URDANETA CITY

UNIVERSITY
A CASE STUDY
PRESENTED TO THE
TAYUG FAMILY HOSPITAL

NEPHROLIT
HIASIS PRESENTED BY:

ALARCIO, ERIKA
APONIO, BRYAN
BRAGA, CHRISTIAN
BUENCONSEJO, JIRAH
AGSAOAY, GLENDA CAYAGO, SOPHIA
AGUNDAY, AISHA CARBILLON, ANGELENE
ARELLANO, ELIZA DE PERALTA, RECHELE
BERGONIA, MICHAEL DELA CRUZ, LIEZEL
 Patient`s
Name: Patient X44
ProfileReligion: INC
Age: 54 years old Nationality: Filipino
Sex: Female Date of Admission:
Marital Status: Married 02/13/23
 Chief
Complaint
 History of present illness
2012: findings of nephrolithiasis - medication prescribed.
Remained asymptomatic for years.
January 2023: (+) flank pain and frequency of urination.
ASSESSM
ENT:
CT SCAN
RESULT
• Normal sized right kidney with
non-obstructing interpolar
nephrolithiasis
• Partial staghorn calculus, left, with
focal upper pole caliectasis
ASSESSME
NT:
Hematology Result
ASSESSME
NT:
Urinalysis Result
 PATHOPHYSIOLOGY
RISK FACTORS
ETIOLOGY • High mineral content in drinking water
• Supersaturation of urine
• Dehydration
• Imbalance of pH in urine
• Family or personal history
• Gout
• Dietary intake
• Hyperparathyroidism
• Obesity
• Inflammatory Bowel Disease
• UTI

Nucleation

Crystal growth and

aggregation Crystal retention Stone formation
 Nursing Diagnosis
• RISK FOR INFECTION RELATED TO BROKEN SKIN AND TRAUMATIZED
TISSUES AS EVIDENCED BY PRESENCE OF CONTAMINANTS AND
ENVIRONMENTAL EXPOSURE.
• RISK FOR BLEEDING RELATED TO SURGICAL INCISION AS EVIDENCED
BY POST SURGERY PROCEDURE.
• PAIN RELATED TO PRESENCE OF POST-OPERATIVE SURGICAL INCISION
AS EVIDENCED BY VERBAL COMPLAINT OF PAIN THAT RADIATES TO
THE FLANK AREA.
 Nursing Interventions
Nursing Interventions Rationale
Monitor vital signs every 15 mins for 2 hours. To assess and monitor changes in patient’s health status
Assess level of pain using of pain scale. To determine effectiveness of therapy for pain.
Assess incision site. To monitor if there is swelling or signs of infection at the incision
site.
Reposition the patient to moderate high back rest to provide To promote comfort and enhance coping abilities.
comfort.
Provide blanket. To provide comfort and reduce risk of hypothermia.
Encourage patient to have deep breathing exercises. To relieve pain and soothe stress, to facilitate proper breathing,
and to increase oxygen saturation.
Change wound dressing To reduce risk of infection and avoid leaking of blood on the
dressing.
Measure and empty the urine bag To avoid over leaking and avoid fluid overload by emptying the
bladder
Administer prescribed medications such as ketorolac and To relieve pain and avoid infection
ceftriaxone
Regulate IVF accordingly To ensures the correct amount of fluid drips from a bag down
the IV into the vein at the correct rate
Administer oxygen therapy To increase oxygen level and facilitate easier breathing
 Medical Interventions
Medical Management General Description Indications or Purposes
Hematological tests are used to detect and
Hematology is the branch of science that deals
diagnose blood related diseases such as
Hematology with the study of blood and blood forming
hemophilia, anemia, leukemia, sickle-cell
organs.
anemia, lymphomas, and several infections.

kidney stone testing, urinalysis often looks for:

Microscopic traces of blood in the urine
Urinalysis is a test of your urine. It involves 
 Abnormalities in urine’s acidity or pH level
Urinalysis checking the appearance, concentration and
content of urine.  Irregular levels of certain minerals that are
associated with kidney stones
 Signs of a urinary tract infection

A procedure that uses a computer linked to an

It is used to visualize the parts of the body, locate
CT Scan x-ray machine to make a series of detailed
the kidney stone and present it’s characteristics.
pictures of areas inside the body.

Pelviolithotomy is defined as a surgical

incision of the renal pelvis of a kidney for
Surgery
removal of a kidney stone. The procedure is done to surgically remove the
(Pelviolithotomy with
Nephrolithotomy is a procedure used to nephrolithiasis present in the left kidney.
Nephrolitotomy)
remove kidney stones from the body when
they can't pass on their own.
FDAR
CHARTING
F PAIN AT INCISION SITE
(Focus)

D S/P Pelviolithotomy with Nephrolitotomy

(Data) Pain rate of 4/10
Afebrile
(-) DOB
Patient was conscious and coherent

A Patient was repositioned

(Action) Encouraged Deep Breathing Exercises
IVF was regulated to 31 gtts/min
Ketorolac 30 mg via IV was administered

R Patient reports only mild pain at incision site

(Response)
 DRUG
STUDY
DRUG CLASSIFICATION INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES
Generic Name: Nonsteroidal anti- Short term -headache -Monitor BP upon administration. < 90/80
Ketorolac inflammatory agents, management of pain -dizziness never administer. Refer to doctor
Brand Name: Toradol non-opioid analgesics (not to exceed 5 days -drowsiness -Patients who have asthma, aspirin-induced
total for all routes allergy, and nasal polyps are at increased risk
Dosage: 30mg/ml combined) -diarrhea for developing hypersensitivity reactions.
Route: IV -constipation -Assess for rhinitis, asthma, and urticaria.
Frequency: q6h MECHANISM OF CONTRAINDICATIONS
ACTION -sweating -Assess pain (note type, location, and
-pt. with moderate or
-ringing in the ears intensity) prior to and 1-2 hr. following
Inhibits prostaglandin severe renal
administration.
synthesis, producing impairment -pain at injection
peripherally site -Caution patient to avoid concurrent use of
-cross-sensitivity with
mediated analgesia alcohol, aspirin, NSAIDs.
other NSAIDs
  -known alcohol
  intolerance
  -pregnancy, labour,
  .
delivery or lactation
FDAR
CHARTING
F RISK FOR INFECTION
(Focus)

D S/P Pelviolithotomy with Nephrolitotomy

(Data)

A Surgical wound, IV site, and Vital Signs were monitored and assessed for signs
(Action) of infection
Surgical dressing was changed
Ceftriaxone 2 grams via IV was administered
Urine bag was emptied
IVF was regulated to 31 gtts/min

R Patient shows no signs and symptoms of infection.

(Response)
 DRUG
STUDY
DRUG CLASSIFICATION INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

Generic Name: Cephalosporin antibiotics Susceptible bacterial infections • Injection site Assessment & Drug Effects
Ceftriaxone of the lower respiratory tract, reactions (swelling,
• Determine history of hypersensitivity reactions to
skin and skin structure, bone redness, pain, a hard
Brand Name: Rocephin cephalosporins and penicillins and history of other
and joint, acute otitis media, lump, or soreness
allergies, particularly to drugs, before therapy is initiated.
Dosage: 2 grams UTIs, septicemia, pelvic
Eosinophilia
inflammatory disease (PID), • • Lab tests: Perform culture and sensitivity tests before
Route: IV intraabdominal infections, • Increased blood initiation of therapy and periodically during therapy.
meningitis, uncomplicated platelets Dosage may be started pending test results. Periodic
Frequency: OD gonorrhea. Surgical (thrombocytosis) coagulation studies (PT and INR) should be done.
prophylaxis. Diarrhea Inspect injection sites for induration and inflammation.
• •
Rotate sites. Note IV injection sites for signs of phlebitis
• Elevated liver
(redness, swelling, pain).
transaminases
• Monitor for manifestations of hypersensitivity. Report
• Low white blood cell
their appearance promptly and discontinue drug.
count (leukopenia)
MECHANISM OF ACTION CONTRAINDICATIONS • Watch for and report signs: petechiae, ecchymotic areas,
• Rash
epistaxis, or any unexplained bleeding. Ceftriaxone
Ceftriaxone works by inhibiting Hypersensitivity to • Increased blood urea appears to alter vitamin K–producing gut bacteria;
the mucopeptide synthesis in the cephalosporins and related nitrogen (BUN) therefore, hypoprothrombinemic bleeding may occur.
bacterial cell wall. The beta- antibiotics
lactam moiety of ceftriaxone • Pain • Check for fever if diarrhea occurs: Report both promptly.
binds to carboxypeptidases, The incidence of antibiotic-produced
endopeptidases, and pseudomembranous colitis is higher than with most
transpeptidases in the bacterial cephalosporins. Most vulnerable patients: chronically ill
cytoplasmic membrane  or debilitated older adult patients undergoing abdominal
surgery.
 
 
 FDAR
CHARTING
F RISK FOR BLEEDING
(Focus)
D Received client at bed hooked with PNSS 1L x 8hr to consume with SD of Tramadol +
(Data) paracetamol. Conscious and coherent, afebrile, (-) desaturation, U/S done remarks
Enlarged kidney with Nephrolithiasis, Post-surgery Pelviolithotomy (L) + Nephrolithotomy
A Assessed patient health status
(Action) Observed severity of bleeding
Monitored VS especially RR and CR
Encouraged ambulation and DBE
Monitored blood loss by frequency of dressing and changed in volume
Administered Medications as ordered
Monitored any untoward sign and symptoms
Promoted Rest and Comfort
Updated AP

R Client will reduce bleeding and will achieve a therapeutic blood level of anti-coagulant as
(Response) evidenced by progress of healing in the incision site, achieved normal VS.
 DRUG
DRUG CLASSIFICATION INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

Generic Name: STUDY

Tramadol + Paracetamol
Analgesic Management of moderate to •
severe pain.
Body as a Whole:
Asthenia, fatigue, hot
Before Drug Administration:
BASELINE ASSESSMENT: Assess onset, type, location, duration of
flushes.
pain. Assess drug history, esp. carbamazepine, analgesics, CNS
Brand Name: Ultracet • Central and Peripheral depressants, MAOIs. Review past medical history, esp. epilepsy,
Dosage: 37.5 mg/325 mg Nervous System: seizures. Assess renal/hepatic function lab values.
Headache, tremor.
During Drug Administration:
Route: PO • Gastrointestinal System:
PO
Frequency: 1 tab q8hrs Abdominal pain,
PRN constipation, diarrhea, • For oral use. Tablets must be swallowed whole with a sufficient
dyspepsia, flatulence, quantity of liquid. They must not be broken or chewed.
dry mouth, vomiting. • You may take Ultracet with or without food, but take it the
• Psychiatric Disorders: same way each time.
MECHANISM OF ACTION CONTRAINDICATIONS Anorexia, anxiety, After Drug Administration:
confusion, euphoria,
Tramadol is a centrally acting • Hypersensitivity to tramadol, insomnia, nervousness. INTERVENTION/EVALUATION
analgesic compound. At least 2 paracetamol or any other
complementary mechanisms component of Ultracet or • Skin and Appendages: • Monitor pulse, B/P, renal/hepatic function.
appear applicable, binding of opioids. Pruritus, rash, increased • Assist with ambulation if dizziness, vertigo occurs.
parent and M1 metabolite to mu- sweating.
Patients who are receiving • Dry crackers, cola may relieve nausea.
opioid receptors and weak •
monoamine oxidase inhibitors
inhibition of re-uptake of • Palpate bladder for urinary retention.
or within 2 weeks of their
norepinephrine and serotonin. withdrawal, patients with • Monitor daily pattern of bowel activity, stool consistency.
Paracetamol is another centrally
severe hepatic impairment
acting analgesic. The exact site and
and patients with epilepsy not
mechanism of its analgesic action is
well controlled by treatment.
not clearly defined. When
evaluated in a standard animal
model, the combination of
tramadol and paracetamol
exhibited a synergistic effect. 
 
Thank you so much for your interest and