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Kidney stones are small deposits that build up in the kidneys, made of calcium, phosphate and other components of foods. They are a common cause of blood in urine. Some types of stones tend to run in families. Some types may be associated with other conditions such as bowel disease, ileal bypass for obesity, or renal tubule defects. A personal or family history of stones is associated with increased risk of stone formation. Other risk factors include renal tubular acidosis and resultant nephrocalcinosis. Kidney stone formation may result when the urine becomes overly concentrated with certain substances. These substances in the urine may complex to form small crystals and subsequently stones. Stones may not produce symptoms until they begin to move down the ureter, causing pain. The pain is severe and often starts in the flank region and moves down to the groin. The size of the renal stone will dictate the natural history of this condition. If the stone is less the 5mm in diameter, then it will most likely pass on future urination. If the stone is larger than 5mm, urological procedures may be required to remove the stone. Surgical intervention will be required in any patient whose urinary tract in completely obstructed. This situations represents a surgical emergency. Symptoms of renal stone disease may include:
• • • • • • • • • • • •
Pain: unilateral or bilateral flank or back pain. Is is normally severe and colicky (spasm-like) in nature, radiating to the pelvis, groin and/or genitals. Nausea, Vomiting, Urinary frequency/urgency, Haematuria (blood in the urine), Abdominal pain, Dysuria (painful urination), Nocturia (excessive at night), Urinary hesitancy, Fever, Chills and Abnormal urine color or smell.
A number of blood and urine tests will be required to detect the presence of infection and test the function of the kidneys. Urinary tests may also allow the type of stone to be identified, allowing further guidance of therapy. When urinary stones are suspected, a x-ray of the abdomen is also required to detect the stones or any other problem causing a similar set of symptoms. Kidney stones are painful but usually are excreted without causing permanent damage. They tend to recur, especially if the underlying cause is not found and treated.
II. PATIENT’S PROFILE: Name: Rodel Garcia Age: 25 years old Sex: Male Civil Status: Married Religion: Roman Catholic Address: Ilocos Norte Occupation: Soldier Current Diagnosis: Nephrolithiasis left II. CHIEF COMPLAINTS: The patient complains of pain at right lower quadrant area radiating to flank right. III. HISTORY OF PRESENT ILLNESS: Patient came in with an ultrasound result of nephrolithiasis left hence, admission. IV. PAST MEDICAL HISTORY: At the year of 2004 she underwent TAHBSO because of ovarian cyst at Veterans Hospital. And in 2007 she was hospitalized because of diabetes. Pt. has no allergies with medications prescribed to her. She has no injuries or accidents incurred. Pt. is hypertensive and diabetic. V. SOCIAL AND ENVIRONMENTAL HISTORY: Mrs. R.M 52 years old mother of 6 children admits that at the age of 18 she began to smoke 5 sticks per day then stopped at year 2009 but started to drink occasionally for socialization purposes. She is fond of eating high salt and high sugar foods with a bottle of acidic beverages. Almost everyday, she eats junk foods, softdrinks and loves to eat in fast food restaurants like jollibee, KFC, and Mcdo. The client is a housewife, and is a high school graduate. She is friendly and loves to mingle with others. Due to her kindness, generosity, and friendly 2
attitude, she is loved by many and is always visited by her neighbors, friends, and relatives in their house and they used to have snacks. Their house is sited along the street and was surrounded by mango trees. She loves to eat mango with fish sauce/ “alamang,” then loves to take a sip on it. VI. FAMILY HISTORY: The patient’s father died because of stroke and hypertension. The mother was deceased with a history of diabetes and hypertension. They had nine siblings, two were twins; our patient was the second child. Two of her sisters was also diabetic and most of them were hypertensive. According to her, their relatives from the mother side have the same illness also and some relatives passed away with the same health problem. VII. PHYSICAL EXAMINATION: • GENERAL SURVEY Pt is 5’2” in height and 73kgs in weight, she is overweight. Pt. has a good posture and gait but her movement was quite limited because of discomfort in her inflamed left foot due to accident before admission. She, during our duty, sometimes complains of on and off pain at the RLQ radiating to back rated as 58/10, from a scale of 0-10, 10 being the highest. Appears clean and neat, practices good hygiene. Mrs. R.M is cooperative and coherent. She has an ongoing IVF of D5LRS infusing well at the left hand.
2. HEAD, EYES, EARS, NOSE, THROAT a. HEAD The client’s head is symmetrical and no fracture observed with a smooth short black evenly distributed hair without flakes, lesions, masses, tenderness and head lice noted on scalp. Face is symmetrical, no pain and tenderness on the temporomandibular joint upon palpation. b. EYES Eyes are symmetrical with evenly distributed hair in the eyebrows and eyelashes. Eyelids can close properly and no difficulty. No discharges, lesions, redness, swelling noted on both eyes. Sclera appears white and palpebral conjunctiva appears pink in color. Pupils are black and symmetrical, pupil is dilated and reactive to light at 2-3 mm. The client has no known deficits such as color blindness. She was not able to read 3
magazines or newspaper at a distance of 36 cm without using reading glass. c. EARS Auricles are symmetrical and the same color as facial skin, has a clean external auditory canal without lesions or discomfort noted. She can hear at a distance of about 2 feet by repeating what we said as requested her to do so. And using the watch tick test she was able to hear ticking and hearing is intact. d. NOSE External nose color is same as facial skin, symmetrical nares, moist pink mucosal wall without discharges and lesions noted. Has a patent nasal cavities and no masses noted. Can differentiate odors since when asked to close her eyes and discriminate orange and coffee, she was able to distinguish the odors of the two. e. THROAT The throat was not edematous and no lesions observed. 3. RESPIRATORY SYSTEM Mrs. R.M has clear breath sounds, no adventitious sound heard upon auscultation with a respiratory rate of 20 bpm which is within normal range. She is not suffering from any form of respiratory disress. 4. CARDIOVASCULAR SYSTEM The patient’s blood pressure ranges from 140/60 up to 160/100 mmHg at the left arm while on lying position. Extremities are warm to touch and peripheral pulses are present, regular and palpable but weak at the radial. Apical pulse is 62 bpm which is within normal. 5. GASTROINTESTINAL SYSTEM The abdomen is globular in shape; non distended, soft, no direct and rebound tenderness. Tympanic sound is heard upon percussion over the bladder. 6. GENITO-URINARY SYSTEM The client eliminates at comfort room. His urine output ranges from 100-1000ml, amber in color for 12hrs and has bowel movement one to two times a day. No bladder distention upon assessment at the hypogastric region. 7. MASCULO- SKELETAL SYSTEM
Skin is moist and warm to touch. understands simple to complex instruction.The client is not in complete bed rest without bathroom privileges and needs minimum assistance in moving and performing ADL because of inflamed left foot. cracks. Nails are clean and well trimmed. The client has a short. No lesion. INTEGUMENTARY SYSTEM The client has a pink palpebral conjunctiva. extension. 9. It is evident that intellectual development is appropriate on his age. No dandruff and parasites observed. place and date) was not limited because the client was able to communicate well. 8. Client is able to perform flexion. 5 . able to write and read. smooth well comb black hair. Can communicate well by verbalization. NERVOUS SYSTEM Orientation of three areas (time. abduction and adduction independently. No other deformities observed. signs of inflammation and bruises noted.
It is preferred that the patient stand for this exam. small portion of the GIT.VIII. IMPRESSION Pneumonitis. heart. • Visualized osseous structures are unremarkable. DIAGNOSTIC: DATE March 7. particularly when studying collection of fluid in the lungs. Chest x-ray include views of the lungs. thyroid gland and the bones of the chest area RESULT • Hazy opacities are seen on the right middle lobe • Heart is not enlarged • Pulmonary vascularity is within normal. the frontal view (referred to as posterioranterior or PA) and the lateral (side) view. 2010 DIAGNOSTIC PROCEDURE KUB DESCRIPTION X rays are a form of radiation that can penetrate the body and produce an image on an x-ray film. PURPOSE Used to evaluate organs and structures within the chest for symptoms of diseases. Consist of two views. Another name for x ray is radiograph. right middle lobe 6 .
the risk of cardiovascular mortality also increases. Increased with B12 and Folate deficiency. it indicates an infection or inflammation somewhere in the urinary tract.0 MCH=27. it indicates an infection or inflammation somewhere in the urinary tract.0 MCV= 82.5% 96.0-7. When the number is high.8 fL 31. systemic illness.031.0 Granulocyte s (%)=50. When the number is high. A high count indicates not a specific disease by itself but indicates infection.070.0 7.9 pq IMPRESSION White blood cells help fight infection. too much of mental stress also increases the count of the white blood cells in the body. Also. transport and distribute antibodies to build the body’s immune system.095. once the count of white blood cell is on the higher side.0 RESULT 10.010. 2010 DIAGNOSTIC PROCEDURE CBC DESCRIPTION Is a series of test used to evaluate the composition and concentration of the cellular components of blood. PURPOSE As a preoperative test to ensure both adequate oxygen carrying capacity and hemostasis NORMAL WBC= 5.DATE March 11. allergy and leukemia.2x10^9/L Granulocyte s= 2. It also help produce. inflammation.2x10^9/L 70. decreased with iron deficiency and thalassemia Mirrors MCV results 8 .
A widened complex indicates ventricular enlargement QT=. 2010 DIAGNOSTIC PROCEDURE ECG DESCRIPTION A test that checks for problems with the electrical activity of your heart. usually a laboratory will offer one test or the other. When a patient has significantly elevated troponin concentrations...34 • DATE March 13. and to distinguish chest pain that may be due to other causes.06 The heart's electrical activity. PURPOSE An electrocardiogram is done to know if: • • • RESULT PR= . 2010 DIAGNOSTIC PROCEDURE Troponin I DESCRIPTION Troponin tests are primarily ordered for people who have chest pain to see if they have had a heart attack or other damage to their heart.DATE March 13. RESULT negative IMPRESSION Normally. then it is likely that the patient has had a heart attack or some other form of damage to the heart 9 . The cause of unexplained chest pain The cause of symptoms of heart disease How well medicines are working and whether they are causing side effects PURPOSE The troponin test is used to help diagnose a heart attack.12-0.18 QRS=. Even slight elevations may indicate some degree of damage to the heart. cardiac troponin levels are so low that they cannot be measured. INTERPRETATION Normal ( 0.20 sec) Duration should not exceed 0. Either a troponin I or a troponin T test can be performed.10 second. to detect and evaluate mild to severe heart injury.
They can be seen with conditions that result in decreased muscle mass. measures how effectively your kidneys are filtering small molecules NORMAL Normal: 44.DATE March 22.2150.28 umol/L IMPRESSION Increased creatinine levels in the blood suggest diseases or conditions that affect kidney function.4 umol/L kidney function. but they are also not usually a cause for concern. IMPRESSION DATE DIAGNOSTIC PROCEDURE DESCRIPTION PURPOSE RESULT 10 . These can include: Low blood levels of creatinine are not common. 2010 DIAGNOSTIC PROCEDURE Creatinine DESCRIPTION PURPOSE RESULT Test is used to assess This test 88.
Multiple hyperechoic foci are seen at the right interpolar area with the largest measuring 2. ultrasound suspected Urinary Bladder scan of the problems in the abdomen and urinary system.60x5. and green. brown. Both cortical thickness are within normal. pH level indicates the amount of acid in urine. • The right cental renal echocomplex is slightly separated. it may indicate a kidney disorder.63x4.003 to 1.030 normally the amount of sugar (glucose) in urine is too low to be 11 .88cm Cortical thickness: 1. Abnormal pH levels may indicate a kidney or urinary tract disorder.07 cm Cortical thickness: 2. cellular fragments. or diseases. • Right kidney sonographically normal left kidney and urinary bladder. cells. and bacteria in urine. These pigments may result from medications. • Multiple nephrolithiasis with mild hydronephrosis. Perinephric regions are unremarkable. DATE April 3. red. including urinary tract infection. PURPOSE They detect the byproducts of normal and abnormal metabolism. kidney disorders and diabetes. 2010 DIAGNOSTIC PROCEDURE Urinalysis DESCRIPTION Urinalysis is a test that evaluates a sample of your urine.0 1. Urinalysis is used to detect and assess a wide range of disorders. Abnormal colors include bright yellow. 2010 Ultrasound of A kind of Identify Kidneys.3cm. pelvis such as a kidney stone or blockage in the intestine • Right kidney: 10.18 • Left kidney: 9.37 • Both kidneys are normal in size with smooth borders and homogenous parenchymal echopattern. dietary sources.03 Sugar +1 IMPRESSION Normal urine is straw yellow to amber in color.March 23. rather than another underlying medical condition. black (gray). But. Higher than normal concentration often is a result of dehydration. normally 1. RESULT Color Yellow Ph Specific gravity 6. normally 5 to 7 Specific gravity shows how concentrated particles are in your urine.
Abnormal colors include bright yellow. cellular ance turbid fragments. yeast. Turbid (cloudy) urine may be caused turbid by either normal or abnormal processes. Abnormal pH levels may indicate a kidney or urinary tract disorder. including urinary tract infection. and bacteria in urine. and bacteria. These pigments may result from medications. brown. yeast. Urinalysis is used to detect and assess a wide range of disorders. Normal conditions giving rise to turbid urine include precipitation of crystals. Turbid (cloudy) urine may be caused by either normal or abnormal processes. Normal urine is transparent. pH 5. kidney disorders and diabetes. normally 5 12 . Any detection of sugar on this test usually calls for follow-up testing for diabetes. Abnormal causes of turbidity include the presence of blood cells.0 IMPRESSION Normal urine is straw yellow to amber in color. 1-3 Normal (Normal value for pus cells in urine is 0-5/hpf) 4-6 Red blood cells (erythrocytes) may be a sign of kidney disorders. Abnormal causes of turbidity include the presence of blood cells. mucus. and bacteria. PURPOSE RESULT They detect the Color Light byproducts of yellow normal and abnormal metabolism. or vaginal discharge. Normal conditions giving rise to turbid urine include precipitation of crystals. Appear Slightly cells..Appeara nce Pus cells RBC detected. or vaginal discharge. and green. mucus. or diseases. black (gray). such as bladder cancer. red. 2010 DIAGNOSTIC PROCEDURE Urinalysis DESCRIPTION Urinalysis is a test that evaluates a sample of your urine. Slightly Normal urine is transparent. dietary sources. pH level indicates the amount of acid in urine. DATE April 11. blood disorders or another underlying medical condition.
In poorly controlled diabetes. 13 .003 to 1. but is detect liver injury most commonly associated with the liver. its 8. rather than another underlying medical condition. it may indicate a kidney disorder. But. Increase in protein usually aren't a cause for concern. Any detection of sugar on this test usually calls for follow-up testing for diabetes. Larger amounts of protein in the urine may indicate a kidney problem.0% or above. infectious mononucleosis.8%-6. congestive heart failure. liver damage. RESULT 20. blood disorders or another underlying medical condition. or myopathy. such as bladder cancer.030 Normally the amount of sugar (glucose) in urine is too low to be detected.005 gravity Sugar Negativ e to 7 Red blood cells (erythrocytes) may be a sign of kidney disorders. bile duct problems. normally 1.5 u/l NORMAL Normal: 5-35u/l HgbA1c Is a form of hemoglobin used primarily to identify the Monitoring the HbA1c in type-1 7. DATE April 14. Normal (Normal value for pus cells in urine is 0-5/hpf) Specific gravity shows how concentrated particles are in your urine.8% 4.9% IMPRESSION elevated levels of SGPT often suggest the existence of other medical problems such as viral hepatitis. Higher than normal concentration often is a result of dehydration. 2010 DIAGNOSTIC PROCEDURE SGPT DESCRIPTION PURPOSE Is found in serum and in typically used to various bodily tissues.RBC Protein 1-15 Trace Pus 1-2 Specific 1.
average plasma glucose concentration over prolonged periods of time.0% IX. It is formed in a non-enzymatic pathway by hemoglobin's normal exposure to high plasma levels of glucose. diabetic patients may improve treatment and in well controlled patients it's less than 7. DM 2. MEDICAL DIAGNOSIS: Nephrolithiasis right. Obese 14 . HPN.
COMPREHENSIVE PATHOPHYSIOLOGY: 15 .X.
constipation abdominal pain. TREATMENT and MANAGEMENT: A. dyspepsia. dry mouth GU: urinary retention and frequency.XI. ● Monitor respiratory status. menopausal symptoms Skin: pruritus. anxiety. drowsiness.Withhold drug and contact prescriber if respirations become shallow or slower than12 bpm. sweating Other: physical or psychological drug dependence. Recommend abstinence. headache. Report signs to prescriber. flatulence. proteinuria. ● Monitor for physical and psychological drug dependence. drug tolerance NURSING INTERVENTIONS Patient monitoring ● Assess patient’s response to drug 30 minutes after administration.) Drug study TRADE AND GENERIC NAME Trade Name: Zydol Generic name: Tramadol CLASSIFICATION Pharmacologic class: Opioid agonist Therapeutic class: Analgesic MECHANISM OF ACTION Inhibits reuptake of serotonin and norepinephrine in CNS SIDE EFFECTS CNS: dizziness. Patient teaching ● Tell patient drug works best when taken before pain becomes severe. ● Tell patient drug interacts with many common OTC 17 . ● Inform patient (and significant other as appropriate) that drug may cause respiratory depression if used with alcohol. confusion EENT: visual disturbances GI: nausea.
or bleeding. hemolytic anemia Musculoskeletal: arthralgia Skin: urticaria Other: pain at I. causing cell to die. 18 . injection site NURSING INTERVENTIONS Patient monitoring ● Monitor coagulation studies. SIDE EFFECTS CNS: headache. Instruct him to consult prescriber before taking these products. bleeding tendency. Patient teaching ● Instruct patient to report persistent diarrhea. hemiparesis. ● Be aware that crosssensitivity to penicillins and cephalosporins may occur.drugs and herbal remedies. abdominal cramps Hematologic: lymphocytosis. ● Assess CBC and kidney function test results. bruising. confusion. TRADE AND GENERIC NAME Trade Name: Rocephin Generic name: Ceftriaxone CLASSIFICATION Pharmacologic class: Thirdgeneration Cephalosporin Therapeutic class: Anti-infective MECHANISM OF ACTION Interferes with bacterial cell-wall synthesis and division by binding to cell wall.M. CV: hypotension GI: nausea. ● Caution patient not to use herbs unless prescriber approves. eosinophilia.
antipyretic. headache.M. and herbs mentioned above. diarrhea. stomatitis Hematologic: thrombocytopenia Skin: rash. vomiting. injection site for hematoma and bleeding. Patient teaching ● Inform patient that drug is meant only for short-term pain management. also acts as potent inhibitor of platelet aggregation SIDE EFFECTS CNS: drowsiness. diaphoresis Other: excessive thirst. anti-inflammatory MECHANISM OF ACTION Interferes with prostaglandin biosynthesis by inhibiting cyclooxygenase pathway of arachidonic acid metabolism. especially those related to the drugs. epigastric pain. ● Instruct patient to avoid aspirin products and herbs during therapy. ● Monitor fluid intake and output. 19 . tests. dizziness CV: hypertension EENT: tinnitus GI: nausea.TRADE AND GENERIC NAME Trade Name: Toradol Generic name: ketorolac tromethamine CLASSIFICATION Pharmacologic class: Nonsteroidal anti-inflammatory drug (NSAID) Therapeutic class: Analgesic. frequent servings of healthy foods. flatulence. ● Caution female patient not to take drug if she is breastfeeding. dyspepsia. ● Advise patient to minimize GI upset by eating small. constipation. injection site pain NURSING INTERVENTIONS Patient monitoring ● Check I.
● Check for diabetes signs and symptoms and disease progression routinely during therapy. excessive hunger. drowsiness. ● Monitor patient for signs and symptoms of hypersensitivity reactions and immediately stop drug and institute emergency measures if such reactions occur. nausea Respiratory: upper respiratory tract infection Other: hypersensitivity reactions NURSING INTERVENTIONS Patient monitoring ● Monitor blood glucose and hemoglobin levels periodically during therapy. and fast 20 . Patient teaching ● Instruct patient to take drug with or without food.TRADE AND GENERIC NAME Trade Name: Januvia Generic name: sitagliptin phosphate CLASSIFICATION Pharmacologic class: Dipeptidyl peptidase 4 (DPP-4) inhibitor Therapeutic class: Hypoglycemic MECHANISM OF ACTION Inhibits DPP-4 and slows inactivation of incretin hormones. ● Teach patient about signs and symptoms of hypoglycemia (such as blurred vision. sweating. helping to regulate glucose homeostasis through increased insulin release and decreased glucagon levels SIDE EFFECTS CNS: headache EENT: nasopharyngitis GI: abdominal pain.
blood pH. glucose. TRADE AND GENERIC NAME Trade Name: Fortamet Generic name: metformin hydrochloride CLASSIFICATION Pharmacologic class: Biguanide Therapeutic class: Hypoglycemic MECHANISM OF ACTION Increases insulin sensitivity by decreasing glucose production and absorption in liver and intestines and enhancing glucose uptake and utilization SIDE EFFECTS GI: diarrhea. ketone. lactate. nausea. Stop drug if acidosis occurs. Patient teaching ● Teach patient about diabetes and importance of 21 .heart rate). abdominal bloating Metabolic: lactic acidosis Other: unpleasant metallic taste. ● Monitor kidney and liver function tests. and metformin blood levels. ● Watch for signs and symptoms of lactic acidosis. To aid differential diagnosis. ● Teach patient about signs and symptoms of hypersensitivity reactions and to immediately contact prescriber if these occur. decreased vitamin B12 level NURSING INTERVENTIONS Patient monitoring ● Monitor blood glucose level closely. check electrolyte. ● Instruct patient to routinely monitor blood glucose levels at home.
TRADE AND GENERIC NAME Trade Name: Micardis Generic name: Telmisartan CLASSIFICATION Pharmacologic class: Angiotensin II receptor antagonist Therapeutic class: Antihypertensive MECHANISM OF ACTION Inhibits vasoconstricting effects and blocks aldosteroneproducing effects of angiotensin II at various receptor sites. ● Teach patient to measure blood pressure regularly and report significant changes. back and leg pain Other: pain. ● Advise patient to report swelling or chest pain. Patient teaching ● Tell patient to take 1 hour before or 2 hours after meals. exercise. peripheral edema. Advise him to take it with meals to reduce these effects.dyspepsia. and upset stomach. and blood glucose monitoring. fatigue CV: chest pain. flu or flulike symptoms NURSING INTERVENTIONS Patient monitoring ● Watch for signs and symptoms of hypotension. abdominal pain Musculoskeletal: myalgia. 22 . ● Inform patient that drug may cause diarrhea. pharyngitis GI: nausea. nausea. vomiting.proper diet. weight control. including vascular smooth muscle and adrenal glands SIDE EFFECTS CNS: dizziness. hypertension EENT: sinusitis. headache. ● Caution patient not to remove tablet from blister pack until just before taking. and tell him that adverse effects often subside over time.
sweating Other: weight gain NURSING INTERVENTIONS Patient monitoring ● Monitor patient for signs and symptoms of adverse cardiovascular reactions. especially those related to the drugs. review all other significant adverse reactions and interactions. nocturia Metabolic: sodium retention Skin: rash. and foods mentioned above. to avoid dizziness or light-headedness caused by sudden blood pressure decrease. 23 . constipation.● As appropriate. and ultimately reducing blood pressure. TRADE AND GENERIC NAME Trade Name: Catapres Generic name: Clonidine CLASSIFICATION Pharmacologic class: Centrally acting Sympatholytic Therapeutic class: Antihypertensive MECHANISM OF ACTION Stimulates alphaadrenergic receptors in CNS. especially blood pressure and pulse. tests. inhibiting vasoconstriction. decreasing sympathetic outflow. dizziness CV: hypotension palpitations GI: nausea. Also prevents transmission of pain impulses by inhibiting pain pathway signals SIDE EFFECTS CNS: drowsiness. dry mouth GU: urinary retention. Patient teaching ● Instruct patient to move slowly when sitting up or standing. ● Frequently assess vital signs. ● Monitor patient for drug tolerance and efficacy.
in brain. B. IV Fluids COMPONENT N 24 CLASSIFICATIO EFFECTS/ USES SIGNIFICANCE .
COMPONENT PLRS CLASSIFICATION ISOTONIC EFFECTS/ USES o When administered intravenously.PNSS ISOTONIC o Used to replace fluids in dehydration o Used frequently in intravenous drips (IVs) for patients who cannot take fluids orally and have developed or are in danger of developing dehydration or hypovolemia o Used to replace fluids in dehydration. Their electrolyte content resembles that of the principal ionic constituents of normal plasma and the solutions therefore are suitable for parenteral replacement of extracellular losses of fluid and electrolytes. o Restores the blood volume rapidly. o The first fluid used when hypovolemia is severe enough to threaten the adequacy of blood circulation and has long been believed to be the safest fluid to give quickly in large volumes. and burn victims.( same osmolarity as our body fluids o Replacement & maintenance of fluid & electrolytes. SIGNIFICANCE o For replacement of acute extracellular fluid losses without disturbing normal electrolyte relationships. it is isotonic. hyponatremia. NURSING DIAGNOSIS 25 . these solutions provide sources of water and electrolytes. XII. go with blood transfusions.
The stones form in the urine collecting area (the pelvis) of the kidney and may range in size from tiny to staghorn stones the size of the renal pelvis itself. Kidney stones are a common cause of blood in the urine and pain in the abdomen. location. oxalate. intensity. xanthine.ACTUAL PROBLEM 1: Acute pain related to presence of obstruction or movement of stone within the urinary system secondary to nephrolithiasis Assessment S: “nagsakit daytoy ko”(pointing her abdominal and flank area) >rated pain as 8 with 10 being the highest O: >w/ guarding behavior noted >complains of pain upon palpation on the RLQ of abdomen >facial mask of pain observed >prefers to position self in side lying A>Acute pain related to presence of obstruction or movement of stone within the urinary system secondary to nephrolithiasis Explanation of the problem Nephrolithiasis: The process of forming a kidney stone. quality. or groin. and precipitating factors >assessed for referred pain Tx: >applied hot compress to flank area >provided comfort measure like backrub measures. urate. quiet environment and calm activities >ambulated patient as much as possible . cystine. flank. The development of the stones is related to decreased urine volume or increased excretion of stone-forming components such as calcium. The cystine stones (below) compared in size to a quarter were obtained from the kidney Objective STO: After 2 to 4 hours of nursing interventions the patient will verbalize relief of pain from a scale of 8/10 to 3-5/10 Intervention Dx: >observed non verbal cues of pain Rationale >observation may/may not be congruent with verbal reports or may be an indicator of present complaint when client is unable to verbalize >to rule out worsening of underlying condition/development of complication >to help determine possibility of underlying condition or organ dysfunction requiring treatment >to reduce pain and promote comfort >to promote non pharmacological pain management >to facilitate passage of stone through the urinary system >to maintain 26 Evaluation Goal met since After 2-4 hours of nursing interventions the patient was able to report relief of pain from 8/10 to 4/10 >assessed level of pain noting its characteristics. Kidney stones occur in 1 in 20 people at some time in their life. and phosphate. a stone in the kidney (or lower down in the urinary tract).
Nausea and vomiting are common. very severe and colicky (intermittent). acceptable level of pain >promotes relaxation. and enhances coping.asp? articlekey=6806 >administered PRN analgesics as ordered Edx: >encouraged use of relaxation techniques such as focused breathing and guided imagery >encourage/assist with frequent ambulation as indicated and increased fluid intake of at least 3–4 l/day within cardiac tolerance.medterms. The pain with kidney stones is usually of sudden onset. and into the groin. Resources: http://www. sudden cessation of pain usually indicates stone passage. down the flank. prevents urinary stasis. vigorous hydration promotes passing of stone. and aids in prevention of further stone formation >to promote wellness >discussed impact of pain on lifestyle/independence and ways to maximize level of functioning >explained cause of pain and importance of notifying caregivers of changes in pain occurrence/characteristics >provides opportunity for timely administration of analgesia and alerts caregivers to possibility of passing of stone/developing complications. >renal colic can be worse in the supine position.com/scri pt/main/art. radiating from the back. not improved by changes in position. reduces muscle tension. 27 . a procedure for crushing and removing the dense stubborn stones characteristic of cystinuria.of a young woman by percutaneous nephrolithotripsy (PNL).
ACTUAL PROBLEM 3: Impaired urinary ilimination r/t decreased renal perfusion secondary to nephrolithisis 28 .
-investigated reports of bladder fullness.increased hydration flushes bacteria.ASSESSMENT S: “di ako masyadong umiihi. . they causes extreme pain. . bun. further GOAL/OBJECTIVE After 8 hours of nursing intervention the patient will be able to have a urine output of 2530cc/hour or void in normal amounts and usual pattern.urinary retention may develop.retrieval of calculi allows identification of type of stone and influences choice of therapy. bladder distention and urinary incontinence.usually frequency and urgency increase as calculus nears ureterovesical junction. .elevated bun. and potentiates risk of infection. -calculi may cause nerve excitability. collaborative -monitored laboratory studies. causing tissue distension (bladder/kidney). When bladder distention is considerably. and -obtained urine for culture and certain electrolytes sensitivities. e. Obstruction in the urinary tract causes urinary retention (accumulation of urine in the bladder). The bladder may stretch excessively. . cr. Note decreased urine output. ureters. or level of consciousness. behavior. -strained all urine. The stone usually develops in the renal pelvis and pass thru the ureters into the bladder.g. dalawa hanggang tatlong beses lng sa isang araw” O. palpate for suprapubic distension. infection and hemorrhage.determines presence of 29 . electrolytes. RATIONALE EVALUATION Goal met since after 8 hours of nursing intervention the patient was able to have a urine output of 2530cc/hour or void in normal amounts and usual pattern. Document any stones expelled and send to laboratory for analysis. . Over distention of the bladder causes poor contractility of the detrusor muscle.accumulation of uremic wastes and electrolyte imbalances can be toxic to the cns.150 cc urine collected for 8 hours -w/ a yellow to brownish colored urine -no crystals or blood observed -goes to comfort room once or twice per shift Ax: Impaired urinary elimination r/t decreased renal perfusion secondary to nephrolithisis EXPLANATION OF THE PROLEM Excessive amounts of calcium in the urine makes the urine more alkaline and the calcium salts precipitate out as a crystals to form renal calculi (stones ). indicate presence/degree of kidney dysfunction. some involuntary urinary “ dribbling ” may occur. As the stones pass along the long. presence of periorbital/dependent edema. and debris and may facilitate stone passage. cr. -encouraged increased fluid intake. When urine is not being excreted the bladder gradually becomes distended with urine.. e. INTERVENTION independent -monitored i&o and characteristics of urine. which causes sensations of urgent need to void. -observed for changes in mental status. blood.g. and bleeding and can sometimes obstruct the urinary tract.. narrow. -determined patient’s normal voiding pattern and note variations. renal failure . -provides information about kidney function and presence of complications. eventually inhibiting the urge to void.
ACTUAL PROBLEM 3: misconceptions Knowledge deficit related to lack of information to present condition as evidenced by questions and statement of 30 .
-stressed importance of increased fluid intake. alcohol *low-calcium diet.. she has kidney stones in which she didn’t know up until she was diagnosed. The learner may be the patient. Teaching may take place in a hospital. -review dietary regimen. or a caregiver unrelated to the patient. restrict chocolate. and others). decreasing opportunity for urinary stasis and stone formation. e.g. EVALUATION >Goal met since after 2 hours of nursing intervention patient was able to verbalize understanding of her disease process and its potential complications. -encourage patient to notice dry mouth and excessive diuresis/diaphoresis and to increase fluid intake whether or not feeling thirsty. green leafy vegetables. attitudes. Learning may involve any of the three domains: cognitive domain (intellectual activities. ambulatory care. understanding reason for restrictions provides opportunity for patient to make informed choices. *low-oxalate diet. beliefs). caffeinecontaining beverages. -reduces risk of calcium stone formation. problem solving. cheese. In the case of this client. -flushes renal system. and psychomotor domain (physical skills or procedures). e. or health promotion... -increased fluid losses/ dehydration require additional intake beyond usual daily needs. legumes. -reduces calcium oxalate stone formation. as individually appropriate: RATIONALE -provides knowledge base from which patient can make informed choices. maintenance.limited lean meat. e. A> Knowledge deficit related to lack of information to present condition as evidenced by questions *low-purine diet. e. -decreases oral intake of uric acid precursors. 3–4l/day or as much as 6–8 l/day.g. or home setting. limited milk. INTERVENTION independent -reviewed disease process and future expectations. -drugs will be given to 31 . affective domain (feelings. a significant other. -discuss medication -diet depends on the type of stone.ASSESSMENT S>``kasatnu ba agkakaroon ti bato? ´´ O> asks questions about her condition >first time to have this condition in the family >unfamiliar with the things that contributes to her condition like salty foods >requested for a list of contraindicated foods EXPLANATION OF THE PROLEM Knowledge deficit is a lack of cognitive information or psychomotor skills required for health recovery. spinach. increases cooperation with regimen. yogurt. Therefore she doesn’t know much about her condition. whole grains.. OBJECTIVE STO: After 2 hours of nursing intervention patient will verbalize understanding of her disease process and potential complications. a family member.g. and may prevent recurrence.g.
B.Fever usually is the first and only sign of infection >diuretic therapy may result in sudden excessive fluid loss even though edema remains >knowledge of causative factors influences of intervention >to prevent bladder distention and urinary stasis which can contribute to the multiplication of pathogens >reduces risk of ascending urinary tract infection >reduces risk for infection Expected outcome LTO:goal met if after 2-3 days of nursing intervention the patient will take the following measures A.The pressure contribute to the pain and urinary stasis promotes secondary to infection The retained urine distend the renal pelvis. demonstrate understanding to given measures c.150 cc urine collected for 8 hours -w/ a yellow to brownish colored urine -no crystals or blood observed -goes to comfort room once or twice per shift >monitor intake and output >explore causative factors.review laboratory data and non verbal cues Tx>maintain hydration and voiding schedule A>Risk for infection related to stasis of urine secondary to nephrolithiasis >Provide regular urinary catheter and perineal care >maintain sterile technique for all invasive procedure such as IV and urinary 32 .Changes to baseline data may indicate the presence of infection. causing pain as violent contraction of the ureter develops to pass the stone along.pressure increases in the area above the stone.If a stone totally or partially obstructs the passage urine beyond its location.apply given instructions in everyday routine Explanation of the problem Calculi traumatize the walls of the urinary tract and irrigate the cellular lining.Eventually there may be compression of the glomeruli and tiny arterioles that supply to the kidney which result in permanent damage. O.POTENTIAL PROBLEM 1: Assessment Risk for infection related to stasis of urine secondary to nephrolithiasis Objectives LTO: After 2-3 days of nursing intervention the patient will be able to understand and identify interventions to prevent and reduce risk of infection Nursing intervention Dx>Monitor and record vital sign especially the temperature Rationales >establishe a baseline for comparison. But the urethral spasm may just as easily hold a stone in place. follow appropriate given instruction.
5 to 4 liter per day. >encourage verbalization of feelings and any significant change to the condition >emphasize necessity of taking antivirals and antibiotics as directed >to maintain normal hydration and prevent urinary stasis >for immediate access nursing intervention >premature discontinuation of treatment when client begins to feel well may result in return of infection and potentiate drug resistant strains >over the counter medication can contribute to the illness which may result for further complication to the condition >emphasize consulting with the physician before selfadministering any over the counter medication 33 .catheter Edx>encourage to increase intake to at least 3.
POTENTIAL PROBLEM 2: Risk for infection related to stasis of urine secondary to nephrolithiasis 34 .
Objective Intervention independent -monitor i&o. as well as accompanying or precipitating events. -increase fluid intake to 3–4 l/day within cardiac tolerance. -maintains circulating volume (if oral intake is insufficient). -documentation may help rule out other abdominal occurrences as a cause for pain or pinpoint calculi. -administer iv fluids. Rationale -comparing actual and anticipated output may aid in evaluating presence/degree of renal stasis/impairment. dehydration and electrolyte imbalance may occur secondary to excessive fluid loss (vomiting and diarrhea). Evaluation Goal met if after 2-3 days of nursing interventions and after pt’s operation the patient will be able to maintain adequate fluid balance as evidenced by vital signs and weight within patient’s normal range. One of the management for this would be to surgically remove the stones in the kidney. moist mucous membranes. flank. clear liquids. -weigh daily. and mucous membranes. -rapid weight gain may be related to water retention. LTO: After 2-3 days of nursing intervention and after operation the patient will be able to maintain adequate fluid balance as evidenced by vital signs and weight within patient’s normal range. -monitor vital signs. skin turgor. moist mucous membranes. electrolytes. or groin. April 19 -w/ good skin turgor A> risk for deficient fluid volume r/t post obstructive diuresis Explanation of the problem Nephrolithiasis. promoting renal function. 35 . Kidney stones are a common cause of blood in the urine and pain in the abdomen. capillary refill. patient may suddenly lose retained fluids that was obstructed before by the stones. and good skin turgor. bland foods as tolerated. indicators of hydration/circulating volume and need for intervention.Assessment O-150 cc urine collected for 8 hours -w/ a yellow to brownish colored urine -no crystals or blood observed -goes to comfort room once or twice per shift -scheduled operation is on Monday. and good skin turgor. -provide appropriate diet. -maintains fluid balance for homeostasis and “washing” action that may flush the stone(s) out. collaborative -monitor hb/hct. document incidence and note characteristics and frequency of vomiting and diarrhea. evaluate pulses. -assesses hydration and effectiveness of/need for interventions. the process of forming a kidney stone. In that reason. a stone in the kidney (or lower down in the urinary tract). The body may not adopt with it immediately thus causing our patient at risk for fluid volume deficit r/t post obstructive dieresis.
call your doctor o Do not stop or change the dose of any of your medications without first talking with your doctor. and cranberry. DISCHARGE PLAN: CRITERIA a. nuts. soybeans and spinach plus maintenance of an adequate intake of dietary calcium. over-the-counter medications or herbal remedies — without first talking with your doctor. such as orange. Restrict intake of oxalate-rich foods. such as chocolate. Keep a list of your medications with you at all times. and cranberry may help with UTI-caused stones.XIII.MEDICATION • • • If you have questions or concerns. • • • • b. o Do not take any new medications — including vitamins.DIET HEALTH TEACHING • • • Drink adequate amount of water Eat food low in protein. Avoid cola beverages.ACTIVITIES c. Orange juice may help prevent calcium oxalate stone formation. Take some fruit juices. nitrogen and sodium. such as coffee. Avoid large intake doses of vitamin c Increased mobility if possible Take all your medications as prescribed by your doctor. 37 . Limit intake of caffeinated beverages.
http://www1.nlm.) Medical-Surgical nursing by Suzane C O’Connell Smeltzer c. McCance (2nd edition) d.gov/medlineplus/ency/article/000077. et al. Health teachings are very important for the patient and his significant others for them to understand and realize that cooperation is very important in the prevention of disease and improvement of his status. h. the group would like to emphasis to these nurses that proper health teaching to the client with the same situation and those similar needs. CONCLUSION AND RECOMMENDATIONS: The case is focused on the importance of precipitating factors that could lead to complicated diseases. Huether and Kathryn L. they should emphasize on the importance of seeking medical advice when feeling not good. complicated diseases should be minimized or prevented as well. Books a.) Drug hand book by Lippincott f.) Fundamentals of Nursing by Kozier.) Pathophysiology by Catherine Paradiso (2nd edition) b. XV.) Nurse’s Pocket Guide by Doenges (11th edition) e. Furthermore. http://www. With these.) Understanding Pathophysiology by Sue E.nih.us. Websites a.XIV.) Anatomy and Physiology by Seeley.cfm? plan=01 38 . The group recommends that during any health teachings.htm b.com/MERLIN/Gulanick/Constructor/index.elsevierhealth.) Anatomy and Physiology by Tortora g. 2. LIST OF REFERENCES 1.
address. marital status occupation. Family history VII. History of present illness IV. Chief Complaint/s. sex. Comprehensive Pathophysiology and Management XI. Social and environmental history VI. religion II. age.main complaint of the patient why s/he seek consultation and hence. XVI. Past medical history V. admitted.final or principal diagnosis X. XV. Nursing Diagnosis Discharge Plan Conclusions and Recommendations List of References Appendices 39 . General Profile/Information-name. Treatment and Management XII. VIII. Medical diagnosis. APPENDICES A) Interview Guide University of the Cordilleras College of Nursing CASE PRESENTATION FORMAT SY 2009-2010 I. III. XIII.XVI. XIV. Physical examination Diagnostics IX.
Jenny Lou DAGUYEN. Aliseus SAGUN. Jay Noted by: 40 . This was chosen by the group from the East Surgical ward. Cielo Cheen ESPERA. Thank you for your kind consideration. Jeany CANABE. Your approval is highly appreciated.B) Request Letter University of the Cordilleras College of Nursing Dr. 2010 during the 3-11shift. Rowena NASUNGAN. Rasi YOCOGAN. The group agreed that nephrolithiasis would be a good case. ATTING. BGH last April 15-17. Katrina DEGAMO. We the BSN III-6D would like to submit the case of Ms. Erik John GONZALES. Jeri Mae BLANCIA. M with a diagnosis of Nephrolithiasis. When we came across this case. we grabbed it because we found it interesting and that this would be a good study. College of Nursing Ms. Petelyn Pangket Clinical Coordinator Level III Dear Ma’am. Since we had our duty at BGH we knew that we will cater to a limited number of patients and that we had difficulty in looking for a good case. Sincerely yours. Marian Grace Gascon Dean.
Petelyn Pangket Clinical Coordinator Level III 41 . Cindy joy Go Clinical Instructor Ms.Ms.
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