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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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
American Kidney Fund. (n.d.). Kidney stone risk factors. Retrieved from https://www.kidneyfund.org/kidney-disease/kidney-problems/kidney-stones/kidney-stone-
risk-factors.html
Drugs.com. (n.d.). Calcium carbonate. Retrieved from https://www.drugs.com/mtm/calcium-carbonate.html.
Drugs.com. (n.d.). Ibuprofen. Retrieved from https://www.drugs.com/ibuprofen.html
Drugs.com. (n.d.). Metoclopramide. Retrieved from https://www.drugs.com/sfx/metoclopramide-side-effects.html
Drugs.com. (n.d.). Tamsulosin. Retrieved from https://www.drugs.com/tamsulosin.html
Garcia-Perdomo, H. A., Solarte, P. B., & España, P. P. (2015). Pathophysiology associated with forming urinary stones. Urologia Colombiana, Vol. 25(2), pp. 118125. DOI: 10.1016/j.uroco.2015.12.013
Healthline Editorial Team. (2018, December 5). Kidney Stones. Retrieved from https://www.healthline.com/health/kidney-stones
Mayo Clinic. (n.d.). Patient Collection Instructions for Kidney Stones. Retrieved from
https://www.bvhealthsystem.org/media/file/New%20Physician%20Announcements/Mayo%20Clinic%20Kidney%20Stone%20Analysis%20Patient%20Col
lection%20Instructions.pdf
Romero, V., Akpinar, H., & Assimos, D. G. (2010). Kidney Stones: A Global Picture of Prevalence, Incidence, and Associated Risk Factors. Rev Urol. 2010
Spring-Summer 12(2-3), e86-e96. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931286/
RxList. (n.d.). Ketorolac. Retrieved from https://www.rxlist.com/consumer_ketorolac_acular/drugs-condition.htm#what_are_side_effects_of_ketorolac
Urology Care Foundation. (n.d.). What are Kidney Stones? Retrieved from https://www.urologyhealth.org/urologic-conditions/kidney-stones
Watson, S. (2017, October 20). 8 Signs and Symptoms of Kidney Stones. Retrieved from https://www.healthline.com/health/symptoms-of-kidney-stones
WebMD. (n.d.). When Do I Need Surgery for a Kidney Stone? Retrieved from https://www.webmd.com/kidney-stones/surgery-for-kidney-stone#1.
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...