Assessment

Subjective:

Diagnosis

Acute pain
related to
biological
factors such
Objective:
as trauma or
. Facial
activity of
Grimace
disease
. Restlessness process
. B.P :

Planning

Nsg.Intervention Rationale

After 8 hrs
Independent:
span of care,
patient will 1. Assess pain
be able to:
location and rate
scale of pain ( 01. patient's
10)
pain will be 2.Encourage
relieved or
increase fluid
controlled
intake
3. Investigate of
2. Patient
bladder fullness
will be able 4. Observe for
to urinate
changes in
with less
mental status ,
pain
behavioural level
and
3. Patient
consciousness
will be able 5.Provide
to be more
comfort measure
comfortable 6.Suggest use of
relaxation
technique and
deep breathing
excercises
Dependent:
1. Administer
antibacterial
meds. As
Prescribed

1. provides
information to
aid in
determining
choice or
effectiveness of
intervention
2. Increase
hydration flushes
bacteria and
toxins
3.Urinanry
retention may
develop, causing
distention ( in
bladder or
kidney) and
potentially leads
to further risks.
4.Promotes
relaxation
refocuses
attention and
may enhance
coping abilities.
5. Promotes
muscle
relaxation
6. Reduces
bacteria present
in urinary tract
and those
introduced by
drainage system

Evaluation