Tilman Family

Fluid & Electrolytes

Thinking like a Nurse Activity

Mary Tilman-Brown was not feeling well over the past several days. She tried to get an appointment
with her primary care provider, but the next available appointment is tomorrow afternoon. She decided
she could not wait and had her husband, Jack, bring her to the ER at midnight last night. Upon arrival to
the ER, Mary complains of severe flank pain. She was admitted to your healthcare facility.

The nurse collects the following assessment data on the client:

 C/O nausea, vomiting
 Temperature= 98.2 º F
 Heart rate= 95 beats per minute
 Respiratory rate= 26 breaths per minute
 Oxygen saturation= 97%
 Numeric pain rating= 9
 Urinalysis:
o Specific gravity= 1.030
o pH = 6.02
o protein = 2+
o RBC’s = positive

1. Based on the assessment findings, choose the most likely options for the information
missing from the table below. Note that not all options will be used.
Initially, upon arrival to the ED, Mary would have _________1__________ to determine
the cause of the pain. In order to determine the cause of Mary’s pain, the nurse anticipates
that Mary will have a ___________2____________ to assess for calcium, uric acid, creatine,
sodium, and total volume. Lastly, Mary would have ___________3___________ to determine
kidney function.

Options
CT with contrast
CT without contrast
24-hour urine
Blood chemistries
KUB
Complete blood count
Urine Culture and
Sensitivity
2. Indicate which nursing action listed in the far-left column is appropriate for each of Mary’s
problems.

Nursing Action Problem or Potential Appropriate Nursing Action

Problem
Start IV fluids at ordered rate Waves of pain rated a 7 on a
numeric scale
Prepare Mary for Oxalate Stones
extracorporeal shock wave
lithotripsy (ESWL)
Limit protein intake Potential Urinary Tract
Infection
Limit intake of strawberries Uric acid stones

3. What teaching would you provide Mary during this hospitalization? About ESWL, both
before and after the procedure? Select all that apply.

____ ESWL is a non-invasive procedure

____ Discomfort may occur during and after the procedure

____ Strain urine and flush strained contents with each void

____ ESWL causes fragmentation of kidney stones

____ ESWL involves high-energy in the form of shock waves

____ ESWL can cause damage to surrounding tissues

____ Increase fluids to help with stone passage

4. Mary was admitted to your medical-surgical unit and has been there for 2 days. She is still
experiencing flank pain.

For each assessment finding, use an X to indicate whether the interventions were
Effective (helped to meet expected outcomes), Ineffective (did not help to meet
expected outcomes), or Unrelated (not related to the expected outcomes).

Assessment Finding Effective Ineffective Unrelated

Mary states, “I strain
my urine sometimes,
but other times I
forget.”
Serum calcium 10.5
mg/dL
Pain rating of 8 on a
numeric scale
Reports passing a
small “rock-looking
thing”.
Voids 200 mLs with
each void.
Temperature of
101.2º F.
WBC 3.9

5. What education would you provide Mary about the avoidance of future episodes? Select
all that apply.

____ Increase protein intake for healing.

____ Limit sodium intake to 3–4 g/day.

____ Limit calcium intake.

____ Drink cranberry juice every day

____ Drink 64 ounces of water everyday