NURS 4434 Houston Baptist Week 4 Childbearing Family Postpartum Careplan Worksheet

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Onfvyr

Health Medical

NURS 4434

Houston Baptist University

NURS

Description

Instructions for the Care plans to be written are found in the respective case studies (Week 4 Case Study and GU Case Study). The answers or responses to the case studies will be filled in the respective Care Plan templates (Postpartum careplan template and Care plan template).

Responses or answers to Week 4 Case Study Should be filled or written in Postpartum Careplan Template AND responses or answers to GU Case Study Week 5 should be filled or written in Care Plan Template.

Every information from external sources should be cited by in-text citation using APA format. Then at the end of the page of responses, references should be done there.

I need this assignment in 48 hours prompt. Contact me in case you need any clarification or information. Thank you

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CLINICAL PERFORMANCEASSESSMENT WORKSHEET Student Name: Rating Scale Date: ________________ Subscales Week ________ Comments Grade 1. ASSESSMENT- Gathered data on the pathophysiology of the illness/disease, medications, culture/spiritual factors, and nutritional status. Incorporated and interpreted new data correctly. Also, gathered information regarding epidemiology & stratification as it applies to client. 2. ANALYSIS/NURSING DIAGNOSIS - Formulated nursing diagnoses for actual & potential health problems relating to health promotion behaviors, growth and development, medications, nutrition, and cultural and spiritual awareness; prioritizes problems according to clients’ needs. 3. PLAN/GOAL - Developed client and family goals that promoted progression toward health. Goals are individualized and SMART (Specific, Measurable, Attainable, Realistic, Time Frame) 4. INTERVENTIONS - Nursing interventions are individualized for the client. Each intervention implements care which reflects planning, organization & flexibility to meet client’s needs that promotes standards of care and practice. 5. RATIONALE - Identified rationale for nursing actions that support the plan of care with current professional literature and research findings. Has significant and complete information regarding health promotion, growth and development, pathophysiology of the illness/disease, medications, nutrition, and treatments; calculates dosage, knows appropriate sites for drug administration, and calculates IV drip rates correctly (if applicable). 6. EVALUATION - Facilitated alteration of care plan to reflect evaluation of client’s progress toward goals; evaluates effectiveness of specific interventions; evaluates ways to maintain standards of care & practice; evaluates criteria that are congruent with clients' health goals. Applies concepts of health promotion & dimensions of health when evaluating care & client outcomes. Reflections of own performance demonstrates self awareness and identifies areas for growth as well as reflects systematic movement to meet course learning objectives . 7. NURSING SKILLS - Performed skills safely & correctly at reasonable speed; adapts to changes from learned sequence; organizes equipment & supplies involved in client care; recognizes obvious breaks in technique. Efficient in use of technology for client care. Demonstrates use of Presence to promote health and healing. 8. COMMUNICATION - Reported & documented medications, procedures, treatments & changes in client’s condition & client responses to care & interventions. Effectively communicated with clients, staff, & faculty. Maintained confidentiality & adherence to information management policies. 9. PROFESSIONALISM - Prepared to give safe care; adhered to policies & reported own errors; assumed responsibility for maintaining safety; took extra precautions to maintain client’s confidentiality; used appropriate channels to promote a high level of care for the client; selected learning experiences which require additional preparation; demonstrated prudent judgment in unfamiliar situations; was punctual; maintained a professional appearance; promoted the client’s welfare & upheld dignity & professional boundaries; reflected consideration of cultural and spiritual differences when interacting with clients & members of the interdisciplinary team. 10. INTERPERSONAL RELATIONSHIPS - Used communication skills in therapeutic relations; adapted communication to client’s developmental level; promoted positive group & learning activities & staff relations; was able to accurately assess own abilities & began to plan for growth in self.. Reflected consideration of cultural and spiritual differences when interacting with clients & members of the interdisciplinary team. KEY: F= Failing (1); MI = Must Improve (2); A=Acceptable (3); C=Commendable (4); and E=Excellent (5) Houston Baptist University NURS 4434 Care of Childbearing Family Postpartum Care Worksheet Student Name Date of Care Pt Initials Rm# Age GTPAL after delivery Allergies Diet Marital Status Current Wt. Birth Wt Gender M/F Delivery Date & Time Vaginal/CS Test and result/date Blood type Rh factor Antibody screen Hgb Hct WBCs Platelets EDC Wks. Gestation Pre-pregnant Wt. Breast/Bottle Baby’s Blood type Test and result/date Rubella HIV RPR/VDRL HbSAg Gonorrhea Chlamydia GBS Interpretation of abnormal lab results: Rhogam Needed? Given? Brief Pregnancy history. Feelings about pregnancy. Family configuration. (prior obstetric history. Brief Labor History (if C-Section, why?). Present Postpartum history, including level of Activity. Vital Signs Date Time Temp Treatment for pain & time: Pulse Respirations BP Pain 0/10 Site Reassessment of pain (Time and Results) Physical Assessment (BUBBLE – HEE) Breasts Nipples (condition, secretion) Abdominal Incision (color, discharge, approximation) Fundus (consistency, height, position) Bowel (sounds, flatus, stool) Hemorrhoids Urinary Elimination Signs of UTI Costovertebral Angle Tenderness Lochia (type, amount) Perineum/Episiotomy (REEDA) Signs of Thrombophlebitis (redness, swelling, warmth, or pain) Edema (site, extent) Emotions (explain evidence of (+) or (-) bonding) Teaching Needs: What is your patient’s culture and what information did you learn about the patient’s culture to assist you in delivering culturally competent care? Infant Intake and Output: Time: Type of Feeding Amount or # of Minutes Voids Stools Newborn Assessment: Male/Female Apgar’s: 1 min _______ 5 min _______ Put an X by the ones that apply ACTIVITY: Quiet Alert/Active Sleeping Lethargic TONE: Normal Jittery Hypo/Hyper Reflexes (+) CRY: Strong Weak High-pitched COLOR: Pink Pale Acrocyanosis Jaundiced Meconium stained Mottled SKIN: Warm Additional Notes when needed: Bruising Cool Petechiae Newborn Rash HEAD: Fontanel Soft/Flat Other Skull molded Caput/Cephalohematoma Forcep marks/Abrasions EYES: Clear Other CHEST: Breath Sounds Clear/Equal Decreased R/L Rales/Rhonchi Grunting Nasal Flaring Retractions Mild/Moderate Heart Sounds Regular/Irregular Murmur (-) absent / (+) present Vital Signs: T______ P______ R______ ABDOMEN Soft Distended Bowel Sounds (-) absent / (+) present GENITOURINARY (Circle the one that applies) Male testes descended/undescended Female normal/discharge Prioritized Problem List/Nursing Diagnoses, R/T and AEB: (two for Mom and one for baby): This section is for any additional evaluation of yourself that you may want to share with the instructor Nursing Skills: Strengths: Opportunities for Improvement: Comments: Initial Assessment Data r/t Priority Nursing Dx: For the MOM Rationale for Nursing Dx #1: 1. 2. Highest Priority Nursing Dx: 3. 4. Plan: Short Term/ Long Term Goal: 5. Interventions: Evaluation: 1. 2. 3. 4. Skills Used for this Nursing Dx: 5. Explore potential Legal/Ethical Issues r/t caring for patient: Safety Concerns when caring for this patient: Rationale for Nursing Dx #1: Initial Assessment Data r/t Priority Nursing Dx: for the BABY 1. 2. 3. Highest Priority Nursing Dx: 4. Plan: Short Term/ Long Term Goal: 5. Interventions: Evaluation: 1. 2. 3. Skills Used for this Nursing Dx: 4. 5. Explore potential Legal/Ethical Issues r/t caring for patient: Safety Concerns when caring for this patient: Houston Baptist University NURS 4434 SCHEDULED MEDICATION WORKSHEET Student __________________________________ Date______________________________ Unit & Room ______________________________ Drug Name Class/Action (Generic & Trade Name) Side Effects Dose/ Route Recmd dose Rationale for your Patient Frequency & Times Military Time You Will Give Lab values/ Nursing implications Week 4 OB Case Study 4/13/2020 Postpartum day 2 Patient states that she has 6/10 pain. M.G’s temperature is 97.8, blood pressure was 119/72, her respiration is 24. Patient’s fasting glucose was 109 mg/dl. Baby Vital signs are heart rate 142, respiration 40, temperature 98.6. 48-hour Bilirubin 13.5 mg/dt. What do you think the pediatrician will order? Mother is trying to breastfeed but after the baby had 2 low blood sugar readings, she was persuaded to give the baby a bottle. Now the blood sugar is normal but the last three feedings were 35 mls, 40 mls, and 50mls. Mother is trying to breastfeed but, the baby does not want to breastfeed any more, because she does not have milk yet. The grandmother likes to feed the baby so the mother can sleep. What can this mother do to get her baby to breastfeed? The grandmother is staying with the mother and three-year-old son because the dad has to go to work. Both mother and baby will have Q8 VS. Complete assessment of mother and baby (cite sources). Care plan for mother and baby. Prioritize Nursing diagnosis (including R/T and AEB) 3 for both mother and baby. Cite where you got this information. HBU Nursing Student Care Plan Student Name: Unit/RN Admitting Diagnosis: Rm# /Admit Date Past medical/surgical history (PMHx): Age/Gender Co-morbidities: Code Status Date: IV Access Medication Times (circle) (PIV, PICC, PORT, IJ, CVAD etc.) L: R: Fluid/Rate: Allergies NKDA □ Diet (NPO, Full, Renal, etc.) Fall Risk 07:00 08:00 09:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00 22:00 23:00 00:00 Drains, Devices, Wounds (Foley, JP, Dressings, Restraints, etc). Pre-shift Report: From the case study given, create what could be received as a Pre-shift report from the previous Nurse and write it here. Isolation Blood Type Vaccines Discharge Plan: Teaching: LABS: Date/Result/Interpretation Indicate if high, low, or within normal limits (WNL) Hgb Hct WBC’s Platelets ABG pH PC02 P02 Sa02 Please attach EKG Strip if applicable PT/PTT INR NA+ K+ LFT’s if relevant BUN Cr HgBA1c Glucose Other relevant labs Ordered Diagnostics/Tests Nursing Assessment Findings/Review of Systems: Chart “by exception.” Neuro/Head/Neck Respiratory (Mucous Membranes, Glasses, Hearing Aids, NVS/ Pupils, Cranial nerves, motor function, Clonus, Seizures, Gait, etc.) (Rate, Rhythm, Pattern, O2 needs, Cough, Trach/Suctioning etc.) Nutrition/Endocrine CV (Diet, % of meals taken, BG/Trends, Tube Feeds, TPN) (Heart Sounds, Pulses, Rhythm, Cap. Refill, Extremities, Pedal Pulses, Weight Attach EKG to back) 1. Priority/Nursing dx. Assessment (as evidenced by) Plan (Goal- short term or GI (Abdomen, Bowel sounds, Bowel Routine, Last BM) GU Integ./MSK/Mobility (Skin, Turgor, Wounds/Incision (s), Hair, Nails, ROM, Safety Concerns e.g. call bell in reach, bed alarm, restraints etc.) Psychosocial (Urinary pattern, Total output, Catheters, Kidney function, Dialysis etc.) (Emotional State, family dynamics, spirituality, pertinent health determinants, Legal/Ethical Issues) Rationale for Goal(s) Intervention (Skills Used/Patient Teaching) Rationale for Goal(s) Intervention (Skills Used/Patient Teaching) Rationale for Goal(s) Intervention (Skills Used/Patient Teaching) long term) Evaluation/Follow Up: 2. Priority/Nursing dx. Assessment (as evidenced by) Plan (Goal- short term or long term) Evaluation/Follow Up: 3. Priority/Nursing dx. Assessment (as evidenced by) Evaluation/Follow Up: Plan (Goal- short term or long term) Pathophysiology Algorithm 1-2 credible (published in the last 5 years and peer reviewed) articles or other credible reference(s) required Etiology that led to the medical diagnosis: Pathophysiology-What is occurring at the cellular/tissue and/or system level? Risk Factors Diagnostic Findings Diagnosis: General Objective/Subjective Clinical Manifestations Relevant DoH (min. 3) and Rationale Complications Gender, health services, environment/working conditions, education and literacy, physical environment, social support networks, personal health practice and coping skills, social environments, healthy child development, biology and genetic endowment, culture, financial and social status General Treatment Treatment for your client Clinical Manifestations of YOUR client (objective/subjective) SCHEDULED MEDICATION WORKSHEET Student Drug Name (Generic & Trade Name) Date Class/Action/ Side Effects Common and SEVERE Dose/ Route/Frequency Is the order within recommended dosing limits? Unit & Room Rationale for your Patient Order frequency & Time(s) you actually gave Lab values/Nursing implications (e.g. if giving K supplement what was the most recent K+ lab? Or if giving insulin what was the blood sugar? If giving cardiac meds what is the apical heart rate/vitals?) Med Surge Week 5 Case Study GU Case Study Mr. Harris is a 65y/o white male (weight 245lbs, height 66inches). He has history of kidney stones (Urolithiasis). He is currently admitted with severe left flank pain, painful urination, hematuria, and nausea for 3 days. On your initial shift assessment, his V/S are as follows: BP 140/90, HR 88 RR 24 T 98.0 Mr. Harris takes Ibupofen (Advil) 800g QID for knee pain and Calcium Carbonate (Tums) very frequently for heartburn. Mr. Harris lives home alone, is a retired truck driver and claims he doesn’t like cooking and he frequently eats fastfood and drinks 4-6 cups of coffee with cream daily. On further assessment Mr. Harris has no health insurance, has not seen a primary care provider since 18 months ago during his last episode of kidney stones. On examining his diagnostic results intravenous pyelography shows a kidney stone on left ureter. His BUN 48mg/dl Creatinine 2.8mg/dl What specific instructions would you give Mr. Harris when he urinates? What specific nursing interventions can help Mr. Harris? What risk factors does Mr. Harris have that leads to the development of kidney stones? What are procedures can be done to remove Mr. Harris kidney stones? What lab results of Mr. Harris should be of greatest concern for the nurse? Formulate a discharge plan for Mr. Harris?
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Explanation & Answer

Here's my final output. Sorry for the delay! Was unsure of some things regarding the baby's condition so had to do a little bit more research. Please let me know if these are okay! 😉 I'd gladly do revision should there be a need. I've attached the outlines as well. 😀

HBU Nursing Student Care Plan

Student Name:

Unit/RN

Admitting Diagnosis:

Rm# /Admit Date 13/4/2020

Past medical/surgical history (PMHx):

Age/Gender 65/M

hx of urolithiasis

Date:

Co-morbidities: obesity, hypertension,
arthritis, heartburn
Code Status

IV Access

Medication Times (circle)

(PIV, PICC, PORT, IJ, CVAD etc.)

L:

07:00

10:00

13:00

16:00

19:00

22:00

R:

08:00

11:00

14:00

17:00

20:00

23:00

09:00

12:00

15:00

18:00

21:00

00:00

Fluid/Rate:
Diet

Allergies

Drains, Devices, Wounds

Renal

NKDA ☑

(Foley, JP, Dressings, Restraints, etc).

Fall Risk

Pre-shift Report: Pt is admitted with severe left flank pain, painful urination, hematuria, and nausea for 3 days.

Isolation
Blood Type
Vaccines
Discharge Plan: fluid/electrolyte balance maintained; complications are prevented or minimized; the disease process and
therapeutic regimen are understood by the patient

Teaching: Nurse teaches pt about different causes of kidney stones and the ways to prevent the recurrence. Encourage the pt to
increase fluid intake in order to have 3,000-4,000mL of urine every 24 hours. Encouraging pt to be more mobile as much as he
can and avoiding excessive intake of vitamins and minerals is important.

LABS: Date/Result/Interpretation Indicate if high, low, or within normal limits (WNL)

Hgb

PT/PTT

Hct

INR

WBC’s

NA+

Platelets

K+
ABG

IVP - urolithiasis on left ureter

LFT’s if relevant

pH

BUN 48 mg/dL

PC02

Cr 2.8 mg/dL

P02

HgBA1c

Sa02

Glucose

Please attach EKG Strip if applicable

Other relevant labs

Ordered Diagnostics/Tests

Nursing Assessment Findings/Review of Systems: Chart “by exception.”

Neuro/Head/Neck

Respiratory

(Mucous Membranes, Glasses, Hearing Aids,

(Rate, Rhythm, Pattern, O2 needs, Cough,
Trach/Suctioning etc.)

GI
(Abdomen, Bowel sounds, Bowel Routine, Last
BM)

NVS/ Pupils, Cranial nerves, motor function,
Clonus, Seizures, Gait, etc.)

With nausea

Nutrition/Endocrine

T = 98.0

CV
(Heart Sounds, Pulses, Rhythm, Cap. Refill,

GU
(Urinary pattern, Total output, Catheters, Kidney
function, Dialysis etc.)

Extremities, Pedal Pulses, Weight Attach EKG to
back)

Frequently eats fast food; drinks 4-6
cups of coffee with cream daily

BP 140/90; HR 88

1. Priority/Nursing dx. Assessment (as
evidenced by)

Acute pain r/t inflammation and
obstruction of the ureter

(Skin, Turgor, Wounds/Incision (s), Hair, Nails,
ROM, Safety Concerns e.g. call bell in reach, bed
alarm, restraints etc.)

RR 24

(Diet, % of meals taken, BG/Trends, Tube Feeds,
TPN)

Integ./MSK/Mobility

Severe left flank pain
and IVP result of a
kidney stone on left
ureter

Plan (Goal- short term or

Psychosocial
(Emotional State, family dynamics, spirituality,
pertinent health determinants, Legal/Ethical
Issues)

Hematuria; with painful urination;
Lives alone; retired truck driver; no
BUN 48 mg/dL; Creatinine 2.8 mg/dL health insurance; hasn’t seen a
primary care provider since last
episode of kidney stones

Rationale for Goal(s)

Intervention (Skills Used/Patient Teaching)

long term)

Relief of pain and
discomfort

This is to show that pain management
Nurse assists pt in ambulating;
methods are effective; also indicates that administration of pain meds as prescribed;
kidney stone isn’t in the ureter anymore close monitoring of pain severity and
prompt reporting (Vera, 2014)

Evaluation/Follow Up: Pt reports relief of pain
2. Priority/Nursing dx. Assessment (as

Plan (Goal- short term or

Rationale for Goal(s)

Intervention (Skills Used/Patient Teaching)

evidenced by)

Impaired urinary elimination r/t
presence of kidney stone on left
ureter

hematuria

long term)

Pt voids in normal amounts This is to show that the kidney stone has
and usual pattern;
passed and isn’t causing any obstruction
experience no signs of
anymore.
obstruction

Promotion of sufficient fluid intake and
ambulation; Recording of I&O plus urine
characteristics; monitoring of laboratory
studies; observe for changes in mental
status (Vera, 2019).

Evaluation/Follow Up: Pt doesn’t develop any complications.
3. Priority/Nursing dx. Assessment (as
evidenced by)

Deficient knowledge regarding
prevention of recurrence of renal
stones

Poor dietary habits (fast
food: high in sodium
and sugar) and daily
intake of coffee with
cream (4-6 cups)

Plan (Goal- short term or

Rationale for Goal(s)

Intervention (Skills Used/Patient Teaching)

long term)

Pt states increased
knowledge of healthseeking behaviors
to prevent recurrence

This is to show that the pt understands the Advise pt to stick with prescribed diet
risk factors that will increase his risk of according to the type of stone he has;
suffering from the same situation in the Instruct pt about signs and symptoms of
future.
complications; Explain the prescribed
medications (action, importance, and side
effects)

Evaluation/Follow Up: Plans are in place to meet after getting discharged; pt verbalizes understanding of the disease process, potential
complications, and his therapeutic needs

Pathophysiology Algorithm
1-2 credible (published in the last 5 years and peer reviewed) articles or other credible reference(s) required
Etiology that led to the medical diagnosis:
Poor food habits and lifestyle; supersaturation of
elements in urine and/or deficit of inhibitors
(Academic Library)

Pathophysiology-What is occurring at the cellular/tissue and/or system level?
The sequence of events in the formation of any urinary calculus includes: urinary saturation, supersaturation, nucleation, crystal growth, aggregation of crystals, crystal retention,
and, finally, calculus formation. Normally, the crystals can easily pass through but when they become large enough, they get stuck and cause a myriad of signs and symptoms. There
are different theories about how stones form: one is when a normally soluble salt supersaturates the urine that it enables crystals to form. When they grow large enough, they can
attach themselves to the urothelium and continue growing. The other theory is that it is in the medullary interstitium that stone formation begins (Garcia-Perdomo, et al., 2015).

Diagnostic Findings

Diagnosis:

* ultrasound

Risk Factors
Male, non-Hispanic white, Hx of kidney
stones, don’t drink enough water, diet
high in protein, sodium, and/or sugar,
overweight
or obese, take certain
General
Objective/Subjective
medicine e.g. calcium-based antacids
(AmericanManifestations
Kidney Fund)
Clinical

* pain in the back, belly, or side, pain
or burning when urinating, urgent
need to go to the bathroom more
frequently, hematuria, cloudy or
smelly urine, little amount of urine
going out, nausea and vomiting, fever
General
Treatment
and
chills (Watson,
2017).
Some kidney stones pass without the need for any
treatment or surgical intervention. If the kidney stones are
too big, here are the interventions that can be done:
shockwave lithotripsy, ureteroscopy, percutaneous
nephrolithotomy or lithotripsy, or open surgery (WebMD).
Medication may also be given to alleviate pain Other
medications are tailored to the type of stone present
(Healthline Editorial Team)

Urolithiasis (left ureter)

* intravenous pyelography
(IVP)
* CT Scan (Medicine.net)

Relevant DoH (min. 3) and Rationale
* white male, 65 years old - The lifetime incidence of kidney stones is nearly 19% in men and 9% in women.
Studies also show that prevalence and incidence rates were highest among whites. There is increasing
prevalence as age increases, too (Romero, Akpinar, & Assimos, 2010).
* previous hx of kidney stones - One of the major risk factors is when a pt had already suffered from kidney
stones before. There is a higher chance that he will develop it again (American Kidney Fund).
* diet consisting of fast food - a non-balanced diet or one that consists of high protein, sodium, and/or sugar
can increase one’s risk of developing kidney stones (American Kidney Fund). Pt eats fast food frequently.

Complications
Serious complications include:
abscess formation, serious infection of
the kidney that reduces kidney
function, ureteral scarring and
stenosis, urosepsis, extravasation,
ureteral perforation, urinary fistula
formation, renal loss due to longstanding obstruction (Dave, 2020)

Treatment for your client
Clinical Manifestations of YOUR client (objective/subjective)
Pt has severe left flank pain, painful urination, hematuria, and nausea for 3 days. Diagnostic results for
IVP show kidney stone on left ureter; BUN is 48 mg/dL and Creatinine is 2.8 mg/dL

Tx of Mr. Harris may include straining of the
urine to check if the stone will pass on its own.
Tamsulosin may be given to increase the chances
of the stone to pass in urine. If not, interventions
for shockwave lithotripsy, ureteroscopy, or open
surgery can be done. Pain and anti-nausea
medication may be given (Urology Care
Foundation).

SCHEDULED MEDICATION WORKSHEET

Student

Drug Name
(Generic &
Trade Name)

Date

Class/Action/
Side Effects Common
and SEVERE

Dose/
Route/Frequency

Unit & Room

Rationale for your
Patient

Is the order within
recommended dosing

Order
frequency &
Time(s) you
actually gave

Lab values/Nursing implications
(e.g. if giving K supplement what was the most
recent K+ lab? Or if giving insulin what was the
blood sugar? If giving cardiac meds what is the
apical heart rate/vitals?)

limits?

Ibuprofen (Advil)

NSAID/ reduces hormones 800 mg/ PO/ QID
that cause inflammation and
pain in the body/ common
side effects: upset stomach,

This drug is taken by the
patient for knee pain.

Antacid, minerals and
1000mg/ PO/ q4h prn
electrolytes/ neutralizes gastric
acidity/ common side effects:
dizziness, nausea, constipation/
severe: rash, hives, red,
swollen, blistering skin, trouble
breathing, swelling of the face,
very bad constipation

2:00 PM
8:00 PM

mild heartburn, bloating,
nausea, constipation/ severe
side effects: peptic ulcer,
perforation, cardiac failure,
liver and kidney failure
Calcium carbonate
(Tums)

8:00 AM

2:00 AM

This drug is taken to
combat heartburn

8:00 AM
12:00 PM
4:00 PM
8:00 PM
12:00 AM
4:00 AM

metoclopramide
(Reglan)

GI stimulant, miscellaneous
10 mg/PO/ before each
anti-emetic/ increases muscle meal and at bedtime
contractions in the upper GI
tract/ common side effects:
diarrhea, drowsiness, muscle
pain or weakness, restlessness/
severe: uncontrolled muscle

This drug is given to stop
or minimize nausea and
vomiting.

8:00 AM
12:00 AM
8:00 PM

Nurse has to monitor v/s of pt well as this
drug can increase risk of stroke if taken in
large doses for a longer period of time.
Monitor output for signs of bleeding as this
can also cause stomach and intestinal
bleeding especially in older adults. Pt can
take the medication with some food to lessen
stomach upset (Drugs.com).

Nurse should instruct patient to chew the
tablets before swallowing. Periodic plasma
calcium levels and urine calcium excretion
tests, especially in patients with mild to
moderate renal dysfunction, on prolonged
treatment, or those with mild hypercalciuria
and/or with a history of kidney stones. Serum
creatinine and other renal function tests,
especially with long-term treatment and/or
those on treatment with cardiac glycosides or
diuretics (Drugs.com).
Nurse should monitor pt for any signs of
movement complications (uncontrolled
muscle movements). Discontinue and report
to physician if signs and symptoms of tardive
dyskensia appear (Drugs.com).

movements,

ketorolac (Toradol)

tamsulosin (Flomax)

NSAID/ blocks the body’s
15 mg/ IV/ q6h
production of certain natural
substances that cause
inflammation/ common side
effects: headache, drowsiness,
indigestion, diarrhea, increased
BUN level/ severe side effects:
abnormal thinking, black
“tarry” stool, depression,
bronchospasm, insomnia, liver
failure

This drug is given for
moderate to severe pain
due to the kidney stone.

8:00 AM
2:00 PM
8:00 PM
2:00 AM

Peripherally acting anti0.4 mg/ PO/ once a day This drug is given to
8:30 AM
adrenergic agent/ relaxes the
alleviate painful urination.
the muscles in the prostrate and
bladder neck, making it easier
to urinate/ common side
effects: cough, fever or chills,
lower back or side pain,
congestion, stuffy or runny
nose, headache, dizziness/
severe: tightness of the chest,
confusion, large, hive-like
swelling on the face, eyelids,
lips, tongue, hands, feet, and
sex organs, irregular heartbeat,
difficult breathing

Nurse has to check with the physician about
lowering the dose as needed for pt as he has
higher creatinine and BUN levels. Nurse has
to collaborate with physician that drug isn’t
used for long-term therapy (maximum of 5
days). Continous monitoring of tests to check
if there are any adverse reactions to the
medication should be a must (RxList).

Nurse has to make sure to administer the
medication 30 minutes after the same meal
daily. Pt has to be taught that the medication
should be swallowed whole and not chewed
or crushed. Nurse should report any severe
reactions right away (Drugs.com).

What specific instructions would you give Mr. Harris when he urinates?

It is important that Mr. Harris filters his first void in the morning using the filter from the stone collecting kit. Most kidney stones are small enough to pass
through urine.

1. During the first void in the morning, use the filter to strain the urine.
2. Check the filter for any particles. It may be very small and may look like a small piece of gravel or a grain of sand.
3. If there is a stone, it has to be air dried thoroughly for 24 hours on a towel or tissue at room temperature. Once fully dry, it should be placed inside the
clean and dry container from the kit.
4. Keep the stone at room temperature until it is time to be taken to be examined (Mayo Clinic).

What specific nursing interventions can help Mr. Harris?
* Monitoring of pain closely and prompt reporting in cases where pain becomes severe.
* Administration of pain medications as prescribed.
* Assisting the pt to ambulate as necessary to alleviate pain.
* Encourage pt to increase fluids.
* Monitor intake and output and patterns of voiding (Vera, 2014)

What risk factors does Mr. Harris have that leads to the development of kidney stones?
Mr. Harris is extremely obese, with a BMI of about 40. He takes calcium carbonate for heartburn frequently, which contains calcium. He also has a very poor diet,
consisting of fast food, which is high in sodium and sugar.

What are procedures can be done to remove Mr. Harris kidney stones?
Some kidney stones pass without the need for any treatment or surgical intervention. If the kidney stones are too big, here are the interventions that can be done:





Shock wave lithotripsy
Ureteroscopy
Percutaneous nephrolithotomy or percutaneous nephrolithotripsy
Open surgery (WebMD)

What lab results of Mr. Harris should be of greatest concern for the nurse?
His BUN and creatinine levels should be of greatest concern for the nurse. Elevated levels may indicate that he is suffering from kidney problems, and this can
become more complicated if left untreated.

References:
Academic Library. (n.d.). Kidney Stones. Retrieved from https://ebrary.net/27232/health/kidney_stones
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risk-factors.html
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Vera, M. (Last updated 2014, January 10). Urolithiasis (Renal Calculi). Retrieved from https://nurseslabs.com/urolithiasis-nursing-management/

Vera, M. (Last updated 2019, April 12). 4 Urolithiasis (Renal Calculi) Nursing Care Plans. Retrieved from https://nurseslabs.com/4-urolithiasis-nursing-careplans/2/


Outline - GU case

I. Patient Information Sheet
II. Nursing Assessment/ review of systems
III. Pathophysiology Algorit...


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