Kidney Stone Ncp

Kidney Stone apprehension Plan Admitting Diagnoses Client not being admitted at this time live Diagnosis Ureteral Calculi Other Medical Diagnoses HTN, Hyperlipidemia, Kidney stones, Smokes Tobacco, Tonsillectomy-child term yrs. Pathophysiology Urinary calculi be hard particles in the urinary system. They may cause pain, illness, vomiting, hematuria, and, possibly, chills and fever due to secondary winding infection. Diagnosis is based on urinalysis and radiologic imaging, usu completelyy noncontrast helical CT. intercession is with analgesics, antibiotics for infection, and, sometimes, shock wave lithotripsy or endoscopic procedures. some 1/1000 adults in the US is hospitalized annually because of urinary calculi, which are also found in about 1% of all autopsies. Up to 12% of men and 5% of women will develop a urinary calculus by age 70. Calculi vary from microscopic crystalline foci to calculi several centimeters in diameter. A spectacular calculus, called a staghorn calcu lus, can fill an entire renal calyceal system. About 85% of calculi in the US are composed of Ca, mainly Ca oxalate. Composition of urinary calculi 10% are uric acid 2% are cystine most of the remainder are Mg ammonium phosphate (struvite).General bump factors include disorders that increase urinary salt concentration, either by increased excretion of Ca or uric acid salts, or by rock-bottom excretion of urine or citrate. Urinary calculi may remain within the renal parenchyma or renal pelvis or be passed into the ureter and bladder. During passage, calculi may irritate the ureter and may become lodged, obstructing urine scarper and causing hydroureter and sometimes hydronephrosis. (Preminger, MD, 2012) Common areas of lodgment include the ureteropelvic junction, the distal ureter, and the ureterovesical junction.Larger calculi are more likely to become lodged. Typically, a calculus must have got a diameter 5 mm to become lodged. Calculi ? 5 mm are likely to pass spontaneously. Even partial obstruction causes decreased glomerular filtration, which may persist briefly after(prenominal) the calculus has passed. With hydronephrosis and high-sounding glomerular pressure, renal blood flow declines, further worsening renal function. Generally, however, in the absence of infection, permanent renal dysfunction chokes only after about 28 days of complete obstruction.Secondary infection can occur with long-standing obstruction, but most uncomplainings with Ca-containing calculi do not have infected urine. Preminger, MD, G. M. (n. d. ). renal lithiasis stones urolithiasis. Retrieved from http//www. merckmanuals. com/professional/genitourinary_disorders/urinary_calculi/urinary_calculi. html Textbook clinical symptoms The major manifestation of stones is onerous pain, commonly called renal colic. Flank pain suggests the stone is located in the kidney or upper ureter. Flank pain that extends toward the abdomen or to the scrotum and testes or the vulva suggests that stones are in the ureters or bladder.Nausea, vomiting, pallor, and diaphoresis often accompany the pain. frequence or dysuria occurs when a stone reaches the bladder. (Ignatavicius & Workman, 2010) pg 1571 Actual symptoms Flank pain extending toward the abdomen, dizziness, sweating, and nausea w/o vomiting. Patient states his pain is an 8/10 on the pain scale. Pain is described as constant and sharp with no alleviating factors. Complications or potential complications Potential Hydroureter, hematuria, hydronephrosis, abrasion, oliguria or anuria, and infection. Ignatavicius & Workman, 2010) pg 1571-1572 Safety Issues Fall risk level Low, but still a potential complication from patient roles c/o dizziness from pain. Delegation Issues Assist patient when ambulating. Client Data Age 38 Physical Exam (include all body systems) (Physical Exam) Age 38 Male Height 69. in weightiness 180lb Temp 99F Pulse 90 Apical Pulse 88 Resp 20 BP 169/71 BP s upine ( Noted O2 Saturation 100% RA NEURO nonfocal, AXOX4, c/o pain. HEENT Denies headache PERRLA, Ears unobstructed, symmetrical, no loss of hearing, Nares are clear, w/o drainage or obstruction, Oropharynx is clear w/ membranes pink in food color and intact, Neck is supple with full range of motion, INTEGUMENT Skin warm, moist-diaphoretic, intact w/saline lock in RU-AC, dressing is clean, intact, non-tender, free of redness. CARDIOVASCULAR No JVD noted, apical pulse regular at 88bpm, S1/S2 auscultated, no c/o chest pain/pressure distal pulses palpated in all extremities, capillary tube refill