Nursingcrib.com Nursing Care Plan Impaired Urinary Elimination

Cues

Nursing Diagnosis

Inference

Objective ◈ c IVF of D5LR 1L @ 30 gtts/min ◈ pale in appearance ◈ weak looking

◈ Impaired Urinary Elimination r/t oral fluid/solid restriction & sensory motor impairment

Oral fluid/solid restriction

Dehydration

Less urinary output

◈ on NPO ◈ c abdominal dressing, dry & intact

Reference: Understanding Pathophysiology, Huether

Objective

Nursing Intervention

Rationale

Short Term Goal

Independent

◈ After 4 hours of nursing intervention, normal urine elimination and output will be maintained.

◈ Assessed patency of foley catheter.

◈ Provides basis for further assessment & action.

◈ Used asepsis and hand hygiene in providing care and manipulating the urinary drainage system.

◈ Prevents or reduces risk of contamination of foley catheter.

◈ Assessed color, volume, odor and components of urine.

◈ Provides information about adequacy of urine output, condition and patency of foley catheter and debris in urine.

◈ (+) anesthetic effect on pelvic & lower extremities Dependent ◈ c foley catheter draining to yellowish urine, > 30 mL/hr

◈ Administered IV fluids such as PNSS on fast drip as prescribed.

◈ By regulating the amount of sodium, the kidney can regulate the volume of body fluids.

Evaluation

◈After 4 hours of nursing intervention, the goal is met through exhibition of adequate urinary output and patent drainage system.