Presenting Sx/Sx That R/T Admitting Diagnoses Fevers/chills, lower back/flank pain, CVA tenderness, N/V, Pyuria, dysuria, frequency, change MS PMH that Relates to Admitting Diagnoses (include supporting rationale) Anatomic defects Urinary stasis Urinary reflux Urinary retention Diabetes BPH Catheters Age Pregnancy Poor hygiene Relevant Medications That Effect or Treat the Dx(s) Broad spectrum Antibiotic Phenazopyridine Analgesic-acetominophen Antipyretic Antiemetic Admitting Diagnosis Pyelonephritis Relevant Labs/Xrays that Confirm the Dx(s) (include supporting rationale) Urinalysis-W BC, Nitrates Urine culture CBC U/S, CT, KUB cystoscopy Medical/Surgical Treatments this Hospitalization Diagnostic Cues R/T 1° Nursing Dx (Data) 1° Nursing Dx Urinary history/physical Impaired urinary elimination Acute pain Knowledge deficit Goal 1 treatment 3 Outcome Goals (Planning) Goal 2 prevention Focus of Care Broad spectrum Antibiotic Specific antibiotic Phenazopyridine Analgesic IV fluid Focus of Care (Interventions) Empty regularly Regular BM Front to back wipe Daily hydration Goal 3 complication Focus of Care Urosepsis Chronic Pyelonephritis End Stage Renal Disease Avoid catheter use unless necessary Early catheter removal Evaluation Evaluation Evaluation