Question

PN 200 Fundamentals of Nursing II Concept Map: Renal Calculi arold Barker is a 50-year-old, married collegeofessor who woke up to severe fine pain in his left flank region this morning. He esented to the emergency room rute distress with significant anxiety, allor and diaphoresis He could not sit still in Bergency Room bed but continued to move around constantly remaining himself. Groans in were constant. He developed nausea from rain and womited twice. The emergency nurse gave him promethazine hydrochloride IV for nausea Since he reported an allergy to meperidine, he was also given morphine IV for pain. Other than a skin allergy with meperidine, the natient has no known other allergies. He not drink or smoke. He gets very little exercise and lately has not been compliant with instructions from his PCP to remain hydrated CT Scan 6-mm radiopaque stone left mid-ureter 1-mm radiopaque stone in inferior calyx of right kidney Urinalysis Microscopic analysis of the specimen revealed significant numbers of red blood cells and white blood cells 1/20

Answer 1

Renal calculi is the formation of stone like structures in the urinary tract/ bladder due to crystallization of minerals present in the urine like calcium and uric acid. It can be in various size and can leads to severe pain, hematuria, nausea, vomitting, dysuria and infection. Some cases can be treaed with medications and rehydration therapy but some needs surgical removal of stones.

Nursing diagnosis 1

Acute pain related to tissue trauma, edema and obstruction due to renal calculi as evidenced by restlessness, diaphoresis and pacing around the room.

Interventions

Assess the  location, duration, radiation to other body parts and intensity of pain by using pain scale.

Provide comfortable measures like warm compression over left flank area, calm and quite environment, positioning etc

Administer pain medications as ordered

Monitor vital signs for signs of severe pain like increased pulse rate and blood pressure.

Encourage to do divertional activities like focused breathing, meditation, listening to music, reading etc.

Encourage oral fluid intake .

Provide emotional support and clarify doubts.

Positive outcomes

Patient will verbalize decrease in pain intensity.

Patient will be able to take rest and become relaxed.

Negative outcome

No reduction in pain intensity

Patient will be restless and irritable and more anxious about his condition.

Evaluation

Patient verbalized decrease in pain intensity and duration.

Demonstrated decreased level of anxiety and restlessness.

Participate in mind deviating activities.

Increase the level of oral fluid intake.

Nursing diagnosis 2

Risk for fluid volume deficit related to renal colic and insufficient fluid intake as evidenced by nausea and vomiting.

Interventions

Assess the level of hydration by checking skin turgor, mucus membrane and palpating peripheral pulses.

Encourage fluid intake and provide Intravenous fluid if ordered and maintain intake output chart.

Assess the frequency of vomiting, amount of vomitus and characteristics.

Monitor vital signs for signs of dehydration like body temperature, blood pressure and peripheral pulse.

Assess the laboratory values for serum electrolyte, renal function test etc to know fluid electrolyte imbalance.

Educate the need of adequate fluid intake to prevent relapse of condition.

Positive outcome

Patient will maintain adequate fluid levels in the body.

Reduce the frequency and duration of nausea and vomiting.

Vitals signs and laboratory values will become normal.

Demonstrate the need of adequate fluid levels and participate in self care.

Negative outcome

Decreased fluid level in he body and rapid low pitch pulse.

Increase in frequency of nausea and vomiting

Demonstrate non compliance with Fluid intake.

Evaluation

Patients achieve and maintain normal body fluid levels.

Verbalize the need of adequate fluid intake.

Reduction in the signs of dehydration demonstrated as normal skin turgor and moist mucus membrane.

Patient will demonstrate adequate fluid intake.