CUES BACKGROUND NURSING PLANNING IMPLEMEN- RATIONALE EVALUATION

KNOWLEDGE DIAGNOSIS TATION

Subjective: Short term: Independent Goal partially met.

“Minsan, pag maiihi na Double J stent is a Impaired Urinary After 1-2hrs of 1. Discuss condition  Understanding After 2 hours of discussion,
ako, hindi pa ako thin tube inserted to Elimination (Urge discussion, patient related to medical of his condition the patient was able to
nakakarating ng banyo, the ureter to prevent or Incontinence) related will be able to diagnosis and will help patient enumerate 4 out of 5
lalabas na agad.” as treat obstruction of the to increased urinary verbalize explain the causes what to methods in managing
verbalized by patient urine flow from the output secondary to understanding of and its effects to anticipate and urinary elimination.
kidney. Double J Stent presence of DJ stent condition elimination gain
Objective: have multiple in right ureter cooperation for The patient verbalized
• Stent inserted in R perforations to allow MANAGING implementing fewer incidences of urge
(Ureter) the urine to drain from Within 8 hours of URINARY interventions. incontinence
the kidney down the duty, patient will be ELIMINATION:
ureter to the bladder. able to enumerate at
least 5 ways of
managing urinary
elimination. 1. Limit fluids 2-3  Limit incidences
hours prior to of nocturia
bedtime

2. Provide assistance  Urinary devices

or devices, as help client to
indicated (urinal, conserve energy
bedpan) within when client
client’s reach finds it hard to
have access to
the bathroom.

3. Assist with  Bladder

developing training aids the
toileting routines patient to
 establish lengthen the
voiding time between
urges to go to
the bathroom
 
 . This also helps
schedule based on to develop
client’s usual voiding regular voiding
pattern and gradually habits
increase time interval

 recommend
consciously
delaying
voiding by  Behavioral
using techniques for
distraction urge
(e.g. slow, suppression
deep breaths),
self-
statements
(e.g. “I can
wait”), and
contracting
the pelvic
muscles when
exposed to
triggers

 encourage
regular pelvic
floor  These exercises
strengthening help strengthen
exercises or the muscles that
Kegel control the
exercises bladder.

4. Advise patient to
 avoid caffeinated  Caffeine has a
beverages and diuretic effect
Long term: alcohol on the body.
Alcohol halts
After 3 days of the production
follow up visits, of ADH,
patient will be able resulting in
to frequency of
 verbalize 1. Encourage patient voiding.
control over and SOs to monitor
voiding and record daily fluid  Observe for
 report intake and progression of
fewer elimination during condition and
incidences hospital stay evaluate
of urge effectiveness of
incontinenc interventions
e
Davis, F.A. (2008) Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales (11th ed) FA Davis Co.