Question

Genitourinary Disorders

Scenario F.F, a 58-year-old man with type 2 DM (non-insulin-dependent diabetes mellitus), presents at the ED with severe R flank and abdominal pain, and NV. The abdomen is soft and without tendemess. The right flank is extremely tender to touch and palpation. VS are 142/80, 88, 20, 99.0°F; urinalysis shows hematuria; an IV of .9 NS is started and is to infuse at 125 ml/h. An IVP (intravenous pyelogram) confirms the diagnosis of a staghorn-type stone in the R renal pelvis. The R kidney looks enlarged. F.F. states that he did not sleep well last night and has not eaten much today. He is obviously very fatigued. His laboratory results are as follows: Na 144 mmolL, K 4.0 mmol/L, CI 101 mmoVL, CO, 26 mmol/L. BUN 30 mg/dL, creatinine 3.6 mg/dL, glucose 260 mg/dL, uric acid 5.0 mg/dL, Ca 9.0 mo/dL. phos 2.6 mg/dL, total protein 7.8 g/dL, albumin 4.0 g/dL, total bilirubin 0.3 mg/dL, direct bilirubin 0.1 mg/dL, chol 200 mg/dL, alk phos 61 U/L, LDH total 100 U/L, AST (SGOT) 13 U/L, ALT (SGPT) 13 U/L, GGTP 40 U/L, amylase 98 U/L. 1. F.F.'s pain is treated with IV morphine. It is late afternoon before he is admitted to your unit, and he is scheduled for lithotripsy in the morning. What specific priorities do you identify for F.F.? 2. The physician has prescribed gentamicin 80 mg IVPB q8h. You question the physician about giving this large of a dose of gentamicin to F.F. You are met with angry and belittling statements. Articulate why you should question this specific order for F.F.

Answer 1

» 2) The Specific Conditions I will look for are as follows @ Acute Urinary tract Infections ② Proper sedation ② Uncontrolled Breeding Disorders 6. Generd/spind Anesthera Administred ① Pregnancy & Sepsis Potentiel Malignant kidney Inour. I will ask this to physician because he in giving such high dose of gentamicin which can further Leak to – O to tonicity Kidney damage - Nemotonicity Allergic factors Gait Instabilities IT I T

3.) To handle this situation with the physician & Vitals Monitoring 6. Too Look for any bleeday, hemorrhage @ Mashitaring Urinary (foley's Catheters) & Anchaning Nepheostoney tubes properly @ Maintains Irrigation during the precaure.

to 4) horgotten Ranel Stones con lead a) Abscen formation b) Chronic kidney Damage c) Urinary fistula Formation da) Urosepsis 5) Roletion between GFR and Creetwine Equation) (Cockproft IM DRD &bation / LGFR - 140- Age x weight in kg 72x Seun creclining 1-1.154 -0.203 to Afe) crechnine (8804 140-sox- 72 3.6 -0.203 1862 (3.670154 (653) 88-4 - 19nd from / 1.73m2 6.) As the patient was crawling off the end of bed. I will catch hold of Patient and Inject some Painkiller by Intre. Muscular Route. such as Dicloftree - Sodium. Ai this crawling is due to pain. 7. You can get this removed in the government set-up as well but it is very troportant to renove this Stone otherwise it can cause serious damage to you whey parenchymes and can findly lead to Chronic Rowel failure