VIII.

NURSING CARE PROCESS Cues S: sensation of bladder fullness, dysuria O: Lower abdominal distention (bladder distention), small frequent voiding or absence of urine output Nursing Diagnosis Altered urination R/T to the presence of blood in the urine (hematuria) by the cues presented Scientific Background Blockage to the urethral passage will lead to the accumulation of large amount of urine to the bladder. Overstretching of the wall of the bladder will occur, if this continues, may lead to the rupture of the wall. Hematuria is one of the symptoms of urinary retention. (www.sciencedaily.com) Nursing Objective/s After 6 hours of nursing intervention the patient will manifest normal amount of urine output (40-60ml/hour) and experience no discomforts in micturition. Intervention INDEPENDENT: *applying hot compress to the suprapubic area *positioning the patient DEPENDENT: *administration of medications, such as: CELECOXIB (Selecap) CIPROFLOXACIN (Ciprobach) COLLABORATIVE: *Ultrasound *Hematology Rationale --to alleviate pain Evaluation Goal unmet. The patient still suffers from dysuria. The urine output still below normal. Presence of blood in the urine.

--for comfortable position

--to minimize pain felt by the patient --to minimize the occurrence of microorganism

IX. DRUG STUDY

Name of the Drug Ciprofloxacin (Ciprobach) Mechanism of Action Indications Contraindications Nursing Responsibility

A broad-spectrum quinolone antibiotic. Exact mechanism is unknown, but bactericidal effects may result from drugs ability to inhibit bacterial DNA gyrase and to prevent DNA replication in susceptible bacteria.

*Mild to moderate Urinary Tract Infections *Mild to moderate bone and joint infections *Mild to moderate Respiratory Tract Infections *Mild to moderate skin and skin structure infections *Infectious diarrhea * Acute Pain & Primary Dysmenorrhea * Familial Adenomatous Polyposis (Off-label) * Osteoarthritis * Rheumatoid Arthritis * Juvenile rheumatoid arthritis * Hepatic Impairment

*Patients with sensitivity to quinolone antibiotics *Pregnancy (Category C) *Caution to patients with CNS disorder

Celecoxib (Selecap)

Celecoxib is a non-steroidal anti-inflammatory drug (NSAID). It blocks the enzyme that makes prostaglandins (cyclooxygenase 2), resulting in lower concentrations of prostaglandins. As a consequence, inflammation and its accompanying pain, fever, swelling and tenderness are reduced. Celecoxib differs from other NSAIDs in that it causes less inflammation and ulceration of the stomach and intestine (at least with shortterm use) and does not interfere with the clotting of blood.

Tobacco Smoking, Increased Cardiovascular Event Risk, Time Immediately after Coronary Bypass Surgery, Poor Metabolizer due to Cytochrome p450 CYP2C9 Variant, High Blood Pressure, Heart Attack, Chronic Heart Failure, Disease of the Heart and Blood Vessels, Stroke, Obstruction of a Blood Vessel by a Blood Clot, Asthma, Ulcer from Stomach Acid, Stomach or Intestinal Ulcer, Liver Problems, Bleeding of the Stomach or Intestines, Kidney Disease, Serious Kidney Problems, Visible Water Retention, Abnormal Liver Function Tests, Pregnancy, Condition of Increased Mast Cells, Extreme Loss of Body Water, Water Retention, A Rupture in the Wall of the Stomach or Intestine, Anemia, Habit of Drinking Too Much Alcohol

1. Obtain specimen for culture and sensitivity tests before first dose. Therapy may begin pending test results. 2. The preferred time for dosing is 2 hours after a meal. Food does not affect absorption but may delay peak serum levels. 3. May cause CNS stimulation. Use with caution in CNS disorders, such as severe cerebral arteriosclerosis or epilepsy, and in other patients who are at increased risk of seizures. 4. May cause dizziness or light-headedness. Warn patients to avoid hazardous tasks that require alertness, such as driving, until CNS effects of the drug unknown. 5. Advise patient to drink plenty of fluids to reduce the risk of crystalluria. 6. Dosage adjustment must be necessary in patients with renal dysfunction. 7. Prolonged use may result in over growth of organism that are resistant to ciprofloxacin. 1. Nurses must teach patients how to take Celebrex properly. In addition, they also must alert patients to the potential side effects of the drug. Celebrex should be taken with food or milk to lessen the chance of gastric upset. Patients should be taught never to crush, dissolve or chew this medication and to never exceed the prescribed dose as deaths have occurred. 2. Patients also should be taught to discontinue Celebrex use and contact their physician if they have any gastrointestinal symptoms such as bloody stools or cramping. Bleeding, fatigue or bruising also should be reported. Patients experiencing difficulty breathing, chest pain, slurred speech or partial paralysis should seek immediate emergency assistance. Celebrex is often discontinued before surgery. Therefore patients should consult their physician before undergoing any surgical procedures. 3. Patients undergoing therapy with Celebrex should be evaluated on an ongoing basis to determine the efficacy of treatment. Signs that a patient is responding properly to treatment include decreased pain and inflammation. During the evaluation process, patients also should be assessed for side effects. If side effects are present, the patient's physician should be notified to determine if the benefits of treatment outweigh the symptoms or risks involved.