Renal Calculi Exam Study Guide 2021, Exams of Nursing

Download Renal Calculi Exam Study Guide 2021 and more Exams Nursing in PDF only on Docsity! 1 RENAL CALCULI EXAM STUDY GUIDE 2021 Professor Norma Miller Tuesday Group Health Alteration 1 September 22, 2017 1. Zeneta Hoffman 2. Steffi Casanova 3. Moses Lackhan 4. Maria Penades 5. Edj Cadet 6. Beverly Gustave 7. Jennifer Gabai 2 RENAL CALCULI EXAM STUDY GUIDE 2021 TABLE OF CONTENTS: Scenario …………………………………………………………………………… Page 2 Questions/Answers .................................................................................................... Page 2 Case Study Progress ................................................................................................... Page 4 Concept Map .............................................................................................................. Page 5 Nursing Interventions / Rationales ............................................................................. Page 6 References .................................................................................................................. Page 12 5 RENAL CALCULI EXAM STUDY GUIDE 2021 If I saw the patient trying to get out the bed I would go in to see if he needs assistance with anything. I would explain to him the importance of him being in bed since he is fatigued and under the effect of opioids, which are risk factors for falls. I would place this patient on fall risk and put the bed alarm on. I would encourage the patient to use the call bell if he needs help with anything. (Perry, Potter, Ostendorf pg 297-298) CASE STUDY PROGRESS F.F. is going to be admitted. You call the unit nurse to give the report. You tell her he’s been up all night with pain that has just been relieved by IV morphine. You don’t know whether he’s going to have lithotripsy or surgery. 7. You tell F.F. he is going to be admitted and will probably need surgery for his kidney stone. He looks at you, panicked, and says, “I can’t do that. I don’t have any insurance. This is costing me a wad already.” How are you going to respond? I understand your concern of the cost, but interventions care is essential to improve your health. The stone will lead to urinary stasis, blood in the urine, and at risk for UTI’s. I can refer you to the hospital’s case manager to discuss financial options or payment plan. There also agencies and programs that are setup to help individual with cost. I can ask the doctor for a referral to social services. 6 RENAL CALCULI EXAM STUDY GUIDE 2021 CONCEPT MAP TEMPLATE STUDENT: PATIENT’S INITIALS: F.F AGE: 58 GENDER: Male MEDICAL DIAGNOSIS: Nephrolithiasis. ASSIGNMENT: 1 Use the concept map model to prioritize patient’s needs/problems. 2 IDENTIFY 8 Nursing Diagnosis (Actual and Potential). 3 In the boxes, TYPE the physiological nursing diagnosis 4 For each nursing diagnosis 5 to 10 nursing interventions and rational for each. 5 This document should be types and each student should have a copy Problem/Need # 4 Risk of injury related to falls. As evidence by: Patient is under the effect of opioids for pain management and is attached to and IV pole. Write Pt. Diagnosis/surgical procedures Staghorn-type stone in right renal pelvis Lithotripsy Key Assessments: 142/80, 88, 20, 99.0° F, hematuria, severe right flank and abdominal pain Problem/Need # 5 Deficient Knowledge r/t insufficient information or knowledge of resources as evidenced by enlarged right kidney and staghorn- type stone in right renal pelvis. Problem/Need # 6 Ineffective health management related to inability to follow diabetes management plan. As evidence by: glucose 260 mg/dl. Patient states that he did not sleep well last night and has not eaten much today. Problem/Need # 7 Fatigue related to lack of energy or inability to maintain usual level of physical activity. As evidence by: Patient states that he did not sleep well and is fatigued. Problem/Need # 8 Fear related to surgery and lack of health insurance. As evidence by: Patient looks panicked, and says, “I can’t do that. I don’t have any insurance.” Problem/Need # 3 Risk for fluid volume, imbalance related to nausea and vomiting As evidence by: Patient reports nausea and vomiting. Problem/Need # 2 Impaired urinary elimination related to obstruction As evidenced by staghorn- type stone in right renal pelvis. Problem/Need # 1 Acute pain R/T reports of right renal colicky pain. As evidence by: right flank is extremely tender to touch and palpation; urinalysis shows hematuria; Vital signs are 142/80, 88, 20, 99.0°F BROWARD COLLEGE NURSING DEPARTMENT 7 RENAL CALCULI EXAM STUDY GUIDE 2021 1. Acute pain R/T reports of right renal colicky pain. As evidence by: right flank is extremely tender to touch and palpation; urinalysis shows hematuria; Vital signs are 142/80, 88, 20, 99.0°F Action/interventions Rationales Monitor for pain at least every 2 hours on even hour. Use pain scale of 1-10. Document nonverbal signs such as increase BP and pulse, restlessness, and moaning. Pain is subjective in nature, and only the patient can fully describe (Newfield, Hinz, Tilley, Sridaromont, Marimba, p. 487). Teach the patient to report pain as soon as it starts. Allow the patient to describe the pain in detail to include aggravating factors, relieving factors and type of pain (burning, tingling, and throbbing). Pain is more readily controlled when it is treated early. Treating pain at first report prevents the client from experiencing a “roller coaster” effect of pain relief alternating with pain elevation (Newfield et al., p. 487). Monitor vital signs at least every 4 hours while awake. Detects early changes that might indicate pain (Newfield et al., p. 487). Monitor Sleep-rest pattern. Promote rest periods during day and at least 8 hours sleep each night. Fatigue may contribute to an increased pain response, or pain can contribute to interrupted sleep (Newfield et al., p. 487). Allow time for the patient to discuss fears and anxieties related to pain by scheduling at least 15 minutes once per shift to visit with the patient on one-to-one basis. Just as pain is unique to the individual, so is the pain control intervention. Discussions with the patient provide collaboration and increase the patient’s compliance. Decreases feelings of powerlessness, and initiates basic teaching regarding control of pain (Newfield et al., p. 487). Teach the patient and significant others: cause of pain, common side effects of analgesics, the low rate of addiction when narcotics are used for pain, the importance of maintain round-the clock dosing for continuous pain and preventive dosing for expected pain. Knowledge assists the patient in feeling like an active participant on the health team. Decreases sense of powerlessness. Promotes effective pain management (Newfield et al., p. 487). Refer the patient to or collaborate with other health-care professionals Collaboration promotes the best long-range plan for management of pain (Newfield et al., p. 487). 2. Impaired urinary elimination related to obstruction As evidenced by staghorn-type stone in right renal pelvis. Action/interventions Rationales Record I&O and characteristics of urine. Provides information about kidney function and presence of complications (infection and hemorrhage). Bleeding may indicate 10 RENAL CALCULI EXAM STUDY GUIDE 2021 Assess the patient’s knowledge of renal stone prevention. The recurrence of renal stones may indicate a knowledge deficit regarding prevention. This information provides the starting base for educational sessions (Gulanick & Myers, p. 805.e1). Assess the patient’s self-efficacy to learn and apply new knowledge about the relationship of diet, fluid intake, and activity to the development or recurrence of renal stones. A first step in teaching may be to foster increased self-efficacy in the patient’s ability to learn the desired information or skills. Some lifestyle changes can be difficult for the patient to make. Restriction of calcium intake may not prevent the recurrence of calcium salt stones. An increased protein intake may be a more significant factor in calcium stone formation. In some patients, an increased calcium intake may decrease the formation of calcium salt stones. Studies suggest a relationship between the intake of sucrose and sodium with increased stone formation. People who have a sedentary lifestyle or limited mobility are at a higher risk for the development of renal calculi because of calcium loss from bones combined with urinary stasis (Gulanick & Myers, p. 805.e2). Assess for a history of medical factors that predispose to the formation of renal stones. Medical conditions that result in the stasis of urine or a calcium imbalance are associated with the development of renal stones. In men, prostatic hyperplasia and the resulting urine stasis may contribute to stone formation (Gulanick & Myers, p. 805.e2). Teach the patient about straining all urine. This procedure detects the passage of stones, stone fragments, or gravel. If the type of stone (i.e., composition) is unknown, the stone may be sent to a laboratory for analysis. This information assists in planning therapy to prevent the recurrence of stones and for diet modification. Stone fragments may continue to pass for weeks after stone crushing or lithotripsy. The patient may be responsible for straining urine at home and recognizing the passage of a stone (Gulanick & Myers, p. 805.e2). 11 RENAL CALCULI EXAM STUDY GUIDE 2021 Teach the patient the importance of maintaining a fluid intake of 3000 to 4000 mL/day. Increased fluid intake helps dilute the concentration of crystals in the urine, prevents urinary stasis, and flushes urine crystals from the kidney (Gulanick & Myers, p. 805.e2). Teach patients to increase activity. Increased physical activity prevents the stasis of urine in the bladder and facilitates passage of stones (Gulanick & Myers, p. 805.e3). Teach the patient to report the signs of infection: • Pain not relieved by medication • Fever accompanied by nausea, vomiting, chills • Changes in appearance or odor of the urine Renal stones may be a factor in developing a urinary tract infection. Some episodes of renal stones may be the result of a urinary tract infection. Early recognition of an infection by the patient allows for prompt treatment (Gulanick & Myers, p. 805.e4). 6. Risk for unstable blood glucose level related to diabetes and excessive stress As evidence by: glucose 260 mg/dl. Patient states that he did not sleep well last night and reports intense pain. Nursing intervention Rationale Investigate the patient’s prior efforts to manage the diabetes care regimen. Successful management of diabetes involves ongoing interaction among patient, caregiver and inter-professional team (Lewis, Bucher, Heitkemper & Harding, 1139). Evaluate the patient’s self-management skills, including the ability to perform procedures for blood glucose monitoring and the ability to afford the cost of treatment. Careful assessment of what it means to the patient to have diabetes is a good starting for teaching (Lewis, Bucher, Heitkemper & Harding, 1139). Monitor glucose levels Normal fasting levels for an adult are 70-105 mg/dl. Critical values for hypoglycemia are less than 40-50 mg/dl. Critical values for hyperglycemia are greater than 400 mg/dl. (Gulanick & Myers, p. 119). Collaborative: Administer insulin as needed and prescribed Patients with diabetes tipe 2 may require exogenous insulin during periods of severe stress such as illness or surgery (Lewis, Bucher, Heitkemper & Harding, 11325). Educate the patient about the importance of following the prescribed treatment regimen. It will have a better understanding on the importance of such treatment and to comply with it. Patients who actively manage their diabetes care have better outcomes than those who do not (Lewis, Bucher, Heitkemper & Harding, 1140). 12 RENAL CALCULI EXAM STUDY GUIDE 2021 7. Fatigue related to lack of energy or inability to maintain usual level of physical activity. As evidence by: Patient states that he did not sleep well and is fatigued. Nursing intervention Rationale Address issues that will interfere with sleep, including pain. Mental and physical stress contribute greatly to a sense of fatigue. (Newfield et al., p. 341) Promote rest at night: Back massage, quit environment. Realistic schedules based on the patient’s input promote participation in activities and a sense of success. (Newfield et al., p. 342) Instruct the patient in stress reduction techniques. Have the patient return- demonstrate at least once a day through the day of discharge. Mental and physical stress contribute greatly to a sense of fatigue. (Newfield et al., p. 342) Provide frequent rest periods. Schedule at least 30 minutes of rest after any strenuous activity Realistic schedules based on the patient’s input promote participation in activities and a sense of success. (Newfield et al., p. 342) Assist the patient with self-care as needed. Plan gradual increase in activities over several days. Allows the patient to gradually increase strength and tolerance for activities (Cox, 342). 8. Fear related to surgery and lack of health insurance. As evidence by: Patient looks panicked, and says, “I can’t do that. I don’t have any insurance.” Nursing intervention Rationale Establish a therapeutic and trusting relationship with the patient and family by actively listening, being nonjudgmental, sitting with the patient, etc. Promotes an environment that encourages the patient and/or family to verbalize concerns. Promotes an empathetic environment (Newfield et al., p. 554). Identify other primary nursing needs, and deal with these as needed. Make referrals to social services or other community resources as needed. Attention to basic needs may decrease feelings of hopelessness and of being of no value. Collaboration promotes a more holistic and complete plan of care (Cox, 554). Provide explanations and appropriate teaching for procedures, diagnosis, treatments, and prognosis. Allows the patient to validate reality (Newfield et al., p. 554). Involve the patient in developing attainable goals and plan of care. Assist the patient to identify positive aspects of the situation Allows the patient to validate reality (Newfield et al., p. 554). Assist the patient to find alternatives to feelings of hopelessness. Validates reality and encourages use of alternate coping techniques (Newfield et al., p. 554). Identify religious, cultural, or community support groups prior to discharge. Provide appointments for follow-up. Support groups can provide advocacy for the patient and continued monitoring and support of the patient after discharge from the hospital