NEPHROLITHIASIS

Republic of the Philippines Tarlac State University COLLEGE OF NURSING Lucinda Campus Brgy.Ungot, Tarlac City Philippines 2300 Nephrolithiasis Presented by: Agcaoili, Claire P. Baluyut, Donna C. Bautista, Karen L. Brojan, May Daisyree C. Bugayong, Emmanuel Dominic Raymond M. Caampued, John Matley M. Calendas, Arcelene Joy E. Capiendo, Mc Jim Emmanuel I. Cas Alyssa Daphne L. Catap, Stephanie Jill L. BSN 3A-A1 Presented to: Jonathan Cura, R.N.,C.R.N. Instructor August 13, 2010 TABLE OF CONTENTS I. II. Introduction …………………………………………………………….. Objectives ………………………………………………………………. Nursing Process ………………………………………………………… A. Assessment ………………………………………………………….. 1. Personal Data ……………………………………………………. a. Demographic Data …………………………………………… b. Environmental Status ………………………………………... c. Lifestyle ……………………………………………………….. 2. Family History of Health and Illness ………………………….. 3. History of Past Illness ………………………………………….. 4. History of Present Illness ………………………………………. 5. 13 Areas of Assessment ……………………….……………….. 6. Diagnostic and Laboratory Procedures ……………………….. 7. Anatomy and Physiology ……………………………………….. 8. Pathophysiology ………………………………………………….. a. Book Based ……………………………………………………. b. Client Based …………………………………………………... B. Planning ……………………………………………………………... Nursing Care Plans ……………………………………………... C. Implementation IV Fluids............................................................................................ Drug Studies………………………………………………………. Diet.................................................................................................... III. IV. SOAPIE............................................................................................ Conclusion ……………………………………………………………… Recommendations ……………………………………………………….. 49 51 3 5 7 7 7 7 7 8 9 10 10 11 29 33 37 37 38 39 39 45 45 INTRODUCTION Nephrolithiasis refers to the condition of having kidney stones. The stones are solid concretions or calculi (crystal aggregation) form in the kidneys from dissolved urinary minerals. The stones are solid and are common in premature infants. (www.wikipedia.com) About 5% of women and 10% of men will have at least one episode by age 70. Kidney stones affect about 2 out of every 1000 people. Recurrence is common, and the risk of the recurrence is greater if 2 or more episodes of kidney stones occur. (www.wikipedia.com) Some type of stones tends to run in the families. Some types may be associated with other conditions such as bowel disease, iliac bypass for obesity, or renal tubule defects. A personal or family history of stones is associated with increase of stone formation. (www.wikipedia.com) For the Filipinos who are fond of eating salty foods and fatty foods, also cigarette smoker and alcohol drinker were at risk for having this condition. In the United States, 23, 685 of its population have the incidence of Nephrolithiasis. (http://kidney.niddk.nih.gov/kudisease/pubs/kustats/) Nephritis, nephritic syndrome, kidney stone and nephrosis has the number of 11,056 or 3.6% over 100,000 populations in the Philippines. (http://www.doh.gov.ph/kp/statistics/lading motality as of 2008). a. Importance of the case study This study is significant to the nursing education of broadening the knowledge of the students’ skills, knowledge and attitude of the nursing practice. It supplies extensive analysis about the condition selected through research and actual observation as it serves as and guidance in developing learned skills in the assessment and management of Nephrolithiasis. Through this study, the researcher will be able to familiarize the different medical approaches toward ongoing curative phase and the holistic approach in assessing patient’s health will be delivered for proper intervention to be given. For the researcher to have a baseline information about nephrolithiasis, management and clinical interventions. b. Reasons of choosing the case study: The researcher choose this study to learn the detailed process of the disease nephrolithiasis associated with it’s prevention and treatment and somehow, help the client and his family to promote and restore support and wellness by providing proper nursing intervention. And for the researcher to have further understanding on the disease. c. Objectives: c.1 General objective: To have a better understanding of the course of the disease, its causes, signs and symptoms, diagnoses & treatment. c.2 Specific Objectives Nurse-Centered 1. Assess properly to determine the contributing factors regarding to the client’s disease and identify any present abnormalities. a. Personal Data b. Family history of health & illness c. History of past illness d. History of present illness e. 13 areas of assessment 2. Gather the needed data that can help to understand how and why the disease occurs. a. Diagnostic & Laboratory procedures b. Pathophysiology (book-based and client-based) 3. Develop an individualized plan considering client characteristics or the situation and setting specific, measurable, attainable, realistic and time-bound plan that reflects the onset, date of problem identified. a. Planning (NCP) ASSESSMENT 1. 6. Judge the effectiveness of chosen interventions. II. To comply with the health teachings provided during the hospital confinement.a) Demographic data NAME: Mr. V AGE: 66 y/o .4. a. Describe nursing care for the client with Nephrolithiasis 4. Learn the actual cause or formation of the disease process. Client daily program in the hospital 5. Personal Data 1. Discuss the implications for medications commonly prescribed for clients with Nephrolithiasis. Discuss the indications and management of the client with Nephrolithiasis 2. Identify major risk on developing Nephrolithiasis Client-Centered 1. 3. nursing care and the quality of care provider. Use the nursing process to provide holistic care for a client with Nephrolithiasis. NURSING PROCESS A. 5. 1944 NATIONALITY: Filipino USUAL SOURCE OF MEDICAL CARE: Phil Health ADMITTING DIAGNOSIS: Nephrolithiasis CHIEF COMPLAINT: Flank pain DATE & TIME OF ADMISSION: July 27. Their house is in close proximity to the RHU. V lives in unfinished house with an existing one bedroom. The back part of their house is a farm planted with corns and rice grains wherein they would also have the capacity to plant any trees or any other vegetation that they can use for other source of food. Water pump outside their house which is owned by them is usually their source of water.SEX: Male CIVIL STATUS: Married RELIGION: Roman Catholic POSITION IN THE FAMILY: Father ADDRESS: Moncada. The drainage is located at 40 m.b) Environmental Status Mr. 1. Tarlca City DATE OF BIRTH: March 20. 2010 / 08:04:14 PM ADMISSION #: 152879 1. distant from their house.c) Lifestyle . he is also fond of listening to radio when he is at rest. he and his friends were having alcohol drinking session. from two packs to one pack of cigarette per day until the day that he is not drinking alcohol and smoking cigarette anymore. He cannot eat foods without having “sawsawan” such as bagoong. from ten bottles to four bottles of beer and redhorse. He also loves salty and fatty food( example: sinigang na baboy na maraming taba or piritong baboy chicharon). when he got married he gradually lessen his take of alcohol and cigarette. usually consumes two packs per day which is equivalent to forty sticks. His main form of exercise is walking. . When he’s not yet married. redhorse and gin. They often starts at 7pm and ended at 11 pm and goes home to sleep when he’s already drunk and wakes up in the morning at 4 to do some household chores. He consumes approximately 5 bottles of gin or 10 bottles of beer and red horse every time they will have session. alamang and patis. from five bottles to two bottles of gin. doing household chores and planting. But. He is also a cigarette smoker. he often drinks alcoholic beverages such as beer. He stated that 4x a week. washing dishes and clothes.The patient’s main habits at home are doing household chores such as cleaning the surroundings. Family History of Health and Illness Paternal Maternal N/A N/A N/A N/A N/A N/A 66 Nephro A&W 64 A&W 62 A&W 59 A&W 57 A&W 56 A&W 55 A&W 53 A&W Schematic Diagram Legends: .2. -Deceased Male -Living Male -Deceased Female -Living Female N/A.Nephrolithiasis -pertains to patient .Not Applicable Nephro. One week prior to admission. and sweeping the floor. History of past illness The client experienced having chicken pox and sore eyes during his childhood years and verbalized that he was unable to complete his immunization. 4. He claims that whenever he gets sick he used OTC drugs such as paracetamol (biogesic and neozep). animals. History of present illness Mr. . Few hours prior to admission. The pain continued until April and he had ultrasound showing that there is a left renal cyst and medications were given. he can no longer tolerate the pain. V felt the pain at first time on March 2010. He can do planting anymore due to pain but he can still do light activity such as washing dishes. The client doesn’t have allergies to drugs. the pain got worst but he can still tolerate and relieved by rest. the patient was unable to walk and straighten up his body due to pain and already needs assistance. or any other environmental agents. He had just lied on bed and tried to overcome the pain. He stated that he was just planting rice at that time and felt the pain on the lower quadrant on the abdomen radiating to back with a pain scale of four over ten. insects. The pain occurs two times a week.3. On June. He just took a rest and the pain is relieved according to him. You can see on his face the worry he feels. Good communication within the family must be maintained to obtain a healthy relationship with one another. V claimed that after his work he use to have bonding moments with his friends. 13 Areas of Assessment 1. he still doing his best to cooperate during the interview.5. perceived social support is being followed by the family to express the love of the family. NORMS: Family members perform roles. Although. Community Health Nursing in the Philippines) . He works as a farmer at the back of their house. he is ill and experiencing pain. (Nursing Fundamentals by Rick Daniel. V 66 years old married and is the eldest among eight siblings of the family. During the interview the patient always thinks about his health condition and when will be the operation. Social support is a perception tat one has emotional and tangible resources to call on when needed. The patient verbalized that he and his family usually communicate with one another during mealtime. Financial aspect is one of the normal constraints in the family. currently he is residing in Moncada. Tarlac. He used to talk to the other patients inside the ward. Mr. Often times they tend to drink alcoholic beverages and consumed up to two bottles each. Social Status Mr. Every misunderstanding throughout the family is being settled immediately. V has a good and harmonious relationship with the people around him. Speech The patient can speak Filipino and Ilocano. He conversed mostly in Tagalog and was able to express himself well. He listened attentively and was cooperative. He was able to state the right time. right place and date of the interview. He was able to recall his activities since this morning. Mental Status General appearance and Behavior The patient was well-groomed. Intellectual Functioning Mr. 2. Patient manifested facial expression and affect in response to various topics of the conversation. Level of consciousness The patient is responsive during the interaction yet as time goes by he is becoming less attentive and loss his focus on the interview. The researchers did not have a hard time explaining anything to him. His speech was understandable and no speech defect was noted. His memory is good because he did not have difficulty in recalling past events in his life including his check up. .Analysis/interpretation: Mr. V was able to understand the questioned ask to him. He entertained every questions asked and answered willingly. He was unable to maintain eye contact during the interview. Orientation The patient was oriented regarding his condition and his stay in the hospital. Nursing. He expresses his opinions and emotions as the researchers go along the conversation. hearing. and personality functioning. Emotional Status During the interview Mr. taste and touch were included. smell.NORMS: Mental status is the degree of comprehensive shown by a person in intellectual. and Health Professions). . Sensory Perception In the assessment of sensory perception. His wife is with home to address his needs and to provide support.(Mosby’s Pocket Dictionary of Medicine. NORMS: It is normal for an individual to react on the stimuli she perceives and feels. psychological. examination of vision. Estes 2006) Analysis/Interpretation: The patient’s mood was influenced by the present condition and the environment. emotional. V is uncomfortable at times when he was experiencing pain and not able to concentrate. (Health Assessment and Physical Examination. 4. Analysis/interpretation: The patient responded accordingly to the situation and can be considered as mentally healthy. 3. Pupils should constrict briskly to direct and consensual light and to accommodation. extra ocular muscle movements and papillary response are still within normal but the client has a blurred vision. the extra ocular muscle movements are being assessed. inferior. a pen was used for the patient to follow from superior. For the test of papillary constriction a penlight was used.Vision In the examination of the eyes. Both eyes of the patient symmetrically followed the pen is moved to the different locations. Standing two feet between the patients other ear. both eyes of the patients should move smoothly and symmetrically in each of the six fields of gaze. To test this. The patient was not able to repeat the words being used. extra ocular muscle movements of both eyes were examined first. The patient was unable to read newspapers showed to him. the voice-whisper test was used. Hearing For the auditory assessment. Standing two feet in front of the patient. . (Health Assessment and Physical Examination. reading is possible at a distance of 14inches for the assessment of near vision. Normally. left. Estes 2006) Analysis/Interpretation The patient’s. The procedure was then repeated to other ear. the Six Fields of Gaze was used as the assessment method. light was introduced from the front to the lateral side of one and then repeated the same procedure to the eye. NORMS: For the test of the Cardinal Fields of Gaze. Both pupils constricted as light was directed to them. words and phrases were whispered and allowed the patient to repeat the words and phrases that were whispered. and right oblique angles. the superior nasal conchae. (Health Assessment and Physical Examination.NORMS: For the auditory accuracy. Estes 2006). causing nerve impulses to be transmitted to the olfactory cortex located in the base of the fontal lobe. (Health Assessment and Physical Examination. she was instructed to close her eyes and let her smell things like orange fruit and alcohol which is present on their table. the patient should be able to repeat words whispered from a distanced of two feet. Analysis/Interpretation: The patient’s auditory accuracy Smell In assessing the sense of smell of the patient. She was then instructed to recognize and name the different materials. Estes 2006). The chemical component of odors binds with the receptors. NORMS: Olfactory receptor cell are located in the upper parts if the nasal cavity. Analysis/Interpretation: It denotes that the patient’s olfactory function transmits impulses to the frontal lobe properly. The client was able to recognize the scent of the things being asked him to smell. and on parts of the nasal septum and are covered by hair like cilia that project into the cavity. . pressure and temperature. the patient was again instructed to close his eyes and let her taste things like sugar and coffee which are present on their table then enabling him to name them. Analysis/Interpretation: Her taste buds that help transmit taste sensations are functioning well. Estes 2006). These receptors originate in the dermis and terminate as either that are encapsulated and found . He verbalized that the spoon soaked from the hot water was hot and the pinch was painful. and salty and sweet near the tip.Taste For the assessment of the sense of taste. (Health Assessment and Physical Examination. touch. sour along the sides. The patient named all things that he tasted. NORMS: The skin contains receptors for pain. Tactile In the examination of the touch sensation of the patient was again instructed to close his eyes and let him feel things like spoon soaked from hot water and pinched his on the forearm to assess pain sensation. The patient responded to the different sensation and expressed what he felt. NORMS: Four qualities of taste are found in the taste buds distributed over the surface of the tongue: bitter is located at the base. He can also move her shoulder medially (toward the midline of the body). Extension and flexion of his wrist can be done. The patient can also flex and extend her knees and do dorsiflexion (flexing the foot at the ankle so that the toes moves toward the chest) or plantar flexion (moving the foot at the ankle so that the toes move away from the chest) of her ankles and feet. The head and neck turn toward the included direction. The lower limb was not able to bear full body weight during standing and ambulation. . followed by the rest of the body. Assessment for the Range of Motion of the patient was done through instructions assistance which includes the ability of the patient to bend her shoulder farther apart. He was not able to transfer easily from various positions. and less distinct signals such as pressure or poorly localized touch are sent via slower sensory pathways. The patient shows active movement against gravity. (Health Assessment and Physical Examination.predominantly in the fingertips and lips. or titling her foot inward and outward and moving it toward away the midline of the body. He was slouched and weak in appearance. 5. Analysis/Interpretation: The patient’s sensory transmission functions well. He can bend her elbows closer and farther apart or rotate it laterally to face upward and medially to face downward. and laterally (away the midline of the body) as well as rotating her shoulder medially and laterally. Motor Stability The patient is able to ambulate from her bed. Estes 2006). and extending it beyond the neutral position. Sensory signals that help determine precise locations on the skin are transmitted along rapid sensory pathways. The normal ROM for the shoulder is forward flexion. Scale 0 1 2 3 4 No muscular contraction Barely flicker of contraction Active movement with gravity removed Active movement against gravity Active movement against gravity and some resistance 5 Active movement against full resistance with no fatigue Scale for Muscle Strength . Estes 2006). hyperextension. internal and external rotation. pronation. plantar flexion. adduction. inversion. and flexion. abduction. extension in some cases. The normal ROM for the elbows is extensions. rhythmic fashion as the heel strikes the floor body weight is then shifted to the bail of the foot. and flexion The normal ROM for the knees is flexion. and then elevates off the floor before the nest step forward. and adduction. The normal ROM of the wrist is extension.Norms: Range of Motion standards are follows: Walking is limited in one smooth. abduction. (Health Assessment and Physical Examination. supination. The normal ROM for the ankles and feet is dorsiflexion. hyperextension is possible. V was able to ambulate. There are no observed involuntary muscle movements. (Health Assessment by Leasia Monahan. Respiratory Status The following listed below were the recorded respiratory rates as per assessment: Table 1. 2010: 6:00am 8:00am 10:00am 2:00pm Norms: Temperature 36.1 Body Temperature Date July 28.2 degree celcius The temperature per axilla is 35. 7. 8 degree celcius 36.9 degree Celcius 36.0 degree Celcius 36. There is uniformity in temperature of her body upon palpation. Muscle strength is equal bilaterally.Analysis/Interpretation: Mr. V’s body temperature taken per axilla is within normal limits. Normal muscle strength allows for complete voluntary range of joint motion against both gravity and moderate to full resistance. 6.0 degress to 36.2 Respiratory Rate Date July 28.5 degree Celcius 36. 2010: 11-7 shift 7-3shift July 30. 6 degree celcius 36.8 degress Celcius. Body Temperature Table 1. Both lower limbs were able to bear full body weight. 2002) Analysis/Interpretation: Mr. 2010: 11-3 shift Respiratory Rate 23cpm . 2010: 11-3 shift July 29.5 degree Celcius 36. The force of the arterial pulse can be classified as in three point scale: 3+--------------fall. thready 0----------------absent Table 1. He has irregular rhythm. the normal respiratory rate for adult is 12. 8. bounding 2+--------------normal 1+--------------weak.3 Pulse Rate and Blood Pressure Date July 28.20 breaths per minute. 2010: 6:00am Pulse rate 71 bpm 68bpm 87 bpm 81 bpm Blood Pressure 100/70 mmHg 100/80 mmHg 120/80 mmHg 120/80 mmHg . normal respiration are regular and even in rhythm. 2006). Circulatory Status Upon assessment of the blanch test results in prompt returning of pinkish color of the nail beds for two seconds. since. 2010 6:00am 8:00am 10:00am 2:00pm Norms: 21cpm 25cpm 20cpm 25cpm 23cpm 23cpm Based on the Health Assessment and Physical Examination Third Edition (Mary Ellen Zator Estes. 2010: 11-7 shift 7-3shift July 30. depth of inspiration is not exaggerated and effortless with the thorax rises and falls in unison in the respiratory cycle.July 29. The patient’s skin turgor after pinching turns to its normal position. Analysis/Interpretation: It shows that there is slight elevation on the respiration. 2010: 11-7 shift 7-3shift July 30. 2010: 11-3 shift July 29. 16 T/L and Hgb 122 g/L. the client stated that he consumes at an average of 4-6 glasses of water per day.20 to 6. it falls under to the 2+ which is normal. Her Body Mass Index is computed as follows: . distributed at around 3 glasses in the morning.30 T/L*. Mary Ellen Zator Estes. 9. He usually eats vegetables. The normal value of hemoglobin is 120 to 180g/L* and the RBC has the standard value from 4. fish and fatty foods such as chicharon. There is an occurrence of increases in the blood pressure of the patient. Nutritional Status According to Mr. *Normal Values of the laboratory results are based on the normal values used in TPH. V. 4 at noon and 3 glasses at evening before and during hospitalization. 2010 reported RBC as 4. Norms: The normal pulse rate ranges from 60-100 beats per minute and the rhythm is normal due to it is regular with equal bilateral strength upon bounding. The patient verbalized that he cannot eat foods without soy sauce and fish sauce .In terms of fluid intake. Analysis/Interpretation: The pulse from the scale given above. 2006).8:00am 10:00am 2:00pm 101 bpm 90 90 120/80 mmHg 120/80 mmHg 120/70 mmHg Laboratory reports dated July 27. The laboratory findings of hemoglobin and RBC are below normal range. he eats three times a day. The normal blood pressure is within the 120 to 140 systolic pressure and 80-90 diastolic pressure. (Health Assessment and Physical Examination Third Edition. BMI=weight in kg Height (m) ² BMI = 48 kg (1. Normal BMI range: <18..68) ² = 17.obesity (Physical Assessment and Health Examination IV Edition by: Carolyn Javis) Analysis/Interpretation: There are no remarkable deviations in the client’s eating pattern.0 – 29.9 thus making her healthy..5 – 24.5……………………………. depending upon metabolic need and demands. Norms: .. 10...9……………………….healthy 25. Fluid intake is on the average of 8 to 10 glasses per day. and attitude. frequency.overweight 30≥……………………………….02 Norms: Normal eating pattern is at on the minimum of 3 times per day. V was not able to defecate for three days (from July 27.5 to 24.9………………………. 2010). Elimination Pattern Bowel Habits: Mr.July 30. Her BMI is within normal limit as compared to the normal value which is 18. Bladder Habits: He voids 3-4 times a day with dark yellow urine in small amount (500cc for 24 hrs) and with pain during urination.underweight 18. 11. His urine output is not within normal range. State or Physical Rest and Sleep The patient had stated that during his hospitalization. Analysis/Interpretation: Mr. His hours of sleep only range three to four hours a day. He also claims that he does not use condoms or other contraceptives with her wife. and changing social relationship (Pediatric Nursing. he experienced sleep difficulties. 2006). since his reproductive organs are not yet fully develop. 12. There is presence of difficulty in urination. Norms: . Norms: Based on Sigmund Freud’s psychosexual development the genital stage is where sexual desires reemerge due to physiological changes. He claimed that his sleep difficulties were primarily due to the pain on the abdomen and the different interactions to check his medical conditions. Thomson Edition 2003). Mary Ellen Zator Estes. Analysis/Interpretation: The patient’s early engagement to sexual activities is normal. V claims that his first coitus happened when he was 27 years old. V has abnormal bowel elimination for three consecutive days. Reproductive Status Mr. fluctuating hormone levels. He has 9 children.Normal bowel movement is 1 to 3 times a day and voiding at 1200 to 1500ml/day. (Health Assessment and Physical Examination Third Edition. Texture is described as cold clammy and a presence of mild sweating. and dry to touch.10 hours of sleep is needed to have an adequate rest and an environment that is conducive to health is necessary to provide comfort to an individual. Pinched skin to test for skin turgor should return immediately after.Based from Daniels (2004) Fundamentals of Nursing. pitting or edema present when pressed firmly for 5 to 10 seconds over tibia or ankle. round and with a 160 degree nail base. Evidence of Pallor is seen in patients who had abortion due to blood loss. are in pink color. the client’s skin is light brown and there is a presence of palmar pallor. There should also be no swelling. Pain was the primary factor of sleep deprivation during these days. It is also hard. immobile and firm in texture. 13. Norms: The normal generalized color for dark-skinned individuals is light to dark brown to olive with milder colored palms. Sclerae are anicteric. skin is uniform similar as in the body. nail beds and lips. Analysis/Interpretation: The client has an abnormal state of sleep and rest. Texture is described as smooth. Mary Ellen Zator Estes. 2006). . soft. State of Skin Appendages Upon inspection. Nails are intact with no swelling on eponychium and are pale in color. soles. grade 3 pitting edema was found in both hands and feet and skin turgor returns promptly after pinching. Nails are present per distal phalanx. 8. Analysis/Interpretation: Palmar pallor is present due to ineffectrive peripheral tissue perfussion and a grade 3 pitting edema was noted in both hands and feet. and his abdomen show signs of tenderness. In abdominal area. warm. (Health Assessment and Physical Examination Third Edition. 370-0. Red blood cells a.510 L/L 120-180 G/L 140-440 G/L . 1. Hemoglobin 3. Monocytes c.20-6.16 T/L 0. Platelets 8.2% 4.Lymphocytes b.9 G/L 10. hematocrit and RBC indices.0-58.1-10.6.371 L/L 122 G/L 393 G/L 4. White Blood cells a. Diagnostic and Laboratory Procedures Diagnostic/laboratory Date ordered and date procedures result/s Hematology Results 07-27-10 Indication/s or Purpose/s Indicates the total number of blood cells as well as the hemoglobin.30 T/L 0. Hematocrit b.6 G/L 13. Results Normal values ( units used in the hospital) Analysis and interpretation of results All results are within the normal range. Eosinophils 2.5% L 4. 6 cm with two reflective structures within both measuring 0.3 cm without shadows. Analysis and interpretation of results Left renal cyst with reflective structures with no shadowing. Results There is a cyst in the lateral cortex measuring 1. .Diagnostic/laboratory procedures Ultrasound Date ordered and date result/s 04-10-10 Indication/s or Purpose/s To visualize of the upper abdominal area for any stones or calculi formed in the kidney. . regulating acid-base balance. among others. and regulation of blood pressure. andatrial natriuretic peptide. aldosterone. from the blood into the urine. which take place in the nephron. Anatomy and physiology The kidney participates in whole-body homeostasis. allowing for only the generation of approximately 2 liters of urine. extracellular fluid volume. in which molecules are transported in the opposite direction. electrolyteconcentrations. The kidney accomplishes these homeostatic functions both independently and in concert with other organs. these include renin. antidiuretic hormone. . is the process by which cells and large proteins are filtered from the blood to make an ultrafiltrate that will eventually become urine. and secretion. angiotensin II. reabsorption. Various endocrine hormones coordinate these endocrine functions. which takes place at the renal corpuscle. Reabsorption is the transport of molecules from this ultrafiltrate and into the blood. Secretion is the reverse process. Many of the kidney's functions are accomplished by relatively simple mechanisms of filtration. Filtration.7. The kidney generates 180 liters of filtrate a day. particularly those of the endocrine system. while reabsorbing a large percentage. 8. Pathophysiology Book Based . Client Based . > Assist patient in a comfortable position regularly. > Encourage deep breathing exercise. R: to promote comfort. R: to reduce pain and provide comfort. > Provide therapeutic touch such as gentle rubbing of back. with 10 being the highest >Weak in appearance >With muscle guarding behavior on RLQ upon movement that last for 5 secs. of appropriate nursing intervention the patient will be able to verbalize relief of pain from a scale of 6/10 to 4/10. > Provide diversional activities such as talking to relatives. R: to reduce muscle tension. Expected Outcome After 2-4 hours of proper nursing intervention the patient’s pain scale will decrease from p/s of 6/10 to 4/10. Interventions > Apply hot compress at the flank area. R: to divert attention from pain. > Encourage or assist with frequent ambulation as indicated. Planning Within 2-4 hrs. . >Complains of pain upon palpation on RLQ of abdomen >Facial grimace >Prefers to position self in side lying >Irritability and restlessness Diagnosis: Acute pain r/t presence of obstruction of cyst within the Left kidney Scientific Explanation: A cyst obstruct the Unpleasant sensory and emotional experience feeling caused by renal cyst that is obstructed within the urinary system resulting to sudden and severe abdominal or flank pain. R: to facilitate passage of stone to renal system.B. Planning Assessment S>”Masakit kapag umuihi ako” O>Rated pain as 6/10. R: to promote feeling of comfort. . R: to increase hydration to flushed bacteria. R: to maintain acceptable level of pain. Interventions > Monitor intake and output and characteristic of urine R: provide information about the kidney function and presence of complication. mga 2-3 beses lang kada araw” O>150cc urine collected for 8 hours >with a yellow to brownish colored urine > no crystals or blood observed > goes to comfort room twice per shift Diagnosis: Impaired urinary elimination related to decreased renal perfusion secondary to Planning Within 6 hours of appropriate nursing intervention the patient will be able to have a urine output of 30-50 cc per hour or void in normal amounts and usual pattern. > Encourage increase fluid intake. > Investigate reports of bladder fullness or palpate suprapubic distension.> Administer medication as prescribed by the physician. R: the urinary retention may develop causing tissue Expected Outcome After 6 hours of appropriate nursing intervention the patient will be able to have a normal urine output and void in a normal amounts as evidenced by 30-50cc level per hour. Assessment S>”hindi ako gaanong umiihi. Assessment S>”Paano ba nagkakaroon ng bato” O>Asking questions about his health problem >Requested for a list of contraindicated foods >Unfamiliar with the things that contributes to his health problem like eating salty foods Diagnosis: Knowledge deficit r/t lack of information regarding current health condition. R: retrieval of calculi allows identification of type of stones and influences choice of therapy. Interventions >review disease process and future expectations R: provides knowledge base from on which patient can make and formed choices >encourage patient to notice dry mouth and excessive diaphoresis and to increase fluid intake whether or not feeling thirsty R: increased fluid losses/dehydration require additional intake beyond usual daily needs >encourage patient to eat * low purine diet (example: Expected Outcome After 2 hrs. the patient will be able to verbalize understanding of his disease process and potential complications. Scientific Explanation: Planning Within 2 hrs. > Document any stone expelled and send laboratory for analysis. of proper nursing intervention. distension and potentiates risk of infection.nephrolithiasis Scientific Explanation: Obstruction of the urinary stones(calculi) in the urinary tract causes urinary retention. of proper using intervention. further imparting urination. the patient is able to verbalized understanding of his disease process and potential complication . Over distension of the bladder causes poor contractivity of the detrusor muscle. And urinary retention causes overflow voiding or incontinence. green leafy vegetables) R: reduces calcium oxalate stone formation *low oxalate diet (restrict chocolate. caffeine) R: reduce calcium oxalate stone formation >discuss medication regimen R: drugs will be given to acidify or alkalize urine . cheese.Lack of cognitive information or psychomotor skills required for health promotion. lean meat. recovery and maintenance. *low calcium diet (limited milk. legumes) R: decreases oral intake of uric acid precursors that leads to formation of uric acid calculi. of proper nursing intervention. dry stool. the patient will demonstrate behaviors to relieved constipation Diagnosis: Constipation r/t insufficient physical activity Scientific Explanation: Decrease in normal frequency of defecation accompanied by difficult or incomplete passage of stool and passage of excessively hard. pineapple >Encourage client to increase mobility or exercise such as walking >Administer laxative medications (Dulcolax) Expected Outcome After 2-4 hrs. Interventions >Monitor intake and output >Auscultate for bowel sounds >Instruct client to increase fluid intake from 4-6 glasses 68 glasses per day >instruct client to eat foods that are high in fiber such as oranges. the patient will demonstrate behaviors to relieved constipation as evidenced by feeling of relieved and urge to defecate .Assessment S>tatlong araw na akong di nakakapagbawas” O>weak in appearance >restless >irritable >abdominal tenderness >discomfort Planning Within 2-4 hrs of proper nursing intervention. he is unable to excrete all the urine in his bladder. Scientific Explanation: Urine retention occurs because the cl.” O> bladder distension > small frequent voiding > urine output of 150cc within 8 hrs Diagnosis: Chronic urinary retention related to pain felt during urination secondary to obstruction of the urinary tract. the patient will be able to void in sufficient amounts (260 cc in 8 hrs. Planning Within 4-8 hrs of proper nursing interventions the patient will be able to void in sufficient amounts with no palpable bladder distention Interventions >evaluate hydration status >pour warm water over perineum to stimulate reflex arc >encouraged client to report problems immediately >measure amount of voided residual >determine frequency of voiding >encourage patient to use valsalva maneuver if appropriate Expected Outcome After 4-8 hrs.Assessment S > “parang puputok na ang pantog ko. of proper nursing interventions.) with no palpable bladder status .ient experiences pain during urination. > increase respiratory rate 25cpm. Diagnosis: Fluid volume excess r/t to compromise renal function. . Planning Within the 8 hours shift of proper nursing intervention the patient will stabilize fluid volume as evidence by balance intake/ output.Assessment S > “Hinang-hina ako” O> grade 3 pitting edema on of hands and feet > intake of six glasses of water a day > 500cc urine output in 24 hours. > Restrict sodium fluid intake as indicated. R: to reduce pressure tissue pressure. R: to avoid further fluid retention. Expected Outcome After 8 hours shift of proper nursing intervention the patient will stabilize fluid volume as evidence by balance intake/ output. > Review intake of sodium and protein. > Observe skin and mucus membrane. R: to have a measurement of fluid output. > Note pattern and amount of urination. Scientific Explanation: Due to impairment of the renal function fluid retention occur that lead to excessive fluid in the body. R: to assess for decubitus or ulceration. R: to have a baseline data of fluid intake and output. Interventions >Note intake and output. >Assist patient when changing position. R: to know if foods taken aggravate the condition. Their electrolyte content resembles that of the principle ionic constituents of normal plasma. 2010 Replacement & maintenance of fluid and electrolytes. Client shows no adverse reactions D5W July 30. IVF Medical Management/Treatment PLRS Date ordered July 27.C. Medical Management i. 2010 Used to supply water and calories to the body. Hypotonic fluid that provides free water for intravenous KVO. Provides a modest sugar source for cellular Indication/s or Purpose/s For replacement of acute extracellular fluid loses without disturbing normal electrolyte relationships Client’s reaction to treatment Client shows no adverse reactions PNSS July 29. These solutions provide sources of water and electrolytes. Isotonic fluid is used frequently in intravenous drips for patients who can’t take fluids orally and have developed or are in danger of developing dehydration or hypovolemic. 2010 General Description Isotonic fluid. IMPLEMENTATION 1. Client shows no adverse reactions . Assess the client’s history for allergic reaction to medication. Inform the client about the procedure. Inform the client not to elevate his hands to prevent back flow of blood. Perform hand hygiene and wear clean gloves. Assess the condition of the vein and signs of infection. . Check the doctor’s order for the flow rate. Maintain aseptic technique.metabolism NURSING RESPONSIBILITIES Before:     During:  After:    Check the doctor’s order at the client’s chart. Ensure proper identification. ask patient about previous reaction to Cephalosporin or Penicillin. Client’s response to medicine with actual side effect Single No side preoperative doses effects noted may decrease the incidence of post operative infections. Assess patient’s infection before therapy.ii. causing cell death. 2010 Route of administration & Dosage & Frequency of administration 1g IVP q12˚ Mechanism of action GENERIC NAME: Ceftriaxone BRAND NAME: Rocephin CLASSIFICATIONS: > 3rd generation Cephalosphorin > Antibiotic Inhibits synthesis of bacterial cell wall. do sensitivity test Before giving the first dose. Indication. Before giving first dose. Assess CBC and kidney function results . Purpose NURSING RESPONSIBILITIES:      Explain to the patient and family on what is the effect of drug and its action. Drugs Name of Drug Date Ordered/ Date taken or given July 28. Short term management of pain NURSING RESPONSIBILITIES:     Explain to the patient and family on what is the effect of drug and its action. Analgesic Antiinflammatory and analgesic activity.Name of Drug Date Ordered/ Date taken or given July 28. Assess patient’s infection before therapy. Purpose Client’s response to medicine with actual side effect  No adverse reaction noted GENERIC NAME: Ketorolac Tromethamine BRAND NAME: Toradol CLASSIFICATIONS: NSAID. Check for any side effects that may occur. . 2010 Route of administration & Dosage & Frequency of administration 30 mg IVP q6˚ Mechanism of action Indication. Monitor fluid intake and output. inhibits prostaglandin and leukotriene synthesis. Purpose Client’s response to medicine with actual side effect No adverse reaction noted GENERIC NAME: Bisacodyl BRAND NAME: Dulcolax CLASSIFICATIONS: Laxatives July 30. 2010 1 tab OD PO Has a known tendency to cause potassium depletion.Name of Drug Date Ordered/ Date taken or given Route of administration & Dosage & Frequency of administration Mechanism of action Indication. . Short term relief of constipation. Check for any side effects that may occur. NURSING RESPONSIBILITIES:     Explain to the patient and family on what is the effect of drug and its action. Stimulates mucus secretion and synthesis contributes to the laxative action of and the part of the potassium secretion is due to mucus release. Monitor fluid intake and output. Assess patient’s infection before therapy. breads Soft Diet July 29. easily digestible foods. soup recommended for people who have GI disturbances or acute infections and those unable to tolerate a normal diet. Low salt. A normal diet limited to soft . 2010 Nutritionally adequate diet differs from the normal diet in having reduced fiber content soft consistency bland flavor. 2010 Is a diet which is intermediate between the clear liquid and mechanical soft diet in characteristics. vegetables No allergic reaction noted No allergic reaction noted .iii. 2010 July 28. Vegetables fruits. Purpose/s The full liquid diet is often used as a step between a clear liquid diet and a regular diet Specic foods taken Client’s response and/or reaction to the diet No allergic reaction noted Full Diet July 27. Fruits. low fat July 29. Diet Type of Diet Date ordered General description Indication/s. 2010 A diet containing limited amounts of fat and consisting chiefly of easily digestible foods of high carbohydrate content It is commonly Banana. > Provided diversional activities such as talking to relatives.3. > Assisted patient in a comfortable position regularly. > Encouraged or assist with frequent ambulation as indicated. > Provided therapeutic touch such as gentle rubbing of back. E> After 2-4 hours of proper nursing intervention the patient’s pain scale decreased from p/s of 6/10 to 4/10. with 10 being the highest >Weak in appearance >With muscle guarding behavior on RLQ upon movement that last for 5 secs. I> Applied hot compress at the flank area. > Administered medication as prescribed by the physician. . Nursing Management (SOAPIER) S>”Masakit kapag umuihi ako” O>Received patient in bed at supine position >with ongoing PNSS @ R arm regulated at 30 gtts/min >awake. of appropriate nursing intervention the patient will be able to verbalize relief of pain from a scale of 6/10 to 4/10. > Increased fluid intake for atleast 3-4 glasses. > Encouraged deep breathing exercise. conscious and coherent >Rated pain as 6/10. >Complains of pain upon palpation on RLQ of abdomen >Facial grimace >Prefers to position self in side lying >Irritability and restlessness A> Acute pain r/t presence of obstruction or movement of stones within the urinary system secondary to nephrolithiasis P>Within 2-4 hrs. conscious and coherent >150cc urine collected for 8 hours >with a yellow to brownish colored urine > no crystals or blood observed > goes to comfort room twice per shift A>Impaired urinary elimination related to decreased renal perfusion secondary to nephrolithiasis P>Within 6 hours of appropriate nursing intervention the patient will be able to have a urine output of 25-35 cc per hour or void in normal amounts and usual pattern. . E> After 6 hours of appropriate nursing intervention the patient had a normal urine output and void in a normal amounts as evidenced by 25cc level per hour. I> Monitored intake and output and characteristic of urine > Encouraged increase fluid intake. > Investigated reports of bladder fullness or palpate suprapubic distension. mga 2-3 beses lang kada araw” O>Received patient in bed at supine position >with ongoing PNSS @ R arm regulated at 30 gtts/min >awake.S>”hindi ako gaanong umiihi. > Documented any stone expelled and send laboratory for analysis. P>Within 2 hrs. conscious and coherent >Asking questions about his health problem >Requested for a list of contraindicated foods >Unfamiliar with the things that contributes to his health problem like eating salty foods A>Knowledge deficit r/t lack of information regarding current health condition.S>”Paano ba nagkakaroon ng bato” O>Received patient in bed at supine position >with ongoing PNSS @ R arm regulated at 30 gtts/min >awake. caffeine) >discussed medication regimen R>After 2 hrs. cheese. I>reviewed disease process and future expectations >stressed the importance of increased fluid intake(3-4 L/day) >encouraged patient to notice dry mouth and excessive diaphoresis and to increase fluid intake whether or not feeling thirsty >encouraged patient to eat * low purine diet (example: lean meat. legumes) *low calcium diet (limited milk. of proper nursing intervention. green leafy vegetables) *low oxalate diet (restrict chocolate. the patient will be able to verbalize understanding of his disease process and potential complications. of proper using intervention. the patient verbalized understanding of his disease process and potential complication . conscious and coherent >weak in appearance >restless >irritable >abdominal tenderness >discomfort A>Constipation r/t insufficient physical activity P> Within 2-4 hrs of proper nursing intervention. of proper nursing intervention. pineapple >Encouraged client to increase mobility or exercise such as walking >Administered laxative medications (Dulcolax) R> After 2-4 hrs. the patient demonstrated behaviors to relieved constipation as evidenced by feeling of relieved and urge to defecate .S>tatlong araw na akong di nakakapagbawas” O>Received patient in bed at supine position >with ongoing PNSS @ R arm regulated at 30 gtts/min >awake. the patient will demonstrate behaviors to relieved constipation I>Monitored intake and output >Auscultated for bowel sounds >Instructed client to increase fluid intake from 4-6 glasses 6-8 glasses per day >instructed client to eat foods that are high in fiber such as oranges. ” O>Received patient in bed at supine position >with ongoing PNSS @ R arm regulated at 30 gtts/min >awake. P> Within 4-8 hrs of proper nursing interventions the patient will be able to void in sufficient amounts with no palpable bladder distention I>evaluated hydration status >poured warm water over perineum to stimulate reflex arc >encouraged client to report problems immediately >measured amount of voided residual >determined frequency of voiding >encouraged patient to use valsalva maneuver if appropriate R> After 4-8 hrs. of proper nursing interventions.) with no palpable bladder status .S> “parang puputok na ang pantog ko. conscious and coherent > bladder distension > small frequent voiding > urine output of 150cc within 8 hrs A>Chronic urinary retention related to pain felt during urination secondary to obstruction of the urinary tract. the patient voided in sufficient amounts (260 cc in 8 hrs. RECOMMENDATION: After stone passage or successful medical/surgical treatment. the client acquires knowledge about the current condition and carries out actions independently. Imaging with non contrast CT scan or KUB should be carried out every six to twelve months to monitor for recurrence or increased in the size of existing stones. CONCLUSION In doing this study. the group had met all the nursing and client objectives that were formulated. The group was able to practice the skills and observed and applies the theories and concept that were learned during lecture days. In addition to this. With regards to the client centered objectives. The group also became familiarized with various tests and diagnosis of the disease. patient should be evaluated metabolically with serum studies and a 24 hr urine profile to determine whether any metabolic abnormalities exist that predispose to stone formation. IV. Periodic 24 hr urine monitoring should be performed to assess the efficacy of dietary/ lifestyle changes and medication. . dealing with a client with Nephrolithiasis gave opportunity to review the different body systems involved and the possible manifestations that would appear on a client with this kind of disease process.III. As student nurses. Patients can be placed on the appropriate medication or alter their diet/lifestyle if needed. the group was able to apply the proper nursing interventions and assessment.