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Nursing diagnosis Nursing outcome Verbalizes Acute painrelated reduced pain level to inflammation, obstruction, and abrasion of urinary

y tract by migration of stones Altered urinary elimination

Nursing Interventions

Evaluation

Administer prescribed analgesic Encourage patient to assume position that brings some relief. Reassess pain frequently using pain scale. Administer antiemetic as indicated for nausea Position the patient for comfort

Urinary Assess degree of Verbalize Elimination: interference/disability understanding of Determine clients previous pattern condition. Ability of the of elimination and compare with current Identify urinary system to situation. causative factors. filter wastes, o Frequency, (Refer to specific conserve solutes, o Urgency, NDs for and o Burning, incontinence/reten collect and o Incontinence, tion as discharge urine in a o Nocturia/enuresis, appropriate.) healthy pattern o Size and force of urinary Achieve Urinary stream. normal elimination Continence:Control o Provides information about pattern or of the elimination of degree of interference with elimination or participate in urine may indicate bladder infection measures to Self-Care: Palpate bladder to assess retention. correct/compensat Toileting: Ability to Fullness over bladder following voiding is e for defects. toilet self indicative of inadequate emptying/retention Demonstrat
and requires intervention. Investigate pain which may be indicative of infection: o location, o duration, o intensity; o Presence of bladder spasms, back or flank pain o Determine clients usual daily fluid intake e behaviors/techniqu es to prevent urinary infection. Manage care of urinary catheter, or stoma and appliance following urinary diversion.

Nursing Interventions

The nurse should:

Perform pain assessments to include Visual Analog, numerical, or Wong-Baker scales as appropriate for patient population to assess level of pain and effectiveness of outcome with pain interventions.

Provide pharmacological education. Narcotics are usually used liberally, such as parenteral (IM/IV) narcotics (ketorolac, [Toradol], meperedine [Demerol], morphine, and oral narcotics/analgesic combinations (Department of the Navy Bureau of Medicine and Surgery, 2004). Use of narcotic medication needs to be explained as well as side effects, such as nausea, vomiting, constipation, and caution with driving or operating machinery. Review bowel patterns and suggest interventions to prevent constipation due to pain medication. Assess contributing factors of dehydration such as nausea, vomiting, and diarrhea and administer antiemetics, such as metoclopramine (Reglan), prochlorperazine (Compazine), granisetron (Kytril), or ondansetron (Zofran). Administer antidiarrheal agents such as loperamide (Imodium), diphenoxylate, atropine (Lomotil), or paregoric and assess effectiveness of outcomes. If severe nausea and vomiting occur, patients must be aware that prevention of dehydration and electrolyte imbalance, may require IV hydration, prescription of anti-emetics, and solutions such as such as Gatorade or Pedialyte to replace electrolytes lost via the GI tract. Assess for vital signs checking for orthostatic hypotension (lowering of blood pressure and increase in pulse with positional changes) and monitoring patient weights. Encourage increases in daily fluid intake, especially water, and monitor outcomes of interventions through patient voiding history and 24-hour urine reports. The most important lifestyle change to prevent stones is drinking more fluids, especially water up to 2 quarts/day. Educate the patient on completing a voiding diary to track daily urine output. Educate the patient on the importance of completing laboratory tests ordered, especially 24-hour urines. This can become an imposition on the patient's quality of life, especially if he is active and working. Educate the patient on collecting urine specimens and straining urine. Educate the patient on diagnostic testing, including required dietary or bowel preparation to reduce anxiety. Educate the patient on the importance of weight loss, maintaining weight loss, and daily exercise. Provide counseling on health promotion and maintenance, stressing the importance of followup care to evaluate causes of stone formation in an effort to prevent future recurrences.

Preventative Health Maintenance/Lifestyle Changes

Effective kidney stone prevention depends upon the stone type and identifying risk factors for stone formation. An individualized treatment plan incorporating dietary changes, supplements, and medications can be developed to help prevent the formation of new

stones. If kidney stones develop despite increasing fluid intake and making changes to diet, medications can be prescribed to help dissolve the stones or to prevent formation of new stones. As a health care provider, it is imperative that causes of stone formation be investigated to prevent future occurrences that may lead to permanent kidney damage. Patient education and counseling are vital to effective care, and can be provided by the urologic nurse to promote lifestyle changes in this patient population. Weight management is a critical factor in managing stone formation and prevention of future occurrences as evidenced by a study at Brigham and Women's Hospital, Boston (Guttman, 2005). Researchers evaluated the correlation of obesity and weight gain and the risk of developing kidney stones. The findings indicated obesity was a contributing factor in stone development since, as we age, the majority of weight gain is from fat tissue not bone or muscle. The risk of developing stones increased by 71% to 109% among younger and older women in the highest weight,BMI, and waist circumference and 33% to 48% in men. These findings support the need for health care providers to emphasize the importance of exercise and weight management in a prevention program. Dietary recommendations for stone formers are discussed in detail by Krieg (2005).
Nursing Diagnosis for Nephrolithiasis

1. Acute Pain related to tissue trauma, increased ureteric contraction, edema formation. 2. Impaired Urinary Elimination related to irritation of the kidney / ureter, mechanical obstruction, inflammation, bladder stimulation by a stone. 3. Risk for Deficient Fluid Volume related to neusea, vomiting. 4. Knowledge Deficit related to misinformation.
Expected Results: 1. Comfort the pain resolved. 2. Impaired elimination pattern is resolved. 3. No deficit fluid. 4. The client will open up requests for information. Nursing Intervention for Nephrolithiasis 1. Observe and record the location, duration, intensity of pain distribution. 2. Explain the cause of pain. 3. Make a control gate on the back. 4. Teach relaxation techniques. 5. Give fluid intake 3000 ml - 4000 ml / day. 6. Collaborative provision of medicines. 7. Monitor intake / output. 8. Observe urination. 9. Prepare a laboratory urine. 10. Observation circumstances bladder. 11. Collaboration laboratory examination. 12. Observe and record abnormalities such as vomiting. 13. Monitor vital signs. 14. Give a diet based on the program.

15. 16. 17. 18. 19. 20.

Collaboration giving intravenous fluids. Give an explanation of the disease process. Explain the importance of fluid intake 3000 - 4000 ml / hr. Explain about diabetes management. Discuss with the client / kelguarga about the rule of treatment & types of food. Instruct the client to do activity regularly.