Question

PN 200 Fundamentals of Nursing II Concept Map: Renal Calculi Harold Barker is a 50-year-old, married, college professor who woke up to severe and intensifying pain in his left flank region this morning. He presented to the emergency room in severe acute distress with significant anxiety, pallor and diaphoresis. He could not sit still in the Emergency Room bed but continued to move around, constantly repositioning himself. Groans from pain were constant. He developed nausea from pain and vomited twice. The emergency room 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 patient has no known other allergies. He does 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

Answer 1

Renal calculi

Nursing Diagnosis

Acute pain in (flank region) related to obstruction as evidenced by patient distress,groaning,stone in the CT scan ,abnormal urine report

Intervention

• Assess the level of pain ,baseline to plan for care
• Administer intravenous fluid as per order to flush out the stone from the ureter
• Administer analgesics to relieve pain
• Administer antiemetics to relieve nsuse and vomiting

Positive Outcomes

• The patient will have decreased pain

Negative Outcomes

• The patient may have frequency and urgency to void

Evaluation

• The patient will exhibit no pain

Nursing Diagnosis

Risk for fluid volume deficit related to renal calculi as evidenced by vomiting, diaphoresis

Intervention

• Administer antiemetics and antacids to relieve nause ,vomiting and prevent acid secretion
• Encourage to take small and frequent fluids to prevent fluid loss
• Administer IVF to prevent any major electrolyte imbalance

Positive outcomes

The patient will be able to consume normally without nausea

Negative outcomes

Lack of adequate fluid supplementation can lead to gastrointestinal problems like constipation

Evaluation

The patient will have decreased nausea and no vomiting