassignmenthelp.com.au
www.freeassignmenthelp.com
www.btechndassignment.cheapassignmenthelp.co.uk
www.cheapassignmenthelp.com
www.cheapassignmenthelp.co.uk/
This document provides instructions for Assignment 2, an individual reflective portfolio worth 60% of the module's grade. Students will critically reflect on their learning throughout the module, synthesizing information from activities and readings. The portfolio should include reflections on group work, seminar discussions, significant learning themes, and how the learning can be applied. It should demonstrate critical thinking, reference theories, and be 3,000 words. Students will be assessed on their use of literature, knowledge of theory, critical analysis, referencing, and writing skills. The portfolio must be submitted electronically by the due date listed on the announcements.
Hello Sir
We are a premier academic writing agency with industry partners in UK, Australia and Middle East and over 15 years of experience. We are looking to establish long-term relationships with industry partners and would love to discuss this opportunity further with you.
Thanks & Regards
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www.onlineassignmenthelp.com.au
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Hello Sir
We are a premier academic writing agency with industry partners in UK, Australia and Middle East and over 15 years of experience. We are looking to establish long-term relationships with industry partners and would love to discuss this opportunity further with you.
Thanks & Regards
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This document discusses change management and how organizations can effectively manage change. It defines change management as focusing on people to ensure smooth, easy, and lasting implementation of change. Key elements for successful change management include communicating the vision, engaging leaders, understanding human behavior, and properly planning changes. Change often faces resistance as people must adapt. The document uses Google as an example of effective change management compared to Yahoo, highlighting how Google involved people in changes and prepared them, while Yahoo failed to recognize that change affects whole organizations.
Urinary Tract Infection with Nursing ManagementSwatilekha Das
Urinary Tract Infection introduction, definition, common microorganisms, classification, predisposing factors, clinical manifestations, pathophysiology, diagnostic studies, medical management and nursing management along with assessment, nursing diagnosis, goal, nursing interventions and expected outcome after the intervention.
Reply to the following 2 posts. In your reply posts, include how th.docxchris293
Reply to the following 2 posts. In your reply posts, include how the information you learned from your peer’s initial post will help you to provide care to a patient.
POST 1
lomerulonephritis
Glomerulonephritis (acute poststreptococcal glomerulonephritis, APSGN), is a representative form of nephritic disease, that occurs following an infection of streptococcal with strains of group A beta-hemolytic streptococcus. According to the National kidney foundation (2020), there are two types, acute and chronic. (NKF, 2020). I will be focusing this discussion on the acute type APSGN. This occurs following an infection in the upper respiratory tract, middle ear infections or strep throat. Whenever there are infections with strains of streptococcus, the immune response is usually initiated in the kidney. This condition develops 10 days up to two weeks following exposure to the strep strain and occurs in children between the ages of 3-7 years, mostly affecting boys. (Hubert & VanMeter, 2018).
Pathophysiology
When persons become infected with the streptococcal strain, subsequent infections causes the body to form antistreptococcal antibodies, thus creating an antigen-antibody complex (type 3 hypersensitivity reaction). When this occurs, the complement systemin becomes activated, which causes the glomeruli of both kidneys to develop an inflammatory response. The inflammatory responses further leads to increase permeability and cell proliferation, where protein and erythrocytes infiltrates and leak into the system. Immunoglobulin G and C3 becomes present in the glomerular tissue and reduction of the serum C3 is noted. If the inflammatory response is severe, and causes reduction in the filtration of the kidney, the glomerular filtration rate (GFR) will decrease and a build up of waste and fluids will occur in the body. If there is impairment in the blood flow, then acute renal failure can occur, increased renin secretion occurs which cause edema and high blood pressure. When these changes are over a prolonged period, scarring of the kidneys can occur. (Hubert et al, (2018).
Signs and symptoms
Edema of the face and periorbital region, generalized edema, due to the retention of fluid and sodium, and the fall in the osmotic pressure, blood pressure elevated, urine color is dark and cloudy, flank or back pain, oliguria results from the decrease in the GFR, and generalized signs of inflammation such as headache, malaise, anorexia and nausea. (Hubert et al, 2018).
Diagnostic testing
The diagnostic tests are blood test (serum urea, creatinine) these will be elevated. GFR will decrease. Blood levels to measure anti-DNase B, streptococcal antibodies. ASO (antistreptolysin O) and ASK (antistreptokinase) will be elevated. Urinalysis will be done to confirm the presence of protein, hematuria and erythrocyte casts. Serum bicarbonate levels and pH will be done same will be decreased, and metabolic acidosis will be present. The patients complement level.
Acute glomerulonephritis is an inflammation of the glomeruli in the kidneys that is usually caused by a bacterial infection or injury. It involves the immune system fighting off an infection which leads to scar tissue formation. Common causes include post-streptococcal infections and other primary glomerular diseases. Diagnostic tests include urine analysis, kidney function tests, kidney biopsy, and imaging tests. Nursing care focuses on monitoring for complications, managing symptoms, and providing education.
The document discusses pancreatitis, including:
1) Pancreatitis is inflammation of the pancreas, which secretes digestive enzymes. It can be acute (sudden and severe) or chronic (long-lasting).
2) Acute pancreatitis symptoms include abdominal pain, nausea, vomiting, and fever. It requires hospitalization, IV fluids, antibiotics, and pain medication.
3) Diagnosis involves blood tests to check enzyme levels and imaging scans like ultrasound and CT or MRI to view the pancreas. Treatment focuses on supportive care while the pancreas heals.
The document provides information on assessing and managing patients with renal disorders. It discusses the functions of the kidney, methods for assessing the renal system including history, physical exam, and diagnostic tests. Nursing management is described for acute pyelonephritis, chronic pyelonephritis, and urinary tract calculi. Interventions include pain management, monitoring fluid intake and output, administering medications, nutritional therapy, and relieving symptoms.
A Clinical Approch Towards Certain Urological MaladiesAditij4
The patient presents with polyuria, pyuria, and hematuria. Differential diagnoses include urinary tract infection, nephrolithiasis, glomerulonephritis, and genitourinary tumors. Evaluation includes urinalysis, urine culture and sensitivity, renal ultrasound, and cystoscopy if indicated. The case involves a young male with a history of neurosurgery who undergoes a water deprivation test consistent with central diabetes insipidus.
The document summarizes topics related to the renal and urinary system, including benign prostatic hypertrophy (BPH), urinary incontinence, and nephrotic syndrome. It provides details on the pathophysiology, signs and symptoms, diagnostic tests, nursing care, and interventions for BPH. Urinary incontinence is defined and its prevalence among older populations is noted. Various diagnostic tests for incontinence are also listed.
This document summarizes acute pancreatitis (AP), including its causes, presentation, diagnosis, severity assessment, treatment, and complications. AP ranges from mild to severe and is commonly caused by gallstones or alcohol abuse. Clinically it presents with abdominal pain and elevated pancreatic enzymes. Imaging like CT can help determine severity and guide management, which involves supportive care, pain control, and treating any underlying conditions or complications like pancreatic necrosis. More severe cases may require antibiotics, minimally invasive drainage procedures, or surgery.
Urodynamic studies are tests that investigate how the lower urinary tract works by measuring bladder pressure and urine flow. They include cystometry, where the bladder is slowly filled and pressure measured; pressure-flow studies, which measure bladder pressure and urine flow; and electromyography, which evaluates pelvic floor muscle function. Urodynamic studies help diagnose lower urinary tract problems causing symptoms like incontinence, frequent urination, and incomplete emptying by identifying issues like obstruction, nerve problems, or muscle dysfunction. The tests are indicated when a patient reports lower urinary tract symptoms and may involve catheters placed in the bladder and rectum/vagina to record pressures during filling and urination.
This document discusses infectious diseases of the genitourinary tract, including definitions of irritative voiding symptoms and objectives for discussing urinary tract infections, prostatitis, epididymitis, and pyelonephritis. It covers etiology, epidemiology, risk factors, signs and symptoms, diagnostic workup, and treatment of these conditions. Specific populations like pregnant women, children, and differences between males and females are addressed.
A 31-year-old female presented with painful urination, dysuria, urgency, and frequency. Her history was notable for a previous urinary tract infection. On examination, she was afebrile with no abdominal tenderness. A urinalysis showed bacteria and red blood cells. She was diagnosed with an uncomplicated urinary tract infection and prescribed levofloxacin and etoricoxib. Patients with uncomplicated infections typically improve with short-term antibiotic treatment, while those with recurrent infections may require long-term prophylaxis.
Bladder pain syndrome, also known as interstitial cystitis, is a chronic condition characterized by pelvic pain, pressure, or discomfort in the bladder. The condition has an unclear etiology but may involve defects in the bladder epithelium or neurogenic inflammation. Diagnosis is based on symptoms persisting for over 6 weeks in the absence of other identifiable causes. There is no universally accepted definition or diagnostic test, but common symptoms include bladder pain worsened by filling and relieved by voiding, as well as urinary urgency and frequency. Treatment follows a stepwise approach starting with lifestyle changes, oral medications, and intravesical therapies before considering more invasive options like hydrodistension, neuromodulation, or rarely, surgery
This document discusses urinary tract infections (UTIs), acute renal failure (ARF), and chronic renal failure (CRF). It covers the causes, symptoms, diagnosis, and treatment of UTIs, which are usually caused by bacteria entering the urethra and bladder. It describes ARF as a rapid decrease in renal function over days to weeks that can result from trauma, illness, or surgery. CRF is the long-term deterioration of renal function over time from any cause of kidney damage. The document provides details on diagnosing and managing these conditions through laboratory tests, imaging, managing fluid and electrolytes, and potentially using dialysis.
The nursing diagnosis for a client with abdominal pain, severe diarrhea, and vomiting would be Fluid Volume Deficit.
The other situations listed do not necessarily indicate a nursing diagnosis on their own. Additional assessment would be needed.
Tuberculosis-Medical and Nursing ManagementsReynel Dan
Tuberculosis is an infectious disease caused by the bacteria Mycobacterium tuberculosis that is usually spread through the air. It leads to eight to ten million new cases globally each year. The bacteria infect the lungs, forming lesions that can heal or progress, potentially spreading through the bloodstream or lymphatic system. Symptoms may include cough, sputum, hemoptysis, fever, and weight loss. Diagnosis involves sputum smears, cultures, chest x-rays, and tuberculin skin tests. Treatment requires months of multiple antibiotic drugs and monitoring for side effects, with the goal of rendering the patient noninfectious and usually resulting in an excellent prognosis with proper treatment.
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This assignment is aiming to identify and discuss pharma cokinetics of drugs given to a patient suffering from asthma, GERD and hypothyroidism. Case study is already been given, drugs given to the patient are protonix, synthroid and metaclopromide.
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This risk management plan addresses risks associated with workplace accidents and operational disruptions at an organization. It involves identifying relevant risks, analyzing their potential impacts, and developing controls to mitigate the risks. The plan will benefit the organization by improving safety, reducing costs from accidents and disruptions, and gaining management support. Key steps include assessing current controls, determining performance metrics, monitoring the plan, and measuring its success in reducing risks.
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This document outlines the requirements for a mid-term assignment assessing strategic international business management. Students must analyze Aldi's potential expansion into one of three target markets - the Czech Republic, Mexico, or New Zealand - by conducting a PESTEL analysis in an appendix and justifying their choice of target market. They must then analyze opportunities/threats using Porter's Five Forces and strengths/weaknesses using VRIO analysis. Finally, students must recommend Aldi's most suitable entry mode and justify it based on their analyses. The assignment aims to assess students' analytical, research, and strategic skills, and will be evaluated based on demonstrated knowledge, argument development, and presentation quality.
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CHINA’S GEO-ECONOMIC OUTREACH IN CENTRAL ASIAN COUNTRIES AND FUTURE PROSPECTjpsjournal1
The rivalry between prominent international actors for dominance over Central Asia's hydrocarbon
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International Conference on NLP, Artificial Intelligence, Machine Learning and Applications (NLAIM 2024) offers a premier global platform for exchanging insights and findings in the theory, methodology, and applications of NLP, Artificial Intelligence, Machine Learning, and their applications. The conference seeks substantial contributions across all key domains of NLP, Artificial Intelligence, Machine Learning, and their practical applications, aiming to foster both theoretical advancements and real-world implementations. With a focus on facilitating collaboration between researchers and practitioners from academia and industry, the conference serves as a nexus for sharing the latest developments in the field.
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Sinan from the Delivery Hero mobile infrastructure engineering team shares a deep dive into performance acceleration with Gradle build cache optimizations. Sinan shares their journey into solving complex build-cache problems that affect Gradle builds. By understanding the challenges and solutions found in our journey, we aim to demonstrate the possibilities for faster builds. The case study reveals how overlapping outputs and cache misconfigurations led to significant increases in build times, especially as the project scaled up with numerous modules using Paparazzi tests. The journey from diagnosing to defeating cache issues offers invaluable lessons on maintaining cache integrity without sacrificing functionality.
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Car accident rates have increased in recent years, resulting in losses in human lives, properties, and other financial costs. An embedded machine learning-based system is developed to address this critical issue. The system can monitor road conditions, detect driving patterns, and identify aggressive driving behaviors. The system is based on neural networks trained on a comprehensive dataset of driving events, driving styles, and road conditions. The system effectively detects potential risks and helps mitigate the frequency and impact of accidents. The primary goal is to ensure the safety of drivers and vehicles. Collecting data involved gathering information on three key road events: normal street and normal drive, speed bumps, circular yellow speed bumps, and three aggressive driving actions: sudden start, sudden stop, and sudden entry. The gathered data is processed and analyzed using a machine learning system designed for limited power and memory devices. The developed system resulted in 91.9% accuracy, 93.6% precision, and 92% recall. The achieved inference time on an Arduino Nano 33 BLE Sense with a 32-bit CPU running at 64 MHz is 34 ms and requires 2.6 kB peak RAM and 139.9 kB program flash memory, making it suitable for resource-constrained embedded systems.
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1. 1
TASK 1
Before handling the case of Sonya, certain documents that should be handed over to the staff and
these documents are
Vital signs- this helps in understanding the situation of the patient as in terms of blood
pressure, heart rate which is abnormally high in this case , level of oxygen saturation in
blood as the blood oxygen carrying capacity is affected in this case, breathing rate, body
temperature as patient often have fever in this case, urine as it shows dark and cloudy
urine which shows infections and secretions like proteins, etc from the body.
Glasgow Coma
Scale
15 alert &
orientated
Blood Pressure 110/60mmHg
Heart Rate 117bpm regular
Oxygen saturation 99% on nasal
prongs@2L
Respiratory rate 18bpm
Pain score 5/10
Temperature 38.6oC
Output 30mL/hr cloudy &
dark
Urinalysis- this helps in investigating the situation of the patient based on their urine
characteristics and the extent of infection. Also as the urine is cloudy and has offensive
smell in patients this test also help in understanding the presence of various proteins,
blood, nitrates, leukocytes, etc in the urine. Generally the technique used in Dipstick
Urinalysis technique.
LEU Positive
2. 2
NIT Positive
URO Negativ
e
PRO Positive
pH 6.0
BLO Positive
SG 1.005
KET Negativ
e
BIL Negativ
e
GLU Negativ
e
Blood cultures- this helps in understanding the cause of infections which may be helping
in further preventions of infections in the patient (Christine et al , 2013)
Medical orders- helps the nurse in following orders in undertaking care of the patient
Medications- helps the nursing in-charge to administer timely and prescribed dosage of
medicines to the patient to allow improvements
Renal ultrasound report- it is the first line in identifying the existence of any obstructions,
stones, etc in the kidney and to identify any structural problems in the patients.
These charts are necessary for the diagnosis of the patient Sonya as
If these documents were not documented correctly, then the nursing plan may not be designed
appropriately and thus will lead to
Increasing severity of the kidney infection
Renal scarring development
Sepsis
3. 3
Impairment of kidney functioning and leading to acute kidney failure or further cause any
Chronic Kidney Disease (Chen et al, 2010)
Renal Abscess which may cost the life of the patient and is a form of necrosis in tissue
which may be caused due to accumulation in the parenchyma of the kidney or perinephric
spaces
Perinephric abscess or abnormality in the urinary tract (Foster et al, 2008)
4. 4
TASK 2
The nursing care plan of the patient will be as follows:
PROBLE
MS/ key
focus areas
INFEREN
CE
GOALS
OF CARE
NURSING
INTERVENTIONS
RATIONALE EVALUATI
ON
Acute
PAIN
Pyelonephr
itis has
symptoms
like pain in
urination
or dysuria
which is
due to
acute
infections
in the
urinary
tract and
kidney
along with
pain and
tenderness
in the
bladder
and around
(Pohl,
2007).
To allow
comfort to
the patient
and help in
further
treatment
of the
kidney
infections.
Also to
identify
any other
severities
from being
developed
in the
patients.
Understand
the intensity,
location and
any
deviations or
exaggeration
s in the pains
to the patient
Providing
sufficient
rest periods
to the patient
and
shortening of
the activity
periods
(Norby,
2007)
Giving
proper
dosage and
administratio
n of
medications
as directed
Severities
of pain
shows
some
infections
Allow
peace and
comfort
to the
patient
and
promote
healing
process in
patients
Analgesic
s help in
relieving
pain and
allowing
feeling of
comfort
to the
patient
To help
After the
administrati
on of the
analgesics
the patient
pain will be
relieved and
controlled
thus helping
in promoting
state of well
being of the
patient
No pain on
urination of
motion of
the pelvis
5. 5
by specialist
on time to
the patient
To help the
patient
through use
of relaxation
breathing
technique
and allow
for
relaxation
in
muscles
Acute
infections
in kidney
and
urinary
tract
Pyelonephr
itis is
basically
caused by
the
infections
of the
urinary
tract and
the kidney
that
develops
from the
cystitis or
bacterial
infection of
the
bladder.
To control
the
severity of
infection
in the
patient
Assess body
temperature
every 4
hours
Record urine
characteristi
c (Pohl et al,
2007)
Allow
patient
drinking 2-3
liter water if
no other
problems
exists as this
will help in
rinsing out
the bacteria
or other
infections
causal
microbes
Vital
signs
indicate
changes
in body
Deviation
s from
expected
urine
volume or
patterns
Handling
urine
stasis
problem
Determin
e impacts
of the
medicatio
ns on
patient
After
successful
nursing
interventions
, the
infections as
visible in
form of
urine and
blood
cultures will
be showing
negative or
diminishing
values on
examination.
6. 6
from body
Monitoring
of urine
culture and
its sensitivity
Provide a
clean and
dry
environment
to patient
Allowing
and asking
patient to
empty
bladder
completely
each time
Administerin
g proper and
timely
medications
as prescribed
by the
experts
Giving
periantal
care to the
patient
(Christine et al,
2013)
Avoid
bacteria
from
infecting
urethra or
other
parts of
body
To
prevent
the
bladder
from
distention
To keep
the
infection
under
control
and
prevent
furtheranc
e
Prevent
urethra
from any
sort of
contamina
tions
7. 7
Changes in
vital signs
Pyelonephr
itis is
accompani
ed by
changes in
the body
vital signs
and may be
accompani
ed by
shivering
fevers,
headache,
nausea, etc.
Helps in
understand
ing of the
patient
response to
medication
s until the
reports are
finally
received to
allow
further
diagnosis
(Norby,
2007)
Monitor
blood
pressure
continuously
or
periodically
Observation
of the mental
status of the
patient and
looking for
consciousnes
s level in
patients
(Colgan et
al, 2011)
To
understan
d the
response
to the
hydration
problems
in the
patient
The
imbalance
of the
electrolyt
es can
have
impact on
the
functionin
g of the
central
nervous
system of
the
patient
Checking for
any
deviations in
the blood
pressure or
other vital
signs of the
patient
which may
reflect the
inefficiency
of the
medications
or need for
surgical or
other
interventions
Anxiety or
fear in the
patient
Due to
developme
nt of so
many
symptoms
and pain in
the body,
To
improve
the level of
comfort in
patients
and reduce
the fears
Monitoring facial
expressions and
body language of
the patient while
urination or passing
motions
Helping
the
patient
through a
range of
motion
exercises
Let the
patient
express his
level of
comfort and
well being in
his own
8. 8
the patient
may have
high levels
of anxiety
in
pyelonephr
itis patient
thus
improving
the
confidence
towards
well being
Allowing
level of
comfort
through
rubbing
the back
or
providing
other
kinds of
breathing
exercises
to the
patient
words
9. 9
TASK 3
Sonya had been prescribed the following medications as:
Analgesics orally- as this helps in better absorption of the analgesic in the whole body along with
helping in relieving of pain and controlling the fever from developing again and again in the
patient.
Vancomycin intravenously- it is an antibiotic and thus administered to treat the kidney and
urinary tract bacterial infections in the patient. Even before the urine test and diagnosis of the
kind of microorganisms causing infections, the antibiotics are used to kill microorganisms. It had
been administered intravenously as its absorption is quite low when it is administered orally to
patients. If the patient responds appropriately to the antibiotics then surgical or other procedures
may not be needed (Colgan et al, 2011).
Hartman’s 1000mls over 12 hours- As it is isotonic to blood and thus helps in replacement of the
body fluid that may be lost along with the necessary minerals due to the acute kidney functioning
impairment in Sonya. This will help the blood from being thick and further affecting the blood
pressure in the patient and thus maintaining the loss of body liquids in case of Sonya.
In order to ensure that the patient is responding appropriately to the medications, the nurse must
check for any deviations in the vital signs or any increase in the following symptoms as
Fever
Hypertension
Nausea
Vomiting frequency
Loin pains
Abnormalities or secretions in urine
Dysuria
10. 10
TASK 4
As in case of the patient Sonya, the signs and symptoms are showing deviations in the vital signs
as the blood pressure is reduced to 95/50 and the patient is on oxygen masks with a heartbeat of
135 bpm and the output is also reduced which shows the patient is not responding to the current
medication and that the complications that may have caused such symptoms are
Significant damages in renal area and possibilities of renal failure (Saddeh et al, 2011)
Development of sepsis
Acute injuries in kidneys or development of Chronic Kidney Disease
Development of Abscess in perinephric area
Acute papillary necrosis which are seen more in old patients or those having previous
incidents of diabetes
Obstructions or calculi in kidneys
ADMINISTRATION OF MEDICATIONS
While administering medications to Sonya, the nurse must be cautious of:
Right medications (check labels, etc) are being given to the right patient
Right dosage as prescribed
Right route as medical order shows
On time
Patient is positively responding to the medicines
Fill in the documents the administration of medications and other observations like vital
signs, urinalysis, etc on time and with correct details (Chen et al, 2010).
This signs and symptoms shows that the patient is not reacting to the Vancomycin and the
supportive therapy being given at the moment and in order to treat the abscess problem the
patient must undergo surgical process for the per-cutaneous drainage or otherwise the doctors
may resort to nephrectomy.
11. 11
However this process may be supported by antimicrobial therapy and if the Psuedomonas
species are found to be causal agents then the doctors may opt for anti-psuedomonal beta lactam
antibiotics while for enterococcci the use of ampicillin as antibiotic is desired (Saddeh et al,
2011).
12. 12
TASK 5
The handover using the ISBAR technique to the nurse of the ICU ward will look like this:
ISBAR
INTRODUCTION Patient’s name- Sonya
Current Date – 11 August, 2016
Admitted on- 5 August, 2016
SITUATION Diagnosis: Acute Urinary tract infection and
Pyelonephritis
BACKGROUND Medical history-
recurring urinary tract infections
Allergies-
allergic to penicillin
Current treatments or interventions-
Hartmann’ s 1000mls over 12 hours
Intramuscular Ondansetron 4 mg prn 12 hourly
Oral paracetamol1g 4 hourly
Oral ibuprofen 400mg 8 hourly
Intravenous vancomycin 1g 12 hourly
ASSESSMENT Last vital signs-
BP-95/50
HR-135
RR- 26
TEMP-39.9 degrees
O.S-96 % HUDSON MASK @6L
CARDIAC- thread and irregular
CAPILLARY REFILL- > 3 seconds
SKIN- pale and poor turgor
DRESSING-
13. 13
Indwelling catheter with hourly bag
collections
Cannula in right arm
URINE/DISCHARGE-
Less than 25 ml/ hour and dark
offensive vaginal discharge
FLUIDS-
300 mls no change
RECOMMENDATIONS Goals- urgency and control of infection
Consultant- Dr. x
Tests-
Blood cultures sent to pathology
MC&S sent to pathology
Ultrasound reports awaited
No artery blood gas done
14. 14
TASK 6
In process of developing the care plan for Sonya who was facing acute urinary tract infections
and Pyronecrlytis development, I have been facing problems in monitoring of the vital signs of
the patient as it was too critical and sensitive part of observing the patient who was being given
initial antibiotic therapy until her reports are finally out. I had been able to handle the situation
quite well but things turned out terrific when there were deviations in case of Sonya who was not
responding to the initial antibiotics treatment and she had to be shifted to the ICU for further
procedures.
While undertaking the care of the patient Sonya and application of the nursing care plan for her, I
have been able to provide holistic nursing care to the patient as
Monitoring of the vital signs and any deviations in the same thus allowing a check on the
patients response to prescribed medications
Allowing administration of medications on time
Monitoring mental consciousness of the patient as may be impacted by electrolyte
imbalances
Monitoring the urination patterns, volume and characteristics and periodic urinalysis to
check severity or damages
Allowing patients with bed pan or other supports for urination
Allowing for maintenance of body fluid volumes
Analyzing signs of pain in patient
15. 15
REFERENCES
Patient - Trusted medical information and support (2016) (online) available at
http://patient.info/in/doctor/pyelonephritis last accessed on 12 August 2016
Christine, C. (2013)administration of medication (online) available at
http://www.healthline.com/health/administration-of-medication#Overview1 last accessed
on 12 August 2016
8 rights of medication administration (2011) Online available at
http://www.nursingcenter.com/ncblog/may-2011/8-rights-of-medication-administration
last accessed on 12 August 2016
Chen KC, Hung SW, Seow VK, et al (2010) The role of emergency ultrasound for
evaluating acute pyelonephritis in the ED. Am J Emerg Med. 2011 Sep;29(7):pp 721-4
Saadeh, S.A., Mattoo, T.K. (2011) Managing urinary tract infections. Pediatr Nephrol.
2011 Nov; 26(11):pp 1967-76.
Colgan, R., Williams, M., Johnson, J.R. (2011) Diagnosis and treatment of acute
pyelonephritis in women. Am Fam Physician. 2011 Sep 1; 84(5): pp 519-26.
Norrby, S. R. (2007) Approach to the patient with urinary tract infection. In: Goldman L,
Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap
306
Pohl A. (2007) Modes of administration of antibiotics for symptomatic severe urinary
tract infections. Cochrane Database Rev. 2007 pp 17;(4)
Foster, R.T. (2008) Uncomplicated urinary tract infections in women. Obstet Gynecol
Clin North Am, PP 235-48
Nursing interventions (2014) online available at http://nursinginterventions-
diagnosis.blogspot.in/2011/06/nursing-intervention-for-pyelonephritis.html last accessed
on 13 August 2016