Date

Cues

Need

Feb 16,
2015

Subjective: gamay
lang iyang gina-ihi

@ Southern
Philippines
medical
Center

Objectives:

E
L
I
M
I
N
A
T
I
O
N

Bladder
Distention
Low amount
of urine
output
Frequent
voiding

P
A
T
T
E
R
N

Nursing
diagnosis
Urinary
retention r/t
infection of
the gastro
intestinal
tract
As
evidenced
by small and
frequent
voiding

Objectives of care
Within the whole
rotation, patient
will be able to:

Void more
frequently
atleast 7-8
times a day
in sufficient
amounts
with no
palpable
bladder

The patients
mother will
be able to
demonstrate
techniques
or behaviors
to alleviate
or prevent
urine
retention

Nursing
interventions
1. Establish
rapport with
the patients
mother
R. to gain
cooperation
and trust
2. Determine
clients
environment
respects
privacy, and
provides
natural
lightning and
readily
accessible
view to
outdoors .
R. an aspect
that can be
manipulated
to enhance
comfort
3. Evaluated
general
hydration
status
R: for the

Evaluation
Goal partially
met
Patient was
able to void
with an
increase on
urine output
however did
not meet the
minimal
frequency of
voiding yet.

nurse to
have basic
data leading
to proper
interventions
4. Note recent
amount and
type of fluid
intake
5. Identify
factors that
effects
frequency of
voiding R: to
know the
appropriate
intervention
to alleviate
factors of
retention
6. Relieve pain
by
administerin
g
appropriate
medications
and
measures R:
to reduce
swelling and
treat

underlying
cause
7. Position the
baby in
upright on
commode or
stand R: to
provide
functional
position for
voiding
8. Promote
hydration
and instruct
the parent to
promote
fluid intake
R: stimulates
frequent
voiding
9. Apply cold
compress on
the umbilical
area R:
stimulates
voiding