Question

Case Study, Chapter 55, Management of Patients With Urinary Disorders

John Lyons has undergone treatment for renal stones three times in the last year. Today he calls this primary health care provider with complaints of acute, excruciating, colicky, pain that radiates down the thigh toward the genitalia. The pain started last night, and has become progressively more severe. He also complains of the urge to void but has little urine output, and it is blood tinged. Due to the pain, he has not taken any fluids or food in 24 hours. Mr. Lyons undergoes lithotripsy, and analysis of stone fragments to reveal calcium stones. (Learning Objective 6)

1. Mr. Lyons’ symptoms are most indicative of stones in what area of the renal system?

Mr. Lyons’ symptoms are most indicative of stones that are in the ureter.

Mr. Lyons has the following orders:

• Morphine sulfate 2 mg IVP every 2 hours as needed for severe pain
• Ibuprofen 600 mg every 6 hours        
• Normal saline at 200 mL/hr
• b. What are the rationales for the above orders?

c. Based on the calcium composition of the stone, what dietary teaching should the nurse include in Mr. Lyons’ plan of care?

Answer 1

b.

• Morphine is a spinal opiate which acts directly on the pain center and can cease the pain immediately by depressing the nociceptive impulses  from the first step in CNS transmission and can give relief to patient suffering from very severe pain
• Ibrufen is a NSAID which inhibit COX2 and decreases the synthesis of prostaglandin involved in causing pain.Giving it every 6 hourly will effectively control pain
• The IV fluid is administered to remove any further blockages in the urinary tract and ensure recovery

c.The diet which is recommended in renal calcium stone are

• Drink plenty of fluids
• Decrease salt intake
• Restrict protein in diet
• Avoid vitamin C food
• Nuts
• Peanuts
• Rhubarb
• Spinach
• Wheat bran
• Avoid oxalate rich food
• Include right amount of calcium in food
• Avoid foods containing sugar ,fructose