COLEGIO de KIDAPAWAN

Paramedical Department
Bachelor of Science in Nursing
First Semester SY: 2022-2023

“UROLITHIASIS”

GROUP 6
Name of the Students:

Palalisan, Yamerah
Palomo, Princess Hope
Panga, Bainor
Pangalong, Normaida
Pecson, Dina
Pore, Lovely Grace

Submitted To:
Ana C. Lagdameo, RN., MN
 TABLE OF
CONTENTS:

Title Page…………………………………………………………………………………………i

Table of Contents………………………………………………………………………………..ii

Acknowledgment………………………………………………………………………………..iii

Contents:

I. Introduction………………………………………………………………………...…….1-2

II. Objectives………………………………………………………………………………..2-3

III. Patient’s Data………………………………………………………..………………….5-6

IV. Family Background/Health History………………………………...………………….7-8

V. Developmental Data…………………………………….…………………………..…9-15

VI. Definition of Complete Diagnosis……………………………………………………16-17

VII. Physical Assessment…………………………………………………………….……18

VIII. Anatomy and Physiology……………………………………………………….……19

IX. Etiology Symptomatology……………………………………………………………20-22

X. Pathophysiology………………………………………………………………………23-26

XI. Doctor’s Order…………………………………………………………………………27-28

XII. Diagnostic Exam………………………………………………………………………29-37

XIII. Drug Study…………………………………………………………………………….38-42

XIV. Surgical Procedure…………………………………………………………………43-44

XV. Nursing Theories……………………………………………………………………44-45

XVI. Nursing Care Plan………………………………………………………………….45-47

XVII. Discharge Plan (M.E.T.H.O.D.S.) ………………………………………………..54

XVIII. Prognosis……………………………………………………………………………55-56

XIX. Recommendation……………………………………………………………………55-56

XX. References…………………………………………………………………………….57
 ACKNOWLEDGEMENT

With the boundless and deep appreciation, the group would like to extend their

heartfelt gratitude and gratefulness to the people who helped to bring this case study

into reality. The group would like to sincerely thank all those who helped with their

valuable support during the entire process of this case study and send their profound

gratitude to the following:

To our family, for the unconditional love and undying support throughout these

years, for the financial support they gave every time we needed it and the

encouragement, they provide this entire process.

To our clinical instructor, Ma’am Ana C. Lagdameo RN. MN, for the exemplary

guidance, assistance and insightful feedback that helped us students to have much

better results and for sharing her expertise generously that gave the case study a lot of

learnings.

Mostly specially, to our Father almighty, for giving her strength, ability, knowledge

and wisdom that took a huge part in completing this case study successfully. Also, for

the life and blessings he showed upon us, we could have never done this without the

faith we have in Him.

I. INTRODUCTION

Urolithiasis is a condition that occurs when these stones exit the renal pelvis and

move into the remainder of the urinary collecting system, which includes the ureters,

bladder, and urethra.

There are many differences in the prevalence rate of kidney stone worldwide, so

this rate is reported as 1–5% in Asia, 5–9% in Europe, and 7–15% in North America.

While in Saudi Arabia, nearly 20% of individuals suffer from kidney stone, it is seen in

only 4% of the population of China. Iran is one of the countries which is located in the

kidney stone belt. According to the results of a study, the prevalence of kidney stone in

Iran is reported 4.2 per thousand, and the highest prevalence in Iran is reported in

western and southwestern provinces such as Ilam, et al. Global data show that the

prevalence of kidney stone has been increasing among both sexes in the last quarter of

the twentieth century, which may be due to environmental factors such as diet and

lifestyle. However, the development of diagnostic procedures for asymptomatic stones

may partially explain this trend. Kidney stone increases with age and is more common

among men than women. Also, the risk of kidney stone decreases with increasing

consumption of fluids, fruits, and vegetables. Sodium restriction reduces the risk of

kidney stone. Due to the increasing trend and high recurrence of kidney stone, also

imposing a heavy financial and medical burden on individuals and society, obtaining

accurate and updated information from different regions of the world can be of great

help to the decisions of health policymakers, to prepare preventive and up-to-date

strategies to reduce this disease. Therefore, this study aimed to assess the prevalence
and risk factors of kidney stone in the adult population of southern Iran based on the

data of the Kharameh Cohort Study.

In Asia, about 1%–19.1% of the population suffer from urolithiasis. However, due

to variations in socio-economic status and geographic locations, the prevalence and

incidence have changed in different countries or regions over the years. The research

for risk factors of urinary tract stones is of predominant importance. In this review, we

find the prevalence of urolithiasis is 5%–19.1% in West Asia, Southeast Asia, South

Asia, as well as some developed countries (South Korea and Japan), whereas, it is only

1%–8% in most part of East Asia and North Asia. The recurrence rate ranges from 21%

to 53% after 3–5 years. Calcium oxalate (75%–90%) is the most frequent component of

calculi, followed by uric acid (5%−20%), calcium phosphate (6%−13%), struvite (2%

−15%), apatite (1%) and cystine (0.5%−1%). The incidence of urolithiasis reaches its

peak in population aged over 30 years. Males are more likely to suffer from urinary

calculi. Because of different dietary habits or genetic background, differences of

prevalence among races or nationalities also exist. Genetic mutation of specific locus

may contribute to the formation of different kinds of calculi. Dietary habits (westernized

dietary habits and less fluid intake), as well as climatic factors (hot temperature and

many hours of exposure to sunshine) play a crucial role in the development of stones.

Other diseases, especially metabolic syndrome, may also contribute to urinary tract

stones.
II. OBJECTIVES

General Objectives:

This case study aims that the students and the readers will gain knowledge and further

understanding about the Urolithiasis

Specific Objectives:

In order to meet the general objective, the group aims to:

Affective:

1. Establish a good interpersonal relationship to the client SO and her family.

2. To be able to give the appropriate health teaching and better understanding of

the disease to the patient, family and significant others.

Cognitive:

3. To be able to define regarding the condition as well as its signs and symptoms.

1. State the past and present health history of the patient.

2. Discuss the anatomy and physiology of the organ involve in patients’ disease.

3. Trace the pathophysiology of the patient’s disease.

4. Formulate nursing care plan related to the disease and determine the possible

nursing intervention that will be a great help in patients’ prognosis.

 5. To know and identify the drugs which the patient receives.

6. Provide the patient SO or family with proper discharge planning.

7. Outline recommendations base on the case studies findings.

Psychomotor:

1. Gather the pertinent data from the patient and her significant others.

2. To apply skills learned in the classrooms to actual handling and caring of a

patient who suffered from regarding to this condition.

III. PATIENT’S DATA

Patent’s Code Name: Patient A.

Age: 54 years old

Nationality: Filipino

Civil Status: Married

Occupation: Driver

Sex: Male

Religion: Roman Catholic

Educational Attainment: High School Graduate

Ward or Unit: Private

Room: 205

Bed No.: Male A

Date of Admission: 03/26/23

Vital signs on Admission:

BP-130/90mmHg

PR- 98bpm

RR- 21cpm

TEMP: 36*c

02 SAT.- 98%

Date of Discharge: Not ready to Discharge

Chief Complaint/s: DOB, pain during pee, left lower quadrant pain of 10/10

Admission/Final Diagnosis: Urolithiasis

Surgical Procedure Performed if any (Date and Time Performed): N/A

Attending Physician: Dr. Exequiel Dimaano M.D and Dr. Burt Robinson Layos M.D

Source of Information/Informant/s: Patient and Watcher

IV. FAMILY BACKGROUND/ HEALTH HISTORY

Genogram

Grand Parents Grand Parents

Father Side Mother Side

Legend: Color:
Present Condition:
-Female Yellow- Urolithiasis
-Male
-Deceased
Blue -Patient Past Condition:
Symbols: Orange: Hypertension
 -Present Condition of the patient Green: diabetic mellitus
-Past Illness of the patient

FAMILY SOCIO ECONOMIC BACKGROUND

The grandparents of patient A. In the father side has a past illness of diabetes

mellitus which lead to renal failure later on and died because of this condition. In the

mother side of patient A., her grandfather also has hypertension and leads to stroke that

cause to his death.

Client’s Health History

B. History of Past Illness:

Patient A. was known of having hypertension for fifteen (15) years. According to

him he had a Hypertension, or high blood pressure that causes complication of diabetes

mellitus for ten (10) years that is believed to contribute most directly of the formation of

kidney stones that over time causes on him to suffer urolithiasis. Hypertension is

believed to be both a cause of diabetic mellitus, as well as because of the damage that

is created by the disease on his kidney. And Over time, poor compliance to his

hypertension and diabetes mellitus causes damage to blood vessel clusters in her

kidneys that filter waste from the blood associated with his diet/ lifestyle and low fluid

intake that also contributes to the formation of kidney stones which causes

complications.
C. History of Present Illness:

Patient A. is a 54-year-old, male, married and a resident of Guyabano Poblacion,

Kidapawan, North Cotabato. He was being hospitalized for the first time due left lower

quadrant pain with pain scale of 10/10. With a vital sign of BP: 130/90; PR: 98 bpm;

RR: 21 cpm; T: 36 °C; W: 88 kgs.; H: 156 cm; O2: 98 % and a pain scale of 10/10 on

his left lower quadrant upon admission. was advised to have Laboratory examination

such as, Complete Blood Count (CBC), Urinalysis, Hemoglucotest, Panel 3

(FBS+Crea+Uric+SGPT+Lipid P), Electrolyte Panel 2 (Na+K+Ca), and Computed

Tomography (CT-Scan) of the abdomen. Which results to urolithiasis.

V. DEVELOPMENTAL DATA

Erikson’s Stages of Psychosocial Development

Stage Psychosocial What happens in Rationale

Crisis/Task this Stage?

1 Trust vs. Mistrust If needs are According to her

(0-18 months) dependably met, she developed

infants develop a trust because

sense of basic trust. her mother is a

full-time and a
 loving mother to

them.

2 Autonomy vs. Toddlers learn to According to

Shame/Doubt exercise will and do her, her mother

(18 months- 3 years) things for let her play and

themselves, or they explore new

doubt their abilities. things.

3 Initiative vs. guilt Preschoolers learn to According to

(3-5 years) initiate tasks and her, during her

carry out plans, or preschool, her

they feel guilty about mother sent her

efforts to be to the school

independent. and listen to

their teacher so

that they can

learn new things

and explore.

4 Industry vs. inferiority Children learn According to

(5-13 years) pressure of applying her, her parents

themselves to tasks, taught them

or they feel inferior. some house

chores so that

they will know

 some

responsibility

while they are

young.

5 Industry vs. confusion Teenagers work at According to her

5-13 years refining a sense of she has more

self by testing roles girl friends like

and then integrating her cousins and

them to form single started to have

identity, or they crushes to

become confused opposite sex.

about who they are.

6 Identity vs. role Teenagers work at According to

confusion refining a sense of her, she married

13-21 years self by testing roles at the age of 16

and then integrating years old.

them to form single

identity, or they

become confused

about who they are.

6 Intimacy vs. isolation Young adults According to

21-39 years struggle to form close her, she has a

relationships and to lot of friends

 gain the capacity fir especially her

intimate love, or they cousins.

feel socially isolated.

7 Generativity vs. The middle-aged She has 6

stagnation discover a sense of children,

40-65 years contributing to the according to her

world, usually she is contented

through family and seeing her

work, or they may children had a

feel a lack of stable job.

purpose.

8 Integrity vs. despair When reflecting on According to her

65 and older his or her life, the she is contented

older adult may feel a of her life, and

sense or satisfaction thankful

or failure. because her

children is

having their

stable jobs.

Sigmund Freud’s Psychosexual Stages

Stage Age Range What happens at this

age?
 Oral range 0–1-year-old Children derive pleasure

from oral activities,

including sucking, and

tasting. They like to put

things in their mouth.

Anal stage 2-3 years old Children begin potty

training.

Phallic stage 3-6 years old Boys are more attached to

their mother, while girls are

more attached to their

father.

Latency stage 6 years old to puberty Children spend more time

and interact mostly with

same sex peers.

Genital stage Beyond puberty Individuals are attached to

opposite sex peers.

Piaget’s theory of cognitive development

Stage Age range Descriptions

Sensory motor 0-2 years Coordination of senses

 with motor response,

sensory curiosity about the

world. Language used for

demands and cataloguing.

Object permanence

developed.

Preoperational 2-7 years. Symbolic thinking, use of

proper syntax and

grammar to express full

concepts, imaginations

and intuition are strong,

but complex abstract

thought still difficult.

Conservation developed.

Concrete operational 7-11 years Concepts attached to

concrete situation. Time,

space, and quantity are

understood and can be

applied, but not as

independent concepts.

Formal operations 11+ Theoretical, hypothetical,

and counterfactual

thinking. Abstract logic and

 reasoning, strategy, and

planning become possible.

Concepts learned in one

context can be applied to

another.

VI. DEFINITION OF COMPLETE DIAGNOSIS

Urolithiasis
Renal stones are formed within the kidneys, and this is called nephrolithiasis.
Urolithiasis is a condition that occurs when these stones exit the renal pelvis and move
into the remainder of the urinary collecting system, which includes the ureters, bladder,
and urethra. Many patients with urolithiasis can be managed with expectant
management, analgesic, and anti-emetic medications; however, stones that are
associated with obstruction, renal failure, and infection require further increasingly
critical interventions
There are multiple types of kidney stones; however, 80% of stones are
composed of calcium oxalate or phosphate. Other stone types include uric acid (9%),
struvite (10%), and cystine (1%) stones and are significantly less common than stones
composed of calcium oxalate or phosphate (80%). The different types of stones occur
due to varying risk factors such as diet, prior personal and family history of stones,
environmental factors, medications, and the patient’s medical history. Common risk
factors for stone formation include poor oral fluid intake, high animal-derived protein
intake, high oxalate intake (found in foods such as beans, beer, berries, coffee,
chocolate, some nuts, some teas, soda, spinach, potatoes), and high salt intake.[2] Oral
hydration is recommended at a rate that produces approximately 2.5 L of urine per day,
and acceptable choices for fluids include water, coffee, tea, beer, and low sugar fruit
juices except for tomato (high sodium content), grapefruit, and cranberry (high oxalate
content). Consumption of citrate helps to prevent stone formation as it inhibits crystal
aggregation by forming complexes with calcium salts within the urine. 60% of patients
with calcium stones have been found to have hypocitraturia. Low calcium intake has
been shown to increase the risk of kidney stone formation, contrary to common belief.
Decreased oral calcium intake will reduce calcium levels within the GI tract, which would
otherwise be available to bind to oxalate. This, in turn, will increase oxalate absorption
and excretion, increasing the risk of stone formation. Vitamin C intake and fish oil have
also been shown to increase the risk of calcium stones
The presence of medical conditions such as chronic kidney disease,
hypertension, gout, diabetes mellitus, hyperlipidemia, obesity, endocrine, and
malignancies increase the risk of the development of kidney stones. Obesity,
hyperlipidemia, and type 2 diabetes mellitus have a strong association with calcium
oxalate and uric acid stones. Patients with histories of hyperlipidemia, hypertension, and
type 2 diabetes mellitus often have diets that are high in animal-derived proteins, salt,
and sugar, placing them at higher risk for stone formation. Insulin resistance in obesity
and type 2 diabetes mellitus promotes metabolic changes that increase the risk of stone
formation secondary to increased urinary calcium and uric acid excretion

VII. PHYSICAL ASSESSMENT

Appearance of the Patient

Patients with urolithiasis usually appear in pain.
Patients tend to move constantly in order to achieve a comfortable position.
Vital Signs
High-grade / low-grade fever.
Tachycardia with regular pulse can be seen secondary to pain.
Tachypnea can be seen.
Skin
Skin examination of patients with urolithiasis is usually normal.
HEENT
HEENT examination of patients with urolithiasis is usually normal.
Neck
Neck examination of patients with urolithiasis is usually normal.
Lungs
Pulmonary examination of patients with urolithiasis is usually normal.
Heart
Cardiovascular examination of patients with urolithiasis is usually normal.
Abdomen
Hypoactive bowel sounds as seen in ileus due to severe pain
Back
Costovertebral angle tenderness(Murphy's punch sign, Pasternacki's
sign, or Goldflam's sign) bilaterally/unilaterally depending upon sides involved.
Genitourinary
Hematuria
Neuromuscular
Neuromuscular examination of patients with urolithiasis is usually normal.
Extremities
Extremities examination of patients with urolithiasis is usually normal.

VIII. ANATOMY AND PHYSIOLOGY

The main functions of the kidney are filtration and excretion of metabolic waste products

from the bloodstream, regulation of electrolytes, acidity and blood volume, and
contribution to blood cell production. The nephron is the functional unit of the kidney.

Each nephron is formed by a glomerulus, a proximal convoluted tubule, loop of Henle,

and distal convoluted tubule. The last part of the nephron is the common collecting duct,

and is shared by many nephrons The blood is filtered in a specialized capillary network

through the glomerular barrier, which yields the filtrated substances into Bowman's

capsule space, and then into the renal tubules. The glomerular barrier is composed by

five layers: the inner layer is the glycocalyx covering the surface of the endothelial cells;

the fenestrated endothelium, the glomerular basement membrane, the slit diaphragm

between the foot-processes of the podocytes; and the sub-podocyte space between the

slit diaphragm and the podocyte cell body.

The job of the kidneys is to maintain the body's balance of water, minerals and salts.

Urine is the product of this filtering process. Under certain conditions, substances

normally dissolved in urine, such as calcium, oxalate and phosphate, become too
concentrated and can separate out as crystals. A kidney stone develops when these

crystals attach to one another, accumulating into a small mass, or stone.

Kidney stones are hard objects, made up of millions of tiny crystals. Most kidney stones

form on the interior surface of the kidney, where urine leaves the kidney tissue and

enters the urinary collecting system. Kidney stones can be small, like a tiny pebble or

grain of sand, but are often much larger. Kidney stones can block the flow of urine,

which can then cause damage to your kidneys and sometimes kidney disease. Stones

increase your chance of urinary and kidney infection and can result in germs spreading

into your blood stream (septicaemia).

IX. ETIOLOGY AND SYMPTOMATOLOGY

Table 1: Symptoms manifested by Patient A
Factors Actual Rationale

Kidney stones
/ are more
Age / Gender
common in men
between ages
of 40 to 60
years old.
There are more
likely to
develope
kidney stones
become of their
diet and
dehydration.

Diet / Eating a diet

 that's high in
protein, sodium
(salt) and sugar
may increase
your risk of
some types of
kidney stones.
This is
especially true
with a high-
sodium diet.
Too much salt
in your diet
increases the
amount of
calcium your
kidneys must
filter and
significantly
increases your
risk of kidney
stones.

Low fluid / Low fluid

intake intake leads to
reduced
diuresis,
resulting in
concentrated
urine. This may
lead to
supersaturation
of minerals
contributing to
the formation of
kidney stones.
PRECIPATATING FACTORS

Factors Actual Rationale

DM / Kidney stone
formation is a
multifactorial
process that is
associated with
other disease
processes.
Insulin resistance
plays a key role
in type 2 diabetes
mellitus (DM),
and it has been
linked to uric acid
stone
formation.1,2
Insulin resistance
might result in a
deficit in
ammonium
production in the
kidney, which
lowers urinary
pH, thus
generating a
favorable milieu
for uric acid stone
formation.

HTN / Kidney stones

affect
hypertensive
patient
disproportionately
 compared to
normotensive
idividuals and it
has the greater
risk of renal
stones formation
esp , when HTN
is associated with
excessive body
weight.

Table 2: Symptomatology

Factor Actual Rationale

Pain may be pain often

felt in the belly starts suddenly.
area or side of As the stone
the back. moves, the pain
changes
location and
intensity.

Pain often
comes and
goes in waves,
which is made
worse by the
ureter
contracting as it
tries to push
the stone out.
Each wave may
last for a few
minutes,
 disappear, and
then come back
again.

Abnormal
urine color may
Abnormal urine
be caused by
color
infection,
disease,
medicines, or
food you eat. It
can also
indicate severe
dehydration or
a condition
involving the
breakdown of
muscle tissue
known as
rahbdomyolsis.

may be due to
a problem in
Blood in urine
your kidneys or
other parts of
the urinary
tract, such as.
Cancer of the
bladder or
kidney,
infection of the
bladder, kidney,
prostate, or
urethra

nausea and
vomiting
people with
kidney stones
to have nausea
and vomiting.
These
symptoms
happen
because of
shared nerve
connections
between the
kidneys and the
GI tract. Stones
in the kidneys
can trigger
nerves in the GI
tract, setting off
an upset
stomach.
Nausea and
vomiting can
also be your
body’s way of
responding to
intense pain.
 X. PATHOPHYSIOLOGY

PREDISPOSING FACTORS PRECIPITATISNG FACTORS

Age/ Gender Diet Low fluid Diabetes Hypertension

intake Mellitus
Kidney stones High sodium, Kidney stones
are more oxalate, fat, sugar, Low fluid intake Insulin affect hypertensive
common in men and animal protein leads to reduced resistance play patient
between ages of diet contribute to diuresis, a key role in disproportionately
40 to 60 years different resulting in DM, and it has compared to
old. They are substances the concentrated been linked to normotensive
more likely to kidney must filter urine. This may uric acid stone individuals. It has a
develop kidney leading to renal lead to formation. It greater risk of renal
stones due to stone formation. supersaturation makes more stones formation
lifestyle and diet High sodium intake of minerals than doubles esp. when HTN is
influences in also increases the contributing to the chances of associated with
working amount of calcium the formation of having kidney excessive body
environment. in the urine. kidney stones. stones. weight.

A diet high in Eating too much Reduced body Insulin Hyperoxaluria and
protein, sodium read meat, fluids affect the resistance might hypercalciuria as
and sugar may poultry, eggs, dilution of the result in a deficit well as
increase the risk shellfish, fast urine by in ammonium supersaturation of
of some type of foods and soda decreasing urine production in calcium oxalate
kidney stone. drinks makes output and the kidney, and uric acid
Too much salt in your body make increasing urine which lower appear to be the
your diet more uric acid I pH leading to the urinary pH, thus most important
increases the the body from formation of generating a factors.
amount of gout can cause stones. favorable milieu
calcium your uric acid kidney for uric acid
kidney must filter stones to stone formation.
and significantly develop.
increases your
risk.

Kidney stones usually will not cause symptoms until it moves around
within the kidney or passes into one of the ureters, that connects the
kidneys, and bladder. In condition is called urolithiasis, at this point sign
and symptoms will be experience such as: severe pain in your lower back/
side of the body, nausea/ vomiting, blood in the urine, pain when
urinating. Unable to urinate, need to urinate more often, fever or chills,
cloudy or foul-smelling urine.
 As kidney stones becomes lodged in the ureters, it may block the flow of
urine and cause the kidney to swell and the ureter spasm, which affect the:

Urinary System - Altered filtration of blood to remove - Severe, sharp pain in the lower
waste and balance fluid levels. side or back of the abdomen;
fever or chills; nausea/ vomiting;
- Altered process of producing urine as
blood in the urine; need to urinate
a waste by-product.
more often; pain when urinating;
- The organs of the urinary system unable to urinate; cloudy or foul-
include the kidneys, renal pelvis, smelling urine
ureters, bladder, and urethra.

Diagnostic Exam and Laboratory Tests

Urinalysis, CBC, Hemoglucotest, Panel 3 (FBS+Crea+Uric+SGPT+Lipid P),
Electrolyte Panel 2 (Na+K+Ca), Computed Tomography (CT-Scan)

UROLITHIASIS

IF TREATED IF NOT TREATED

Medical Surgical Nursing

Management Management Management Urinary tract infection
- Ketorolac - Ureteroscopy - Acute Pain
- K. Citrate - Impaired Urinary
Elimination Renal scarring
- Febuxostat
- Risk for Deficient
- Tamsulosin
Fluid Volume
- Remoston Sepsis
- Risk for Injury

XI. DOCTOR’S ORDER - Deficient Knowledge

Patient name: Good Prognosis PATIENT A. Renal

Birthday: January 19, failure
1969 Room No: 205

DEATH
Attending Physician : : Dr. Exequiel Dimaano M.D and Dr. Burt Robinson Layos M.D

Date & Progres Doctor’s order Rationale

Time s notes
7:15 pm -wt. 88kg - Please admit - To be able to provide the patient
March patient to room of with the specific care needed and
26,2023 choice under the have ethical considerations and also
service of Dr. to protect their freedom to make
Dimaano and Dr. healthcare decision
Layos.

-recent Concent -to secure concent.

- low salt, low fat, - To have less waste for removal

diabetic diet. during dialysis

-Monitor Vs q4, I&O q -To have baseline data.

shift and record.

-IVF; PNSS 1L at
120ml alternate C - To regularly check the condition of
PLR 1L at 120 x3 the patient
cycle.

-Labs:
-CBC
- To check for Urolithiasis
-Urinalysis, attach to
-to have baseline data
chart
- hgt now then 3x a
day monitoring
.
-meds;
-ketorolac 20mg IVTT
now then qs round
the clock
-Ceftriaxone 2g ivtt
q24 ANST
-K citrate 10mg 1tab
3x a day.
-CBG -Tambusulin 400mg
3/26/2023 tablet 1tab once a
8:30pm 334 gldl
day.
-please give 10 units
regular insulin 5Q
-regular insulin Scale,
SQ for pre-meals.
 CBG coverage
<140 -0units
141-190 -2units
191-240 -4units
241-290 -6units
291-340 -8units
3/26/2023 >349 -10 units
8:30pm
-CBG TID AC
3/26/2023
-for creatinine
9:30pm
-start linagliptin 5mg
tab, 1tab OD
-DM diet
-monitor CBG TID
3/27/2023 - (F) cld. AC
Pan -febuxostal 40mg tab
(-) OD
(L)pysure
-PNSS 100 cf
3/28/2023 -ALd, -FF CT
pan

-refer to Dr. salvana

3/29/2023
-PNSS 1L x120cc/hr
-monitor CBG TID Ac

-PNSS 1L 100cc/hr
>meds
-remostatin 5mg
-copez PS

XII. DIAGNOSTIC EXAM

Renal stones are formed within the kidneys, and this is called nephrolithiasis.

Urolithiasis is a condition that occurs when these stones exit the renal pelvis and move
into the remainder of the urinary collecting system, which includes the ureters, bladder,

and urethra. Many patients with urolithiasis can be managed with expectant

management, analgesic, and anti-emetic medications; however, stones that are

associated with obstruction, renal failure, and infection require further increasingly

critical interventions.

here are multiple types of kidney stones; however, 80% of stones are composed

of calcium oxalate or phosphate. Other stone types include uric acid (9%), struvite

(10%), and cystine (1%) stones and are significantly less common than stones

composed of calcium oxalate or phosphate (80%).The different types of stones occur

due to varying risk factors such as diet, prior personal and family history of stones,

environmental factors, medications, and the patient’s medical history. Common risk

factors for stone formation include poor oral fluid intake, high animal-derived protein

intake, high oxalate intake (found in foods such as beans, beer, berries, coffee,

chocolate, some nuts, some teas, soda, spinach, potatoes), and high salt intake.[2] Oral

hydration is recommended at a rate that produces approximately 2.5 L of urine per day,

and acceptable choices for fluids include water, coffee, tea, beer, and low sugar fruit

juices except for tomato (high sodium content), grapefruit, and cranberry (high oxalate

content). Consumption of citrate helps to prevent stone formation as it inhibits crystal

aggregation by forming complexes with calcium salts within the urine. 60% of patients

with calcium stones have been found to have hypocitraturia Low calcium intake has

been shown to increase the risk of kidney stone formation, contrary to common belief.

Decreased oral calcium intake will reduce calcium levels within the GI tract, which would

otherwise be available to bind to oxalate. This, in turn, will increase oxalate absorption
and excretion, increasing the risk of stone formation. Vitamin C intake and fish oil have

also been shown to increase the risk of calcium stones.

Diagnostic Exams
Date Test Normal Patients Clinical Nursing
Ordered Value Result Significance Responsibility

March Hemoglucotes 3.8-6.9 18.37 Hemoglucotest Check patient’s

26,2023 t mmo1/1 is the term blood sugar
used to before meals,
designate the at bedtime, and
method of as needed for
measuring symptoms of
blood glucose. hypoglycemia
It is also known or
as a capillary hyperglycemia.
glycemic test, Use the
or simply following table
glucometry. to administer
The insulin lispro
quantification of PRN.
blood glucose
requires a
device known
as a
glucometer,
which is quick
and easy to
use.

Order Date Test Normal Patients Clinical Nursing

Value Result Significance Responsibility
March 26, HBA1C 5.7-6.4% 12.6 The A1C test Ensure that
2023 —also known you
as the understand
hemoglobin the patient's
A1C or condition, the
HbA1c test— reason for the
is a simple test, and the
blood test possible
that outcomes of
measures the
your average procedure.
blood sugar
levels over
the past 3
months
Electrolyte Panel 2 (Na+K+CA)
Order Date Test Normal Value Patients Clinical Nursing
Result Significance Responsibility
March 26, Sodium 135.00- 134.9 A sodium Monitoring
2023 148.00mmo1/L blood test is sodium levels
a routine test and identifying
that may be clinical
used to manifestations
check your that can
general indicate further
health. It may complications
be used to of underlying
help find and medical
monitor conditions.
conditions Electrolyte
that affect the management
balance of requires
fluids, serious
electrolytes, assessment
and acidity in and delicate
your body. treatment.
The test is
often done as
part of a
group of tests
called an
electrolyte
panel.
Potassium 3.50- 4.48 A potassium Monitor ins
5.30mmo1/L blood test and outs.
measures the Check serum
amount of potassium
potassium in levels.
your blood. Follow ECG
Potassium is closely to look
a type of for peaked T
electrolyte. waves.
Electrolytes Educate
are patient on
electrically hyperkalemia.
charged Administer
minerals that diuretics as
help control ordered.
fluid levels Administer
and the insulin to lower
balance of potassium as
acids and ordered.
bases (pH Check blood
 balance) in glucose when
your body. administering
They also insulin.
help control Check BUN
muscle and and creatinine
nerve activity levels.
and perform
other
important
functions.
Calcium 1.00- 1.22 Serum Assess for
1.32mmo1/L calcium is a signs of
blood test to neuromuscular
measure the excitability
amount of including
calcium in tetany and
the blood. Chvostek's
Serum and
calcium is Trousseau's
usually signs. Close
measured to monitoring of
screen for or the patient's
monitor bone respiratory
diseases or status is
calcium- critical.
regulation
disorders
(diseases of
the
parathyroid
gland or
kidneys).

Executive Panel 4
Date Test Normal Value Results Clinical Nursing
Ordered Significance Responsibility
March 26, Fasting blood 3.88- This measures Apply direct
2023 sugar 5.82mmo1/L your blood sugar pressure to
after an the
overnight fast venipucture
(not eating). A site until
fasting blood bleeding
sugar level of 99 stops.
mg/dL or lower is Provide a
normal, 100 to balanced
125 mg/dL meal or a
indicates you snack.
have Instruct the
prediabetes, and patient that
 126 mg/dL or he may
higher indicates resume his
you have usual
diabetes. medications
that were
stopped
before the
test
Creatinine 62.00- 130 This test Explain to the
105.00umo1/L measures patient that
creatinine levels the serum
in blood and/or creatinine test
urine. Creatinine is used to
is a waste evaluate
product made by kidney
your muscles as function.
part of regular, Explain to the
everyday activity patient that
he may
experience
slight
discomfort
from the
tourniquet
and the
needle
puncture
Uric acid 200.00- 490 This test Explain who
420.00umo1/L measures the will perform
amount of uric the
acid in a sample venipuncture
of your blood or and when.
urine (pee). Uric Notify the
acid is a normal laboratory
waste product and the
that your body physician of
makes when it drugs the
breaks down patient is
chemicals called taking that
purines. Purines may affect
come from your test results; it
cells when they may be
die. necessary to
restrict them.
Instruct the
patient to fast
for 8 hours
before the
test.
SGPT ALT Up to 40 U/L 90.8 The alanine You usually
aminotransferase need to fast
 (ALT) test is a (not eat or
blood test that drink) for
checks for liver several hours
damage. Your before these
doctor can use tests.
this test to find
out if a disease,
drug, or injury
has damaged
your liver.
Cholesterol 3.23- A complete Perform a
5.17mmo1/L cholesterol test Lipid profile
— also called a blood test.
lipid panel or lipid
Check blood
profile — is a pressure and
blood test that blood sugar
can measure the to ensure
amount of they are both
cholesterol and in the normal
triglycerides in range.
your blood. Check for
chest pain.
Check if
weight is in
the normal
range.
Check if the
patient
smokes or
has quit.
Ask the
patient about
diet and
exercise.
Triglycerides 0.00- People also ask Apply direct
0.00mmo1/L What does pressure to
triglycerides test the
for? venipuncture
A triglycerides site until
test is a blood bleeding
test that stops.
measures the If a
amount of a fat in hematoma
your blood called develops at
triglycerides. the
High triglycerides venipuncture
may increase site, continue
your risk for a direct
heart attack or pressure.
stroke. A Tell that
triglycerides test patient that
 can help you he may
decide if you resume his
need to take usual diet and
action to lower medication
your risk. that was
discontinued
before the
test, as
ordered.
LDL 0.00- LDL (low-density Perform a
cholesterol 0.00mmo1/L lipoprotein) Lipid profile
cholesterol, blood test.
sometimes called Check blood
“bad” cholesterol, pressure and
makes up most blood sugar
of your body's to ensure
cholesterol. High they are both
levels of LDL in the normal
cholesterol raise range.
your risk for Check for
heart disease chest pain.
and stroke. Check if
weight is in
the normal
range.
Check if the
patient
smokes or
has quit.
Ask the
patient about
diet and
exercise.
HDL 0.00- An HDL Check blood
0.00mmo1/L cholesterol test pressure and
measures the blood sugar
amount of high- to ensure
density they are both
lipoprotein in the normal
(good) range.
cholesterol in
your blood. High
HDL levels may
lower your risk
for heart disease.
CBC TEST
Date Test Normal Results Clinical Nursing
Ordered value Significance Responsibility
March 26, Hemoglobin 135-175g/L 166 A hemoglobin test Explain that
2023 is often used to slight
 check for anemia, discomfort
a condition in may be felt
which your body when the skin
has fewer red is punctured.
blood cells than Encourage to
normal. avoid stress if
possible
because
altered
physiologic
status
influences
and changes
normal
hematologic
values.
Explain that
fasting is not
necessary.
Hematocrit 42.00-50.00 50.3 Hematocrit is a carefully
blood test that assess the
measures how patient with a
much of a low
person's blood is hematocrit for
made up of red his/her ability
blood cells. This to tolerate
measurement physical
depends on the activity.
number of and
size of the red
blood cells. Blood
transports oxygen
and nutrients to
body tissues and
returns waste and
carbon dioxide.
RBC 4.50-5.00 5.48 An RBC count is a Allow vacuum
blood test that in vacutainers
measures how to draw
many red blood blood, never
cells (RBCs) you force blood
have. RBCs into tubes;
contain Consider
hemoglobin, a angiocath/IV
protein which size when
carries oxygen. drawing
How much oxygen blood.
your body tissues Elevated
get depends on RBC results.
how many RBCs Dehydration.
you have and how
 well they work.
MCV 80-100 91.9 MCV (mean Explain test
corpuscular procedure. ·
volume) measures Encourage to
the average size avoid stress if
of your red blood possible
cells. It's included because
in a common altered
blood test called a physiologic
complete blood status
count (CBC). influences
Considered and changes
alongside the normal
results of other
tests, an MCV
blood test can
help your
healthcare
provider
determine if you
have anemia, liver
disease or other
conditions
MCH 27-31pg/cell 30.4 The purpose of a Explain test
mean corpuscular procedure. ·
hemoglobin Encourage to
(MCH) test is to avoid stress if
calculate the possible
amount of because
hemoglobin in an altered
individual red physiologic
blood cell. The status
MCH test is one of influences
several tests that and changes
are used to normal
diagnose and
classify different
types of anemia.
MCHC 320-360g/L 331 The purpose of an Administer IM
MCHC test is to or IV iron
evaluate whether when oral
RBC are carrying iron is poorly
an appropriate absorbed.
amount of Perform
hemoglobin. sensitivity
MCHC is one of testing of IM
several iron injection
measurements to avoid risk
of
anaphylaxis.
 Leucocyte 5-10x10^9/L 11.99 A white blood cell Monitor vital
no. CONC (WBC) count is a signs for
(WBC) test that measures signs of
the number of infection ·
white blood cells Monitor for
in your body. It early signs of
may also be localized and
called a leukocyte systemic
test. infection for
patients at
risk
Neutrophils 55-65 81.8 Neutrophils are Encourage to
the most common avoid stress if
type of white possible
blood cell in your because
body. An absolute altered
neutrophil count physiologic
identifies whether status
your body has influences
enough and changes
normal
hematologic
values.
Explain that
fasting is not
necessary. ...
Apply manual
pressure and
dressings
over puncture
site on
removal of
dinner.
Lymphocytes 25-40 11.3 Lymphocytes are This test
a type of white measures
blood cell. They how quickly
help your body's erythrocytes
immune system or red blood
fight cancer and cells (RBCs)
foreign viruses settle at the
and bacteria. Your bottom of a
lymphocyte count test tube that
can be taken contains a
during a normal blood sample.
blood test at your
healthcare
provider's office.
Monocyte 2-6 5.0 This test counts
the five types of
white blood cells
in your blood
 sample to verify
whether or not
your cell count is
normal, too high
or too
Eosinophils 1-5 0.3 eosinophil count is assess
a blood test that severity of
measures the parasitic
number of one infections,
type of white and monitor
blood cells called response to
eosinophils. treatment.
Eosinophils
become active
when you have
certain allergic
diseases,
infections, and
other medical
conditions.
Basophils 0-1 1.6 This test shows Explain test
the number and procedure
condition of your
white blood cells,
your red blood
cells and your
platelets.
Platelets 140-440 217 A platelet count Perform a
test measures the thorough
number of physical
platelets in your examination. .
blood. A lower ..
than normal Assess vital
platelet count is signs. ...
called Monitor lab
thrombocytopenia. values. ...
Continuously
monitor
coagulation
values. ...
Provide
antidotes as
necessary. ...
Review and
identify
medications
that can
increase the
risk of
bleeding. ...
Provide
 medications
as ordered. ...
Prepare and
assist in
platelet
transfusion.

Urinalysis
Physical examination
Color Light yellow
Reaction :5.0
Character Hazy
Specific gravity 1.030

COMPUTED TOMOGRAPHY RESULT

SIZE THICKNESS
RIGHT KIDNEY 11.0 X 5.6 2.4
LEFT KIDNEY 12.0 X 6.2 2.3

Both kidneys are normal in size and location.

Both shows cortical density. An 18 mm avoid exophytic isodense mass seen in the right
cortex.
The right collecting system is mildly dilated. A 1.3 dense stone seen in the renal pelvis.
Minute stones also seen in the collecting system largest measures 0.7 cm stone in the
inferior pole.
Perinephric fluid and fat stranding appreciable.
Urinary bladder is distended with normal wall thickness.
Prostate is enlarged with calcifications and measures 4.2 x 4.5 x 4.6 cm (volume= 43cc)
Atherosclerotic change seen in the aorta.
Degenerative changes evident in the spine.
Liver is diffusely hypodense.
No other remarkable findings.
IMPRESSION:
- Obstructive uropathy due to a calculus in the renal pelvis, left with perinephric fluid
- Isodense exophytic right renal mass (small renal cell CA, oncocytoma)
- Enlarged prostate with calcifications
- Fatty Liver
- Atherosclerotic Aorta
- Degenerative disease of the spine

XIII. DRUG STUDY

1. K-citrate
Drug name Action Indication Contraindi Adverse Nursing
cation effect considerati
on
Citrate to treat contraindica GI: stomach •Check
inhibits kidney ted in pain Doctors
stone stone patients order
Generic formation condition with CV: difficult - to avoid
name: by called renal hyperkalemi breathing, medical
K-citrate complexing tubular a shortness of error
with calcium acidosis. breath,
Brand in the urine, irregular •Monitor
name: inhibiting heartbeat V/S
urocit k spontaneou - to ensure
s the patient
Classificatio nucleation, health
n: and before
urinary preventing taking the
alkanizers growth and drugs.
agglomerati
Route: PO on of •Inform
crystals. patient to
Dosage: take meals
1080 mg before take
the drugs
-to prevent
GI upset

•Educate
the patient
 in possibly
side effects
pf the
drugs.
-for safety
precautions

•Report any
unsualities
problem.
-to prevent
complicatio
ns

•Record
and
document
-for
evidenced
of the
activity

2. Ketorolac
Drug name Action Indication Contraindi Adverse Nursing
cations effect responsibil
ity
inhibiting manageme contraindica Lethargy, • Check
both COX-1 nt and ted in drowsiness, doctor’s
and COX-2 treatment of pregnancy nausea, order
enzymes acute vomiting, -to avoid
which are moderate to epigastric medical
Generic normally severe pain. pain, error.
name: responsible gastrointesti
ketorolac for nal •Monitor
converting bleeding, V/S
Brand arachidonic headache, -to ensure
name: acid to Rarely, patient is in
toradol, prostaglandi diarrhea, good
birolac ns. occasional condition
convulsions before
Classificatio , administer a
n hypertensio meds.
nonsteroidal n, acute
anti- renal •ask the
inflammator failure, patient if
y respiratory she/he
depression, allergic to
Route: IM and coma. medication
 - to prevent
Dosage: worsen the
15mg condition of
patient.

• educate
the patient
in possibly
side effects
pf the
drugs.
-for safety
precautions

•Record
and
document
-for
evidence of
activity.

3. Febuxostat
Drug name Action Indications contraindic Adverse Nursing
ations effects responsibil
ity
Generic inhibiting indicated for contraindica unstable • Check
name: the activity the chronic ted in chest pain, doctor’s
Febuxostat of an manageme patients heart order
enzyme that nt of with cardiac attack, -to avoid
Brand is hyperurice disease, stroke, or medical
name: responsible mia in adult pregnancy, death error.
adenuric for the patients hepatic
synthesis of with gout disease and •Monitor
Classificatio uric acid, who have breastfeedi V/S
n thereby an ng -to ensure
xanthine reducing inadequate patient is in
oxidase serum uric response to good
inhibitor acid levels. a maximally condition
titrated before
Route: PO dose of administer a
allopurinol, meds.
Dosage: who are
40mg intolerant to •ask the
allopurinol, patient if
or for whom she/he
treatment allergic to
with medication
 allopurinol - to prevent
is not worsen the
advisable. condition of
patient.

• educate
the patient
in possibly
side effects
pf the
drugs.
-for safety
precautions

•Record
and
document
-for
evidence of
activity.

4.Tamsulosin

Drug name Action Indications Contraindi Adverse Nursing

cations effect responsibil
ity
Tamsulosin to treat the contraindica dizziness, • Check
is a symptoms ted to lightheaded doctor’s
selective of an patient with ness, a order
alpha1A- enlarged hypersensiti spinning -to avoid
Generic adrenergic prostate vity, sensation, medical
name: receptor (benign hypotension and fainting. error.
Tamsulosin antagonist. prostatic , prostate
The effects hyperplasia cancer, •Monitor
Brand of or BPH) hepatic V/S
name: tamsulosin which disease, -to ensure
Contiflo XL, are targeted include pregnancy patient is in
Faramsil for the difficulty and good
MR, smooth urinating breastfeedi condition
Flomaxtra muscle ng before
XL, receptors of administer a
Pamsvax the prostate meds.
XL, and urethra.
Tabphyn Blocking •ask the
MR. this patient if
receptor she/he
Classificatio relaxes the allergic to
n smooth medication
alpha
 blockers muscle of - to prevent
the bladder worsen the
Route: PO and urethra condition of
to improve patient.
Dosage: urine flow.
40mg • educate
the patient
in possibly
side effects
pf the
drugs.
-for safety
precautions

•Encourage
patient
complete
bed rest.
-if the
adverse
effects are
present.

•Record
and
document
-for
evidence of
activity.

5. Remoston
Drug name Action Indications Contraindi Adverse Nursing
cations effect responsibil
ity
Sambong Treatment contraindica skin: skin • Check
(Re-leaf) for anti- ted to irritation doctor’s
also urolithiasis patient with and itching order
contains in patients hypersensiti -to avoid
borneol with urinary vity. medical
Generic which has tract stones error.
name: tonic effect with normal
Remoston that kidney •Monitor
promotes function V/S
Brand muscle -to ensure
name: relaxation patient is in
sambong and good
sesquiterpe condition
 Classificatio ne which before
n has an administer a
anti- inhibitory meds.
urolithiasis property in
the Ca- •ask the
Route: PO ATPase patient if
activity in she/he
Dosage: the allergic to
500mg sarcoplasmi medication
c reticulum - to prevent
but the worsen the
exact condition of
mechanism patient.
is unclear.
• educate
the patient
in possibly
side effects
pf the
drugs.
-for safety
precautions.

•Record
and
document
-for
evidence of
activity

XIV. SURGICAL PROCEDURE

Ureteroscopy is a procedure to address kidney stones, and involves the passage of a

small telescope, called a ureteroscope, through the urethra and bladder and up the

ureter to the point where the stone is located. Ureteroscopy is typically performed under

general anesthesia, and the procedure usually lasts from one to three hours.
If the stone is small, it may be snared with a basket device and removed whole from the

urIf the stone is large, or if the diameter of the ureter is narrow, the stone will need to be

fragmented, which is usually accomplished with a laser. Once the stone is broken into

tiny pieces, these pieces are removed.

The passage of the ureteroscope may result in swelling in the ureter. Therefore, it may

be necessary to temporarily leave a small tube, called a ureteral stent, inside the ureter

temporarily to ensure that the kidney drains urine well.

Ureteroscopy usually can be performed as an outpatient procedure, however; patients

may require an overnight hospital stay if the procedure proves lengthy or difficult.

XV. NURSING THEORIES

Robert Havighurst’s Theory “Middle age stage”

According to Havighurst middle age lasts from age 30 to age 60 and is the time

when most people start a family and settle into their adult lives. They maintain jobs, find

new leisure activities, manage social responsibilities, and adjust to physical changes.

And successfully accomplishes the developmental tasks at a stage, they feel pride and

satisfaction, thus, they also earn the approval of their community or society. Moreover,

success provides a foundation that allows a person to accomplish the other

developmental tasks that they will encounter at the later stages. The patient belongs to

the Middle Age stage which covers ages 36 to 60 years old. The developmental tasks in

this stage includes achieving an adult civic and social responsibility, establishing and

maintaining an economic standard of living, assisting teenage children to become

responsible and happy adults, developing adult leisure-time activities, relating oneself
tone’s spouse as a person, accepting and adjusting to the physiologic changes or

middle age, and adjusting to aging parents.

Sigmund Freud’s Theory “Talk therapy or Psychoanalytic Therapy”.

Psychoanalysts help clients tap into their unconscious mind to recover

repressed emotions and deep-seated, sometimes forgotten experiences. By gaining a

better understanding of their subconscious mind, patients acquire insight into the

internal motivators that drive their thoughts and behaviors. Doing so enables patients to

work toward changing negative, destructive behaviors. Freud believed that certain types

of problems come from thoughts, feelings, and behaviors buried deeply in the

unconscious mind. Therefore, the present is shaped by the past — an individual’s

current actions are rooted in early childhood experiences.

Jean Piaget’s theory of cognitive development

suggests that intelligence changes as children grow. A child’s cognitive development is

not just about acquiring knowledge, the child has to develop or construct a mental

model of the world. Cognitive development occurs through the interaction of innate

capacities (nature) and environmental events (nurture), and children pass through a

series of stages. Sensorimotor stage (0–2 years old) Preoperational stage (2–7 years

old) Concrete operational stage (7–11 years old) Formal operational stage (11 years old

through adulthood).

Age
Developmental
 level and task

Sensorimotor The
stage (0–2 sensorimotor
years old) stage is the first
phase of
children’s
cognitive
development.
During this
stage, children
primarily learn
about their
environment
through their
senses and
motor activities.

The According to
Preoperational Piaget, this
Stage 2-7 years stage occurs
old from the age of
2 to 7 years. In
the
preoperational
stage, children
use symbols to
represent
words, images,
and ideas,
which is why
children in this
stage engage
in pretend play.

I Concepts
attached to
The Concrete
concrete
Operational
situations.
 Stage 7-11 Time, space,
years old and quantity
are understood
and can be
applied, but not
as independent
concepts.

Formal Theoretical,
operational 11 hypothetical,
years and older and
counterfactual
thinking.
Abstract logic
and reasoning.
Strategy and
planning
become
possible.
Concepts
learned in one
context can be
applied to
another.

XVI. NURSING CARE PLAN

NURSING CARE PLAN – Acute Pain
Assessment Diagnosis Planning Intervention Rationale Evaluation
March 27, Acute pain Short term: Independent: Goal met.
2023 @ 9:00 related to After 2 - Document the pt’s - Help in
A.M. increased hours, of characteristics and determining the Short term:
frequency/ nursing level of pain (pain effectiveness of After 2
Subjective: force of intervention scale 1-10). the treatment and hours, of
“Sakit kayo ureteral s, the monitoring of nursing
akong kilid contractions patient will progress. interventio
ma’am, dili as be able to - Monitor vital signs. - To provide ns, the
nako evidenced report relief baseline mgt. patient had
makatindog by of pain from - Implement comfort - Promotes reported
sa ka sakit”, verbalizatio 10/10 to measures (back rub, relaxation, relief of
as verbalized n of severe 4/10 with restful environment). reduces muscle pain from
by the pt. pain on spasms tension and 10/10 to
LLQ, controlled. enhances coping. 4/10 with
Objective: moaning - Assist the patient - Ambulation can spasms
- Increased and facial Long term: with frequent aid in the controlled.
frequency/ grimace After 1 day ambulation. passage of kidney
force of of nursing stones via gravity. Long term:
ureteral Rationale: intervention, - Provide rest in - This promotes After 1 day
contractions Acute pain the patient between activities relaxation of nursing
- is common will be able and a peaceful reducing muscle interventio
verbalization in patients to appear environment. tension. n, the
of severe with relax and patient
pain on left urolithiasis will be able Dependent: appeared
lower because the to sleep/rest - Administer - To relieve pain relaxed
quadrant pain passage of appropriatel medication, as relaxes the and can
- moaning kidney y. prescribed. muscles spasms. sleep/rest
and facial stones - Encourage pt and - Promotes appropriate
grimace through the increase fluid intake frequent urination ly.
- VS taken: urinary tract up to 3-4 liters a day and prevent
BP: 130/90 can cause as tolerated. passing of stones.
PR: 98 bpm irritation, - Educate pt about - Sitz bath is
RR: 21 cpm inflammatio sitz bath and apply a proven to be
T: 36 °C n, and warm compress to effective in
W: 88 kgs. obstruction, the lower abdomen. muscle relaxation.
H: 156 cm leading to - Educate pt about - This facilitates
O2: 98 % intense diversional activities control of
- Pain scale: pain. such as focused attention from
10/10 breathing and guided pain and
imagery. relaxation of
muscles.
- Encourage pt to - For immediate
report feelings of any action and
changes in pain. management

NURSING CARE PLAN – Impaired Urinary Elimination

Assessment Diagnosis Planning Intervention Rationale Evaluation
March 27, Impaired Short term: Independent: Goal met.
2023 @ 9:00 urinary After 8 - Assess the pt’s - This will serve as
A.M. elimination hours of current elimination baseline data to Short term:
compare with the After 8
Subjective: related to nursing pattern and compare present condition. hours of
“Gagmay stimulation interventio it with the patient’s nursing
lang kayo of the n, the normal elimination interventio
akong ginaihi bladder by patient will pattern. - This will n, the
ma’am”, as calculi be able to - Monitor patient’s determine the pt’s patient has
verbalized by renal or achieve a intake and output. hydration status. achieved a
the pt. ureteral normal - To check for normal
irritation as elimination - Palpate the bladder. bladder distention elimination
Objective: evidenced amount and fluid retention. amount
- Stimulation by urgency and - It facilitates the and
of the bladder and pattern. - Assist the patient passage of kidney pattern.
by calculi, frequency with frequent stones.
renal or to urinate Long term: ambulation. - Calculi may cause Long term:
ureteral and After 3 - Determine patient’s nerve excitability, After 3
irritation oliguria days of normal voiding which causes days of
- Urgency (retention) nursing pattern and note sensations of nursing
and interventio variations. urgent need to void. interventio
frequency to Rationale: n, the n, the
urinate; The patient will Dependent: - Adequate fluid patient has
oliguria presence be able to - Encourage an intake increases verbalized
(retention) of kidney verbalize increase in water urine production. techniques
- VS taken: stones in techniques intake. - This will relieve to prevent
BP: 130/90 the urinary to prevent - Encourage the bladder distention urinary
PR: 98 bpm tract can urinary patient to void every and avoid urine retention
RR: 21 cpm cause retention 2 to 3 hours. accumulation. and
T: 36 °C blockages and will be - This may help the experience
W: 88 kgs. or partial able to - Instruct the patient primary care d no signs
H: 156 cm obstruction experience to strain every urine provider to plan of
O2: 98 % , impaired no signs of voided and document appropriate obstruction
urinary obstruction the characteristics of treatment. .
elimination . the stones and urine. - Bladder training
is a - Educate on bladder prevents urinary
common training and pelvic retention relieving
problem in floor exercises. bladder distention.
patients - Elevated BUN, Cr,
with - Check laboratory and certain
urolithiasis. studies (electrolytes, electrolytes indicate
BUN, Cr). presence and
degree of kidney
dysfunction.

NURSING CARE PLAN – Risk for Deficient Fluid Volume

Assessment Diagnosis Planning Intervention Rationale Evaluation
March 27, Risk for Short term: Independent: Short term:
2023 @ 9:00 deficient After 8 - Monitor intake and - Adequate intake After 8
A.M. fluid hours of output along with and output mean hours of
volume nursing the patient’s daily adequate kidney nursing
Objective: maybe intervention, weight. function and intervention,
- Post related to the patient hydration status of the patient
obstructive post will be able the patient. has
diuresis obstructive to maintain - Dehydration and maintained
- Nausea/ diuresis, adequate - Assess the electrolyte adequate
vomiting nausea/ fluid patient’s mental imbalance may fluid
(generalized vomiting as balance as status and skin affect the patient. balance as
abdominal evidenced evidenced integrity every 2 evidenced
and pelvic by by vital hours. by vital
nerve presence signs and - Monitor vital signs - VS changes as signs and
irritation from of renal weight frequently. indication of weight
renal or calculi within hypovolemia. within
ureteral colic) patient’s - Check Hb and Hct, - Assesses patient’s
- VS taken: Rationale: normal electrolytes. hydration and normal
BP: 130/90 Patients range, effectiveness or range,
PR: 98 bpm with palpable. need for palpable.
RR: 21 cpm urolithiasis interventions.
Dependent:
T: 36 °C are at risk Long term: Long term:
- Administer - Maintains fluid
W: 88 kgs. for After 3 days After 3 days
intravenous fluid as balance and
H: 156 cm deficient of nursing of nursing
ordered. prevents
O2: 98 % fluid intervention intervention
volume s, the dehydration. s, the
- Instruct the patient - To replace lost
due to patient will on gradual oral patient has
factors be able to volume from maintained
intake as tolerated. vomiting and
such as maintain peripheral
dehydratio peripheral maintain pulses,
n, reduced pulses, - Educate the homeostasis. moist
oral intake, moist patient about fluid - Electrolyte-rich mucous
and mucous replacement oral fluids such as membranes
increased membranes therapy. sports drinks can , and good
urinary , and good help replace fluid skin turgor.
output skin turgor. loss.
resulting - Administer
from the antiemetics as - Resolve vomiting
formation ordered. and prevent
and electrolyte
passage of imbalance.
kidney
stones.
 NURSING CARE PLAN – Risk for Infection
Assessment Diagnosis Planning Intervention Rationale Evaluation
March 27, Risk for Short term: Independent: Short term:
2023 @ 9:00 infection After 8 hours After 8 hours
A.M. may be of nursing - Monitor vital - To provide of nursing
related to interventions signs. baseline interventions,
Objective: introductio , the patient management. the patient
- Impaired n of will be able will be able to
urinary bacterial to verbalize - Monitor fluid - For adequate verbalize
elimination following understandin intake and output. kidney function understandin
- Infected, manipulatio g on and hydration g on
scarred ns of the preventing status. preventing
tissue may be urinary infection and infection and
a site for - Monitor patient’s - To identify
tract and be able to be able to
calculus urine output (color indication of
obstructed demonstrate demonstrate
development urinary or smell). onset infection.
techniques, techniques,
- infected blood flow lifestyle lifestyle
- Instruct patient to - To reduce
calculi possibly changes to changes to
properly wash bacterial
- urinary tract evidence promote safe promote safe
genital area after colonization.
infection by environment. environment.
urinating.
- VS taken: impaired
BP: 130/90 urinary Long term: Long term:
PR: 98 bpm elimination. After 1 week Dependent: After 1 week
- For immediate
RR: 21 cpm nursing - Instruct the patient action for onset nursing
T: 36 °C Rationale: interventions to report changes in infection. interventions,
W: 88 kgs. Urolithiasis , the patient color and smell of the patient
H: 156 cm can lead to will be able urine. will be able to
O2: 98 % urinary to adapt adapt
stasis, techniques - Encourage patient - For assurance techniques
which and be able on contacting of right and and be able
enables to maintain health care provider appropriate to maintain
bacteria to consistency for further check-up therapies and consistency
adhere to in preventing if infection occur. medications in in preventing
the infection. regard of the infection.
urothelium infection.
and
multiply,
thereby
causing
infection.

NURSING CARE PLAN – Deficient Knowledge

 Assessment Diagnosis Planning Intervention Rationale Evaluation
March 27, Deficient Short term: Independent: Short term:
2023 @ 9:00 knowledge After 8 - Emphasize - Flushes renal After 8
A.M. related to hours of importance of system, decreasing hours of
lack of nursing increased fluid intake opportunity for nursing
Subjective: exposure interventio of 3–4L a day or as urinary stasis and interventio
“Unsa may and n, the much as 6–8 L a day. stone formation. n, the
dpat nako unfamiliarit patient will - Promote regular - Inactivity patient had
buhaton ani y with the be able to activity and exercise contributes to stone verbalized
akong sakit information verbalize program. formation through understand
ma’am?”, as resources understand calcium shifts and ing of the
verbalized by as ing of the urinary stasis. disease
the pt. evidenced disease - Assess the patient’s - To determine the process
by asking process level of knowledge pt’s cognitive level and
Objective: questions and and understanding. to properly plan for potential
- Questions; potential an effective complicatio
request for Rationale: complicatio teaching approach. ns of
information Patients ns of - Assess the patient’s - Certain beliefs having
- Lack of with having beliefs and may block the renal
exposure/rec urolithiasis renal willingness to learn. patient from calculi.
all may have calculi. accepting
- Unfamiliarity deficient information from
with knowledge another person. Long term:
information Long term: Dependent: After 3
regarding
resources After 3 - Educate the patient - Detailed days of
the
- VS taken: days of about his/her information about nursing
condition,
BP: 130/90 nursing condition and the condition will interventio
its
PR: 98 bpm interventio treatment plans in a help the patient ns, the
manageme
RR: 21 cpm ns, the language that the accept and trust the patient has
nt, and
T: 36 °C patient will patient can easily treatment plan. initiated
prevention
W: 88 kgs. be able to understand. necessary
strategies,
H: 156 cm initiate - Encourage lifestyle - High sodium and lifestyle
as well as
O2: 98 % necessary modification such as animal protein food changes
potential
lifestyle proper diet and have increased and
complicatio
changes regular exercise. renal stone participate
ns and
when to and be formation. in
- Instruct the patient - This will
seek able to treatment
to repeat the given determine the
medical participate regimen.
information about patient’s
attention. in
his/her condition. comprehension of
treatment
regimen. the information
given.
XVII. DISCHARGE PLANS (M.E.T.H.O.D.S.)
Medicatio Exercise Treatment Health Out Diet Sexuality
n Environmen teaching patient
t
Home Exercise . Drinking Limit the Instruct °Drink plenty Encourage
Medication helps in water. amount of patient of fluid: 2-3 the patient to
maintaining Drinking as salt to attend quarts/day. continuously
Advised
the overall much as 2 (sodium) in follow exercise and
the patient °Limit foods
fitness of the to 3 quarts your diet. up Diet, regular
to have with high
body. (1.8 to 3.6 Eat a checkup exercise and
drug oxalate
Regular liters) a day balanced and to self-
compliance content.
exercise will keep diet that is monitor management
as
keeps your urine not too the °Eat enough are essential
prescribed
obesity, dilute and high in health dietary and also eat
by the
cholesterol, may protein. conditio calcium. a balance
physician
and blood prevent Limit foods n of the diet that not
as °Avoid extra
pressure in stones that are patient if too high in
check. Since from high in a their calcium protein and
Ketorolac
these are the forming. substance have supplements avoild extra
K. Citrate risk factors called any . calcium
Pain
Febuxostat for kidney relievers.
oxalate, problem °Eat a supplements
stones, it is which can to the moderate .
Passing a
easy to cause the amount of
Tamsulosin establish that small stone
kidney patient protein.
can cause
Remoston exercising some
stones. conditio
can prevent These n call °Avoid high
discomfort. salt intake.
kidney foods the Dr
To relieve
stones to a include always °Avoid high
mild pain,
considerable dark green doses of
your doctor
extent. vegetables, vitamin C
may
rhubarb, supplements
Also, if you recommen
chocolate, .
exercise d pain
wheat
regularly, it relievers
bran, nuts,
helps in such as
cranberries
maintaining ibuprofen
, and
the levels of (Advil,
beans.
salt, calcium, Motrin IB,
and minerals others) or
in the body. naproxen
This will sodium
 ensure that (Aleve).
the excess
Medical
oxalates,
therapy.
salt, and
Your doctor
minerals are
may give
flushed out of
you a
the body
medication
thereby
to help
preventing
pass your
them from
kidney
crystallizing.
stone. This
Exercise will
type of
also divert
medication,
the excess
known as
calcium to
an alpha
the bones.
blocker,
Regular relaxes the
exercises muscles in
help to your ureter,
prevent helping you
further pass the
enlargement kidney
of the stone. stone more
Mild quickly and
exercises like with less
jogging and pain.
skipping can
reduce the
chances of
salts and
minerals
sticking to
the stone,
thereby
keeping the
size of the
stone in
check.

XVIII. PROGNOSIS
 Category Poor Fair Good Rationale
Onset of illness / Our patients
seems for
medical care
Duration of / The patient
illness experience with
immediate
consultation to
the physician
Attitude/willingly / The patient is
of illness decided to
undergo for
ureteroscopy
surgery for his
condition which
is urolithiasis
Environment / Our patient is a
driver, didn't
maximize
drinking water
Age / The patient is
54 years old for
his condition he
is already in
the age range
to be
diagnosed of
his current
diagnosis
Family support / The patient
significant
others are
supportive but
they're give
much time to
drinking water

XIX. RECOMMENDATIONS
This case study has provided as with important information about the patient having
Urolithiasis nursing care. In order to ensure that optimal health is restored and
maintained, the group would like to recommend the following:
To the patient
 Patient should have a follow up checkup as advised by doctor.
 Practiced healthy lifestyle and proper hygiene
 Adhere therapeutic plan by the doctor.

To the family and significant others
 Assist client and her activity.
 Should actively participate in providing, promoting, assisting the client to perform
health activities.
 Should be knowledgeable of the signs and symptoms of complications to be
reported.
 Should understand the importance of follow up checkup for the monitoring of
complications.
To the caregivers
 Explain or teach about the nature of the patient’s conditions.
 Always make ones self-available for the patient needs.
 Provide emphasis on strict compliance of medication.

References:

https://www.ncbi.nlm.nih.gov/books/NBK559101/#:~:text=Renal%20stones%20are
%20formed%20within,ureters%2C%20bladder%2C%20and%20urethra.
https://bmcurol.biomedcentral.com/articles/10.1186/s12894-022-01161-
x#:~:text=There%20are%20many%20differences%20in,population%20of%20China
%20%5B4%5D.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524187/#:~:text=Roughly%20half
%20a%20century%20before,the%20coexistence%20of%20both%20diseases.

David L. Keller, MD. (October 20019). Kidney stones. Cleveland Clinic Journal of

Medicine
Matt Vera, R.N. (March 1, 2023). Urolithiasis (Renal Calculi). Nurseslabs

Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An

evidence-based guide to planning care. St. Louis, MO: Elsevier.