Introduction

Renal stones are formed within the kidneys, and this is called nephrolithiasis. Urolithiasis is a
condition that occurs when these stones exit the renal pelvis and move into the remainder of the
urinary collecting system, which includes the ureters, bladder, and urethra. The symptoms of kidney
stone are related to their location whether it is in the kidney, ureter, or urinary bladder (S.B.N. Kumar,
et. al., 2012). Initially, stone formation does not cause any symptom. Later, signs and symptoms of the
stone disease consist of renal colic (intense cramping pain), flank pain (pain in the back side), hematuria
(bloody urine), obstructive uropathy (urinary tract disease), urinary tract infections, blockage of urine
flow, and hydronephrosis (dilation of the kidney).

Globally, kidney stone disease prevalence and recurrence rates are increasing (T. Knoll, 2010),
with limited options of effective drugs. Urolithiasis affects about 12% of the world population at some
stage in their lifetime (C.K. Chauhan, et. al., 2008). It affects all ages, sexes, and races (O.W. Moe, et. al.,
2010) but occurs more frequently in men than in women within the age of 20–49 years (V.O.
Edvardsson, et. al., 2013).

Common risk factors for stone formation include poor oral fluid intake, high animal-derived
protein intake, high oxalate intake (found in foods such as beans, beer, berries, coffee, chocolate, some
nuts, some teas, soda, spinach, potatoes), and high salt intake (M.J. Chung, 2017). Oral hydration is
recommended at a rate that produces approximately 2.5 L of urine per day, and acceptable choices for
fluids include water, coffee, tea, beer, and low sugar fruit juices except for tomato (high sodium
content), grapefruit, and cranberry (high oxalate content). Consumption of citrate helps to prevent
stone formation as it inhibits crystal aggregation by forming complexes with calcium salts within the
urine. Low calcium intake has been shown to increase the risk of kidney stone formation, contrary to
common belief. Decreased oral calcium intake will reduce calcium levels within the GI tract, which
would otherwise be available to bind to oxalate. This, in turn, will increase oxalate absorption and
excretion, increasing the risk of stone formation. Vitamin C intake and fish oil have also been shown to
increase the risk of calcium stones.

Occlusion of the renal system can follow resulting in nephrolithiasis and eventually kidney
failure. The following case describes a patient in which urolithiasis resulted in occlusion of the renal
system and nephrolithiasis. This case was significant because it paved a way into a deeper extent in
knowing the whole picture of its disease process which is mostly experienced by male adults than of
women. Moreover, it also enriches my practice and awareness in handling these kinds of cases as it
needs constant monitoring towards the patient's condition.
 NURSING HEALTH HISTORY

Nursing health history is a tool used by nurses to gather important and relevant information that
would help in the patient’s care. It does not only record the client’s problems but describes the client as
a whole and in relation to social and physical environment and other important components that affects
client’s perceptions towards health. The gathered information obtains knowledge of client’s problems
and needs within the context of the particular client’s life that will support therapy and care.

The student had chosen a case in relation to the Care of Clients with Medical Surgical Problem
for the Individual Case Study, all of the information gathered in this report are obtained through a
thorough interview from the patient and the data gathered are limited only from the information
gathered through the said interview. To maintain confidentiality, the student used a pseudonym, Patient
B.

Patient Demographic Profile

Patient B, is a 72 year old male, living in Cabadbaran City. He was born on February 14, 1950 and
was a Christian- Seventh Day Adventist by faith. Patient’s current weight is 50 kg and is 172.5 cm tall.
Patient B, lives at Purok 1, Punt Puting, Cabadbaran City and was living with his wife. Patient works as a
driver sometimes if his son lets him use the motorized tricycle.

Patient Health History

Patient B, has no history of a family comorbidities. However, patient mentioned that he has
arthritis. According to the patient, he have undergone a surgery (year wasn’t mentioned) due to a
vehicular accident where he had an open reduction internal fixation (ORIF). He is also currently taking
his maintenance medication, such Rifampicin 150mg + Isoniazid 75mg (Anti-Tuberculosis) in which he
started taking last November 2021.

History upon Admission

About a month PTA noted difficulty urination with scanty urination which became intolerable
thus advised for consultation. Patient B was then instructed for work up CT stonogram. According to
Patient B, he had started experiencing the intolerable symptoms of ureterolithiasis three days prior to
his admission where he experienced pain that radiates to the lower abdomen and groin. Patient also
said that he experienced urinating in small amounts. He was then admitted at Manuel J. Santos Hospital
in Butuan City, last March 28, 2022 at 8:30PM.
 PHYSICAL ASSESSMENT

Physical assessment is an organized systemic process of using the techniques of inspection, palpation, percussion, and auscultation in
collecting objective data based upon a health history and head-to-toe or general systems examination. A physical assessment should be adjusted
to the patient, based on his needs. It can be a complete physical assessment, an assessment of a body system, or an assessment of a body part.
Nursing assessment do sometimes contribute to the identification of a medical diagnosis, the unique focus of a nursing assessment is on the
patient's responses to actual or potential problems.

Inspection to inspect, carefully look, listen, and smell to distinguish normal from abnormal findings. It is important to deliberately
practice the skill and learn to recognize all the possible pieces of data that can be gathered through inspection alone.

Palpation involves using the sense of touch to gather information. Through touch you make judgements about expected and unexpected
findings of the skin or underlying tissue, muscle, and bones.

Percussion involves tapping the skin with the fingertips to vibrate the underlying tissues and organs. The vibration travels through the
body tissues, and the character of the resulting sound reflects the density of the underlying tissue. The denser the tissue, the quieter is the
sound. By knowing how various densities influence sound, it is possible to locate organs or masses, map their edges, and determine their size.

Auscultation involves listening to sounds the body makes to detect variations from normal. Some sounds such as speech and coughing
can be herd without additional equipment, but stethoscope is necessary to hear internal body sounds.

Patient was assessed last April 5, 2022

Materials used:

 Tape measure
 Ruler
 Thermometer
 BP apparatus
 Wrist watch
 Penlight
 Pulse Oximeter
 LEGEND:

BLACK – NORMAL

RED - ABNORMAL

GENERAL SURVEY

ASSESSMENT OBSERVATIONS
Body build Ectomorph
Posture Erect during sitting and walking
Hygiene and grooming Untrimmed and unkempt finger nails
Attitude Cooperative
Affect/mood Patient is alert during interview session
Quality and quantity of speech Patient was able to speak and respond well to questions.
Relevance of thoughts The patient responds accordingly and responses correlate to the
questions asked.

VITAL STATISTICS

ASSESSMENT MEASUREMENTS INTERPRETATIONS

Height 172.5 cm
Weight 50 kg
BMI 16.8 Underweght

VITAL SIGNS

DATE INITIAL VITAL SIGNS LATEST VITAL SIGNS

Temperature Pulse Respiration Blood Temperature Pulse Rate Respiration Blood SpO𝟐
Rate Rate Pressure Rate Pressure
April 5, 2022 36 ℃ 83 bpm 22 bpm 120/80mmH 35.6 ℃ 82 bpm 20 bpm 120/90mmH 97%
g g
April 6, 2022 37.1 ℃ 78 bpm 22 bpm 130/80mmH 36.6 ℃ 78 bpm 22 bpm 130/80mmH 97%
 g g

BODY PART INSPECTION PALPATION PERCUSSION AUSCULTATION

SKIN Skin color is uniform Skin is dry. Skin turgor N/A N/A
thorough out the body. returns within 2 seconds
after pinching and no
edema noted.
HAIR Hair is grey, baldness Hair is dry. N/A N/A
noted. No pediculosis or
dandruff noted. Heart
shape hairline noted.
NAILS Finger nails are Nails are smooth and firm. N/A N/A
untrimmed and unkempt. During the capillary refill it
Nail plate are attach to returns within 2 seconds
the nail bed. to blanched nail beds
when pressure is
released.
SKULL Head is rounded, No nodules palpated N/A N/A
normocephalic and
symmetrical.
EYES Eyelashes are curled out No pain felt in the lacrimal N/A N/A
and symmetric. Eyebrows gland and nasolacrimal
are symmetrical in sac.
movement. Pupils are
black, equal in size and
constrict to light. Cornea
is transparent and shiny
Sclera and conjunctiva are
clear and free of
discharges, lesions and
redness.
EARS Auricles are same in color No nodules and palpated N/A N/A
as facial skin and recoils over the ears and in the
 back The outer canthus of
eyes is aligned in the top
pinna and having a 10
degree angle. No cerumen
noted on both ear.
NOSE Nose in midline in face,
septum is midline and
intact.
MOUTH AND THROAT Lips are dry, no lesions
present. No dental caries
seen. Buccal mucosa is
pink and no lesions. Uvula
is in midline. Tongue is in
midline, pink and no
lesions. Palates are pink
and no lesions present.
NECK No bulging masses seen.
Coordinated muscle
movements and no
discomfort if neck is move
from side to side. Jugular
vein is not visible.
CHEST & LUNGS Symmetric in shape.
The chest expands
symmetrically during
breathing.
HEART AND CENTRAL No visible veins present.
VESSELS No visible pulsation seen
on the pericardium
ABDOMEN Umbilicus is midline. No
visible pulsation and
vascular pattern seen
mastoid process
No tenderness palpated N/A N/A
over the sinuses.
Not able to assessed N/A N/A
because patient is
uncomfortable in the
procedure.
No nodules and lymph N/A N/A
nodes noted. Trachea is in
midline
No masses or nodules No adventitious sounds
noted For tactile fremitus, heard.
bilateral vibrations/ sound
waves is felt
N/A N/A No bruit auscultated No
heart murmurs heard
Bowel sounds are heard
at a rate of 10 clicks per
minute.
No bruit heard over
abdominal aorta. No
 friction hub over liver and
spleen is present
GENITALIA Was not able to assess Was not able to assess N/A N/A
because patient is because patient is
uncomfortable uncomfortable
ANUS Was not able to assess Was not able to assess N/A N/A
because patient is because patient is
uncomfortable uncomfortable
BACK AND EXTREMITIES Erect posture during No edema or tenderness N/A N/A
sitting and standing palpated over extremities.
Extremities are
symmetrical in size. Arms
and legs doesn’t show full
ROM without assistance.
 Anatomy and Physiology

Anatomy is the study of the structure and relationship between body parts, while physiology is the study
of the function of body parts and the body as a whole. This section intends to identify and explain parts
and areas of the body that is affected by the disease and to initially provide insight as to where areas
contain deviation to preliminary understand the pathophysiology of the disease which will be further
explained and mapped out in the next section.

The Urinary System and Stones

The urinary filtrate is formed in the glomerulus and passes into the tubules where the volume
and content are altered by reabsorption or secretions. Most solute reabsorption occurs in the proximal
tubules, whereas fine adjustments to urine composition take place in the distal tubule and collecting
ducts. The loop of Henle serves to concentrate urine composed of 95% water, 2.5% urea, 2.5% mixture
of minerals, salts, hormones, and enzymes. In the proximal tubules, glucose, sodium, chloride, and
water are reabsorbed and returned to the blood stream along with essential nutrients such as amino
acids, proteins, bicarbonate, calcium, phosphate, and potassium. In the distal tubule, the salt and acid-
base balance of blood is regulated.

Kidney Stone Compositions

The chemical compositions of urinary stones include crystals and noncrystalline phases or the
organic material (the matrix). The organic matrix of urinary stones consists of macromolecules such as
glycosaminoglycans (GAG’s), lipids, carbohydrates, and proteins. These molecules play a significant role
by promoting or inhibiting the processes of kidney stone development. The main components of the
stone matrix are proteins (64%), nonamino sugars (9.6%), hexosamine as glucosamine (5%), water
(10%), and inorganic ash (10.4%). The matrix acts as a template participating in the assembly of kidney
stones. The matrix of all stones contains phospholipids (8.6%) of the total lipid, which in turn represents
about 10.3% of stone matrix. Cell membrane phospholipids, as part of organic matrix, promote the
formation of calcium oxalate and calcium phosphate stones. Albumin is the major component of the
matrix of all stone types.

Mechanisms of Renal Stone Formation

The pathogenesis of kidney stone or biomineralization is a complex biochemical process which

remains incompletely understood. Renal stone formation is a biological process that involves
physicochemical changes and supersaturation of urine. Supersaturated solution refers to a solution that
contains more of dissolved material than could be dissolved by the solvent under normal circumstances.
As a result of supersaturation, solutes precipitate in urine leads to nucleation and then crystal
concretions are formed. That is, crystallization occurs when the concentration of two ions exceeds their
saturation point in the solution. The transformation of a liquid to a solid phase is influenced by pH and
specific concentrations of excess substances. The level of urinary saturation with respect to the stone-
forming constituents like calcium, phosphorus, uric acid, oxalate, cystine, and low urine volume are risk
factors for crystallization. Thus, crystallization process depends on the thermodynamics (that leads to
nucleation) and kinetics (which comprises the rates of nucleation or crystal growth) of a supersaturated
solution. Therefore, lithiasis can be prevented by avoiding supersaturation.
 LABORATORY RESULTS

Laboratory tests check a sample of a person’s blood, urine, or body tissues. A technician or
your doctor analyzes the test samples to see if the results fall within the normal range. The tests use a
range because what is normal differs from person to person (Smith, 2019). In the case of Patient M, he
was ordered to be test for CBC (Complete Blood Count), ultrasound and a urinalysis which results are
provided below.

Hematology: Complete blood count

A complete blood count (CBC) is a test that measures the cells that make up the patient’s blood. In the
case of excessive vagina bleeding, CBC is ordered to look for altered count results of test typical of the
later stages of diagnosis. Also, used to help detect a variety of disorders including infections, anemia,
diseases of the immune system.

TESTS RESULT REFERENCE INTERPRETATION

Hemoglobin 74 136-167 Below normal range
Hematocrit 0.22 0.40-0.50 Below normal range
WBC 6.85 5.0-10.0 Within normal range
Segmenters 0.54 0.37-0.72 Within normal range
Lymphocytes 0.28 0.20-0.50 Within normal range
Eosinophil 0.07 0.00-0.06 Slightly above normal range
Monocytes 0.11 0.08-0.14 Within normal range
Basophils 0.00 0.0-0.01 Within normal range
Platelet 453 150-390 Slightly above normal range

Electrolyte Panel

TESTS RESULT REFERENCE INTERPRETATION

Potassium 4.6 3.5-5.3 Within normal range
Sodium 140.0 135-148 Within normal range

Chemistry Section

TESTS RESULT REFERENCE RESULT REFERENCE INTERPRETATION

(c.u.) (s.i.)
Creatinine 2.40 0.90-1.50mg/dl 213.312 80.00-133.00mmol/L Above normal
range
BUN Blood 18.0 8.12-22.97mg/dl 6.426 2.90-8.20mmol/L Within normal
Urea range
Nitrogen
Name of Drug Date Classification Dose/ Mechanism of Contraindications Side Effects Nursing
Ordered Frequency Action Responsibilities
Generic 4/6/22 Antiurolithic 500mg 1 For renal and urinary None known. No untoward - Liquid intake
Name: tab TID disorders including Special warnings side effects should be
Pinene alpha urolithiasis. and precautions have been increased
+ beta, for use reported during therapy.
Camphene, ROWATINEX Rowatinex® is not
Cineol, promotes diuresis suitable for use in - Store at
Fenchone, and relaxes urinary patients with temperatures
Borneol, tract spasm, thus severe colic, not exceeding
Anethol and assisting the passage anuria or severe 30 degrees
Olive Oil of stones. The infection of the Celcius
therapeutic effect of urinary tract.
Brand Name: the balanced
Rowatinex combination of
terpenes reduces
urinary tract
inflammation,
stimulating renal
blood flow through
the kidneys and
increasing the
output of less
concentrated urine.

Generic 4/6/22 Ketoanalogues, 600mg 1 For prevention and Hypersensitivity Metabolism and - administer
Name: essential tab TID treatment of to the active nutrition with food to
Ketoanalogue amino acids damages due to substances or to disorders: Very prevent GI
faulty or deficient any of the rare: upset
Brand Name: protein metabolism excipients. hypercalcaemia. - instruct
Aminolog in chronic kidney Hypercalcaemia. If patient to
disease in Disturbed amino hypercalcaemia report
connection with a acid metabolism. occurs, the immediately if
limited dietary intake of symptoms of
protein intake of 40 vitamin D hypercalcemia
g/day or less should be occurs like
(adult).  reduced. In case muscle
of persisting weakness,
AMINOLOG allows hypercalcaemia, constipation
the intake of the dose of the - monitor signs
essential amino product as well of
acids while as the intake of hypercalcemia
minimizing the any other and electrolyte
amino-nitrogen calcium sources levels
intake. Following has to be
ingestion, the reduced.
ketoanalogues are
transaminated by
taking nitrogen from
non-essential amino
acids, thereby
decreasing the
formation of urea by
re-using the amino
group. The levels of
accumulating uremic
toxins are
decreased. Keto-
and/or hydroxy-
acids do not elicit
hyperfiltration of
residual nephrons.
Ketoacid-containing
supplements have a
positive influence on
the renal
 hyperphosphatemia
and secondary
hyperparathyroidis
m and can improve
renal
osteodystrophy.
The use of
AMINOLOG in
association with a
very low protein diet
allows a reduced
intake of nitrogen
while avoiding the
deleterious
consequences of
inadequate dietary
protein intake and
malnourishment.

Contraindicated
Generic 4/6/22 Iron 1 tab BID Ferrous sulfate is with allergy to any CNS: CNS - warn patient
Name: Preparation given to the patient ingredient; toxicity, that stool may
Ferrous for the prevention sulphite allergy; acidosis, coma be dark or
sulfate and treatment of hemochromatosis, and death with green
irondeficiency hemosiderosis, overdose
Brand Name: anemia brought haemolytic - arrange for
Hemarate FA about by the illness anemias GI: GI upset, periodic
anorexia, monitoring of
Elevates the serum nausea, Hct and Hgb
iron concentration, vomiting, levels
and is then constipation,
converted to diarrhea, dark
Hgb or trapped in stools,
the temporary
reticuloendothelial staining of
cells for storage and teeth (liquid
eventual conversion preparations)
to
a usable form of iron
 NURSING CARE PLAN 1

CUES NURSING OBJECTIVES NURSING RATIONALE EVALUATION

DIAGNOSIS INTERVENTIONS
Subjective: Risk for impaired Short Term Goal: Assessment: Short Term Goal:
“sakit man gamay physical mobility
akong kilid mam di related to pain as Within 4 hours of Determine and note Aids to evaluate site After 4 hours of nursing
ko kayu maka manifested by nursing location, duration, of obstruction and interventions the patient
tarong og tulog,” as discomfort interventions the intensity (0–10 progress of calculi was able to report pain is
verbalized by the patient will be able scale), and radiation. movement. Flank relieved with spasms
patient. to be relieved from Document pain suggests that controlled.
pain. nonverbal signs such stones are in the GOAL MET.
Objective: as elevated BP and kidney area, upper
- pain score of 7 out Long Term Goal: pulse, restlessness, ureter. Flank pain Long Term Goal:
of 10 moaning, thrashing radiates to back,
- positioning to Within 3 days of about. abdomen, groin, After 3 days of nursing
ease pain noted nursing genitalia because of interventions the patient
- sleepiness noted interventions the proximity of nerve was able to participate in
- signs of irritability patient will be able plexus and blood ADLs
noted to improve physical vessels supplying and desired activities
mobility with other areas. with improved
reduced level of Sudden, severe pain independence and
pain and may precipitate increased function of
discomfort. apprehension, lower extremities.
restlessness, severe GOAL MET…………………………
anxiety. …..K.Josol,FSUU/SN(4/6/22)

Determine degree of To assess functional

Immobility Ability

Justify and clarify Provides

cause of pain and opportunity for
the need of timely
notifying caregivers administration of
of changes in pain analgesia (helpful in
occurrence and enhancing patient’s
characteristics. coping ability and
may reduce anxiety)
and alerts caregivers
to possibility of
passing of stone and
developing
complications.
Sudden cessation of
Independent: pain usually
indicates stone
Implement comfort passage.
measures (back rub,
restful Promotes
environment). relaxation, reduces
muscle tension, and
enhances coping.
Encourage use of
focused breathing, Redirects attention
guided imagery, and helps in muscle
diversional activities. relaxation.

Assist with frequent

ambulation as Renal colic can be
indicated and worse in the supine
increased fluid position. Vigorous
intake of at least 3– hydration promotes
4 L a day within passing of stone,
cardiac tolerance. prevents urinary
stasis, and aids in
prevention of
further stone
Provide for safety formation.
measures by
 indicating situations To ensure safety
that will prevent and
from injury provide comfort

Apply warm
compresses

Relieves muscle
Check and sustain tension and may
patency of catheters reduce reflex
when used. spasms.

Prevents urinary
Collaborative: stasis or retention,
reduces risk of
Administer and increased renal
advise patient pressure and
medication infection.

To facilitate
restoration of health

NURSING CARE PLAN 2

CUES NURSING OBJECTIVES NURSING RATIONALE EVALUATION
DIAGNOSIS INTERVENTIONS
Subjective: Impaired Urinary Short Term Goal: Assessment: Short Term Goal:
“ginagmay ra akong Elimination related
ihi,” as verbalized to renal or ureteral Within 4 hours of Record I&O and Provides After 4 hours of nursing
by the patient. irritation as nursing characteristics of information about interventions the patient
evidenced by interventions the urine. kidney function and was able to consume at
Objective: oliguria patient will be able presence of least 4-6 glasses of water.
- oliguria to increase fluid complications GOAL MET.
- 1-3 glasses of intake. (infection and
water consumed hemorrhage). Long Term Goal:
noted Long Term Goal: Bleeding may
indicate increased After 3 days of nursing
Within 3 days of obstruction or interventions the patient
nursing irritation of ureter. was able to report back of
interventions the ususal pattern of voiding
patient will be able Determine patient’s Calculi may cause and was able to have more
to void in normal normal voiding nerve excitability, urine than the previous
amounts and usual pattern and note which causes amounts.
pattern. variations. sensations of urgent GOAL MET…………………………
need to void. …..K.Josol,FSUU/SN(4/6/22)
Usually frequency
and urgency
increase as calculus
nears ureterovesical
Independent: junction.

Encourage the To facilitate

patient to walk if spontaneous
possible. passage.

Promote sufficient Increased hydration

intake of fluids. flushes bacteria,
blood, and debris
 and may facilitate
stone passage.

Offer fruit To help acidify

juices ,particularly urine.
cranberry juice.

Observe for changes Accumulation of

in mental status, uremic wastes and
behavior, or level of electrolyte
consciousness. imbalances can be
toxic to the CNS.

Maintain patency of May be required to

indwelling catheters facilitate urine flow
(urethral, urethral, and prevent
or nephrostomy) retention and
when used. corresponding
complications.

Check laboratory Elevated BUN, Cr,

studies (electrolytes, and certain
BUN, Cr). electrolytes indicate
presence and
degree of kidney
Collaborative: dysfunction.

Irrigate with acid or Changing urine pH

alkaline solutions as may help dissolve
indicated. stones and prevent
further stone
formation.

Obtain urine for Determines

 culture and presence of UTI,
sensitivities. which may be
causing or
complicating
symptoms

NURSING CARE PLAN 3

CUES NURSING OBJECTIVES NURSING RATIONALE EVALUATION
DIAGNOSIS INTERVENTIONS
Subjective: Self-care deficit Short Term Goal: Assessment: Short Term Goal:
“lisud ilihok man related to decrease
gud,” as verbalized strength and Within 4 hours of Assess capability to To identify the After 4 hours of nursing
by the patient. endurance nursing do activities patient’s status interventions the patient
secondary to interventions the was able to ask for help
Objective: disease condition patient, with the Discuss the To educate the with his SO. “Nagpatabang
- With assistance in help of the SO, will importance of patient about the ko og ilis kay wa nakoy
doing activities be able to initiate hygiene importance of ilisay,” as verbalized by the
- dry skin noted hygiene for the hygiene patient.
- untrimmed nails patient to feel fresh Independent: GOAL MET.
noted and comfortable.
- the same clothes Instruct SO to clean For proper personal Long Term Goal:
from the other day Long Term Goal: and cut long hygiene
noted fingernails After 3 days of nursing
Within 3 days of interventions the patient
nursing Instruct SO to do For proper personal was able to maintain
interventions the sponge bath hygiene proper hygiene.
patient will be able GOAL MET…………………………
to enhance proper Encourage to do oral For proper personal …..K.Josol,FSUU/SN(4/6/22)
hygiene hygiene hygiene
maintenance.
Encourage SO to be For the SO will be
involve in giving able to apply the
patient proper procedures at home
hygiene

Instruct SO to To make the patient

provide non- feel comfortable
constricting clothes
Obtain urine for
culture and
sensitivities.
 Discharge Plan

Medications: Rowatinex 500mg 1 tab TID; KAA (Aminolog) 600mg 1 tab TID; Ferrous FA (Hemarate FA) 1
tab BID
- explained that Rowatinex helps in reducing urinary tract inflammation and and
relaxes urinary tract spasm.
- explained that Aminolog is a prevention and treatment of damages due to
faulty or deficient protein metabolism.
- explained Ferrous FA is a supplemental to diet to ensure iron levels stay within
normal range
- explained that iron may bring out black, tarry stools and constipation as a side
effect; instructed not to take iron with milk as it decreases absorption.

Environment: Instructed client to ensure adequate rest periods; to avoid heavy and/or strenuous
activities; to gradually resume activities of daily living at home.

Treatment: Instructed to return 1 week after discharge for follow-up check-up at OPD.

Health Teachings:
- Instructed to follow prescription strictly and to take medications on time.
- Emphasized the importance of a healthy, balanced-diet to ensure faster recovery.
- Encouraged patient to voice out concerns to S/O; emphasized the importance of
providing support and facilitating a therapeutic environment and a therapeutic
approach to discussing health concerns.

Observable Signs and Symptoms: Instructed to observe signs and symptoms of hypertension,
dehydration, difficulty of breathing and seek for medical assistance if persist.

Diet: Encouraged to avoid fatty and salty foods and hav foods risch in fiber such as fresh fruits, broccoli,
potatoes, and oats. Encouraged to eat foods rich in iron such as dark green-leafy vegetables.

Spirituality: Encouraged to continuously pray and seek support from family and friends.