Pelviolithiasis is the presence of stones in the renal pelvis.

The renal pelvis is the enlarged upper end of the ureter, the tube through which the urine flow from the kidney to the urinary bladder.

A kidney stone is a hard, crystalline, mineral formed within the kidney of urinary tract. It is formed in the body from different compounds, most are calcium oxalate or calcium phosphate however, uric acid, struvite, and cystine are also stone formers

Uric acid is a waste product of the body excreted through the urine and stool. However, if the kidneys fail to excrete uric acid properly it will remain in the blood and will eventually result to gout or kidney stones.
Uric acid stones are formed because of the excess uric acid in the urine.

It is one of the most painful urologic disorder. Each year almost 3 million people suffer from pelvic stones.

Genetic High protein and salt intake, diet rich in meat, fish, chicken Vitamin B6 deficiency Dehydration Excessive vitamin C intake, Calcium supplements, and antacids containing calcium

Flank Pain Hematuria Nausea and vomiting Fever, chills Urinary urgency and difficulty

Laboratory test
Urinalysis Blood test

Ultrasound CT scan X-ray

SURGICAL TREATMENT
Pyelolithotomy

-the procedure of choice for stones within the renal pelvis, including stones that demonstrated minimal invasion into calyces and infundibulum. CONSERVATIVE THERAPY Hydration Diet Lifestyle changes

Pain Management Increase fluid intake Observe for anuria Observe for signs of infection Strain the urine to detect stones passing through and save the stones for analysis

Reduce anxiety
Health teaching
Explain procedure to patient and family
Explain importance of exercise and diet

modification If undergoing flank of abdominal incision, teach deep breathing exercises and coughing exercise

Functions of kidneys: -Regulate blood volume and composition -help regulate blood pressure -synthesize glucose -release erythropoietin -participate in vitamin D synthesis -excrete wastes in the urine

Name: Mrs. Tabarol Age: 51 Sex: Female Address: Iyatan St. Ilaya Del Sur, Paete, Laguna Nationality:Filipino Religion: Catholic Civil Status: Married Birthday: 12/02/1960 Date and time of admission: June 27, 2012 (9:15am) Final diagnosis: Pelviolithiasis Principal Operation/ Procedure: Left Pyelolithotomy

During early 2011, Mrs. Tabarol complained of on and off flank pain radiating to her left trunk, hypertension and hyperacidity. She decided to have a consultation at Pakil Hospital where she was diagnosed of UTI and was admitted for a week. She had undergone an ultrasound which revealed two stones in the renal pelvis at 0.7 and 0.8 cm in size. She was prescribed to take Acalka (potassium citrate) twice or thrice per day for a year, Co-amoxiclav taken 3x per day for a month, ranitidine (Zantax) and omeprazole for her hyperacidity and vitamin B complex. She also used herbal medicine like sambong and had decided to change her eating habits.

After a few months, she complained of hyperacidity that she cannot bear and consulted at a private clinic at Pagsanjan where she was prescribed to take Maalox everytime she experience hyperacidity and heartburn. Mrs. Tabarol went to Dra. Villanueva for a second opinion regarding the result of her ultrasound and was told that she has to undergo surgery within 2 months to prevent the increase in size of her stones and was then referred to Dr. Chumacera at Laguna Doctor's Hospital. She was then referred by Dr. Chumacera at Laguna Provincial Hospital for surgery.

At 6 years old, she was diagnosed with asthma but did not progress. during her college years, she was accidentally hit by a reversing passenger jeepney on her left breast and ignored it. During early 1980's, she had felt a lump on her left breast and had a left breast biopsy which returned negative. Patient has no known allergies.

The patient's mother had a history of hypertension, CVA and goiter while her father was hypotensive. She was the youngest of the five children, two of her siblings has DM, one has stroke and the other has choledocholithiasis.

Before Hospitalization

During Hospitalization She verbalized that she realizes that it is her fault why she is in the hospital. In spite that she already knows her condition, she still continues to take food high in sodium and fats. She promises that she will follow the medication and avoid the foods/ beverages that are bad for her. She stated that she experienced loss of appetite because she was used to in eating salty foods before she was hospitalized. Now she is able to identify the importance of her diet which is to avoid foods high in fats and sodium.

I. Health perception/Health management

She stated that her perception to health is when there is no feeling of pain or illness, if she having a perspiration and if she normally doing thing well. She verbalized that she is aware and understand her health condition.

II. NutritionaL Metabolic Pattern

Pattern/

The patient stated that shes having three meals per day. Her usual meals are meat, fish, and vegetables. She loves to eat fatty and salted foods such as peanuts and cornick. She verbalized that she lost her weight about 5 kg. From 64 to 59 kg. She sometimes skipped her breakfast and keeps herself hungry for about two hours. She drinks at least six (6) glasses of water a day which is the same as 1440 ml. a day. She also takes milk during breakfast or before going to sleep. She mentioned that she does not drink coffee and doesnt drink much soft drink. She also said that she started having loss of appetite because of her hyperacidity.

Before Hospitalization

During Hospitalization Patient stated that after the procedure, she did not have bowel movement for two days. She did not complain of any difficulty in urination or urgency. And she observed that the color of her urine is light yellow.

III. Elimination Pattern

Patient verbalizes, at first she is eager in drinking plenty of water so that she may urinate more often since drinking more water makes her urinate more frequent but then she gets tired of doing this thats why she limited again her fluid intake and sometimes delays the time when she needs to urinate especially at bed time. Her bowel movement is once a day, with black stool. In addition to that, she stated that she doesnt have any difficulty in defecating.

IV. Activity and exercise Pattern

Patient verbalizes that she gets easily stress She stated that she can do her daily activity out. She does not have any exercise. The with some assistance from her husband and patients lifestyle include activity such as other family members. eating and doing house chores, being a Brgy.officer ,she is active in participating to any Brgy.activities. She also makes sure to have a quality time with her family.

Before Hospitalization

During Hospitalization

V. Sleep/Rest Pattern

The patient verbalized that she usually has six The patient stated that she needs to sleep (6) hours of sleep every day. She usually go to most of her free time to recover and restore sleep at eleven (11) in the evening and wakes energy. up five (5) in the morning. There are in between resting period any time every day by taking naps 15-20 minutes.

VI. COGNITIVE/PERCEPTUAL PATTERN

The patient stated that shes not having difficulties in understanding and following directions. Her ability to concentrate in work is still intact. She is still able to retain information, and make decisions and solve problems related to work and family. She also said that she uses reading glasses and that she is farsighted. She had her last eye check up on January 2012. The patient did not report any hearing difficulties.

During history taking of the patient, she recalls her personal information without difficulties and with confidence and consistencies. She still uses her reading glasses when she needed to and also has good hearing acuity.

Before Hospitalization

During Hospitalization Even though she was hospitalized, the patient stated that it is just temporary and after she is well, she can be functional again and resume to her usual role as a wife, a mother, a sibling, and as a barangay kagawad. The patient has a good eye contact and is relaxed while expressing herself.

VII. SELF-PERCEPTION/SELFCONCEPT PATTERN

The patient described herself as a jolly, positive-thinking person. Masaya ako kapag nakakatulong ako sa ibang tao. She said that she sees herself as a hardworking person because she doesnt want other people to have something bad to say about how she works. She wants her peoples satisfaction. Most of the instances that she loses hope are due to her family problem such as when that time that her daughter got pregnant when she was still in college and when her eldest son got separated from his wife. The patient is living with her husband and one of her sibling. All of her children have now their own families. Both she and her husband have jobs where they get their daily needs. She felt that the people in her barangay accepted her as their kagawad because they cooperate whenever she asks.

VIII. ROLE/RELATIONSHIP PATTERN

According to the patient, her whole family is very caring to her. Her husband is very supportive to her financially and morally, as well as their children who helped much in her hospital bills. The patient added that they were extra caring to her now due to her current condition.

Before Hospitalization

During Hospitalization

SEXUALITY REPRODUCTIVE PATTERN

The patient stated that her sexual relationship The patient stated, Normal lang na hindi with her husband is satisfying even though muna naming ginagawa yon mag-asawa, they only do it once a month. kakaopera ko lang kasi, eh. She mentioned that she used IUD as a contraceptive for 18 years which started on year 1987. Her menstruation began when she was 12 years of age and her menopause at 49 years old. In times of stress, the patient stated that She still does like what she usually does in talking with her husband, other family times of stress before she was hospitalized. members, and significant others make her feel much better. She denies use of any medications, drugs, alcohol, or tobacco to relax. Wala akong bisyo, as the patient added. She also said that praying the rosary helps in calming her mind. The patient, as a Catholic, goes to church Patients current health status did not interfere regularly with her husband and/or other family with her faith. member. She believes that praying is She still prays the rosary while in the hospital. important in life.

X. COPING/STRESS-TOLERANCE PATTERN

XI. VALUE/BELIEF PATTERN

Hematology 06-08-12
Result Bleeding Time Clotting Time 2mins 50sec 4 mins 0 sec Ref Value 1-5 mins 2-6 mins Interpretation NORMAL NORMAL

Blood Typing

O/ Rh typing (+)

Clinical Chemistry 06-08-12

Result
Sodium Potassium 144.6 5.39

Normal Values
135-155 mEq 3.4-5.3 mEq

Interpretation
NORMAL ABNORMAL

Hematology 06-08-12
Test WBC RBC HGB HCT MCV MCH MCHC RDW PLT PCT MPV PDW Result 8.0 4.77 12.3 0.43 91.0 25.8 233.0 11.8 259.0 0.15 5.7 18.6 Ref. Value Interpretation 5.0-10.0x109/L F 4.2-5.4x1012/L M 4.5-6.2x1012/L 13.0-17.0g/dl 0.39-0.53 80-100f/L 27.0-32.0 pg/L Low 320-360 g/l 10.0-16.5%CV 150-450x103/ul 0.10-1.00% 5.0-10.0 fL 12-18%

Serotology &Immunology 06-08-12

Hepa B surface Antigen Result Reactive Normal Values Interpretation Person is infected, it is reactive because patient has infection.

Widal Test

1:20, 1:40,1:80,1:160,1: 320 Result Reactive Interpretation Person is infected.

06-20-12 HBsAg

Differential Count
Neutrophil Lymphocyte Monocyte Total Absolute Count 4.4 3.3 0.3 8.0 % count 55.0 40.7 4.3 100 Ref Value 50-70% 20-50% 02-09%

Coagulation Factor 06-08-12

Examination PTT Ratio Control Patients Value 41.0 sec 1.42 31.5 sec Normal Value 2.7-34 sec 0,8-1,2 Interpretation NORMAL

Urinalysis 06-20-12
Color Transparency Specific Gravity Reaction Albumin Glucose RBC Epith Cells Mucus Thread Bacteria A.Urates WBC Result Yellow Hazy 1.020 6.0 Trace Negative 2-4 Few Few Many Moderate Over 100 Normal Values Interpretation

1.0015-1.030

ACIDIC

Few Few

Laboratory 06-20-12
Thyroid Free T4 (ECLIA) TSH (ECLIA) Within range result 16.15 1.200 Ref Result 12.0-220 pmol/L 0.270-4.200 mIU Interpretation NORMAL NORMAL

Blood Chemistry
Examination FBG BUA CREA 95 M 62-115 F 53-97 NORMAL S.I. Result 4.9 Ref. Value 3.9-5.9 2.5-6.4 Interpretation NORMAL

Chemistry 06-25-12
SGPT/ALT SGOT/AST Result 11.6 12.0 Ref Value 4-38 IU/L 0-40 IU/L Interpretation NORMAL NORMAL

Chest XRAY (PA) View:

There are no active lung infiltrates The heart is not enlarged Aorta is tortuous The cp sulci,diaphragm and bony thorax are unremarkable

Impression: Tortuous Aorta

06-27-12 10:30 1:20PM 4 PM

Temperature 36.0 36.9 36.7

Pulse 69 73 76

Respiration 23 20 24

Blood Pressure 140/100 130/90 140/100

06-28-12
6 PM

Temperatur e 35.7 Temperatur e 37

Pulse
70

Respiration
24

Blood Pressure
150/90

06-29-12
8 PM

Pulse
83

Respiration
31

Blood Pressure
150/110 140/80

06-30-12 12 NN

Temperature 36.5

Pulse 76

Respiration 20

Blood Pressure 130/90 110/70 Blood Pressure 140/100 120/90

07-01-12

Temperature

Pulse

Respiration

4 AM

36.8

88

19

07-02-12 4 PM

Temperature 36.4

Pulse 81

Respiration 19

Blood Pressure 130/90

120/70

07-03-12 12 AM

Temperatur e 36.6

Pulse 76

Respiration 22

Blood Pressure 140/100

DRUG

CLASSIFICATIO N
: 3rd generation cephalosporin

USE

ACTION

ADVERSE EFFECT
Sz (high dose), pseudomembran ous colitis, diarrhea, cholelithiasis, rash, urticaria,pruritis, phlebitis, pain at IM site

NURSING CONSIDERATIO NS
monitor, HR, BP, temp, sputum, UA, CBC, billirubin, jaundice Use with caution in pt.s with beta lactam allergy (do not use if hx of anaphlaxis or hives) Check abd pain, emesis, diarrhea, or constipation, Evaluate IO, watch for elevated liver function test results

1. Cefuroxime

750mg IV q8

UTI, perioperative prophylaxis

2. Omeprazole

40 mg cap OD

Class: proton pump inhibitor

Reduce gastric acid secretion and increases gastric mucus bicarbonate production, creating proactive coating and easing discomfort from excess gastric acid.

DRUG

CLASSIFICATI ON

USE

ACTION

ADVERSE EFFECT

3. Ketorolac

30 mg IV q8 x 3 doses

4. Amlodipine Antihypertens ive 5 mg tab

to control hypertension

OD

Interferes with prostaglandin biosynthesis by inhibiting cyclooxygenas e pathway of arachidonic acid metabolism also act as potent inhibitor of platelet aggregation decreases intracellular Ca level, inhibits smooth muscle contractions and relaxing coronary and vascular smooth muscles,

NURSING CONSIDERATI ONS monitor adverse reaction, especially prolonged bleeding time and CNS rxn Check IM injection for hematoma and bleeding MIO BP when adjusting dosage Tell pt. to take missed dose as soon as remembered and next dose in 24 hours Take with

anxiety,dizzin ess, fatigue, hypotension, palpitations, abd pain

DRUG

CLASSIFICATION

USE

ACTION

ADVERSE EFFECT

NURSING CONSIDERATIONS

5. Tramadol

Analgesics

100 mg IV q6 x 4 doses

Moderate to moderately severe pain

Inhibits reuptake of serotonin and norepinephrine in the CNS.

dizziness, spinning sensation;constip ation, upset stomach,headac he;drowsiness; or feeling nervous or anxious.

nausea, vomiting, sweating, itching and constipation

Assess type, location, and intensity of pain before and 2-3 hr (peak) after administration. Assess BP & RR before and periodically during administration. Assess bowel function routinely Monitor patient for seizures. Encourage patient to cough and breathe deeply every 2 hr to prevent atelactasis and pneumonia.

DRUG

CLASSIFICATION

USE

ACTION

ADVERSE EFFECT

NURSING CONSIDERATION S assess patients for any contraindications should be taken with food or milk to lessen the chance of gastric upset. Patients should be taught never to crush, dissolve or chew this medication and to never exceed the prescribed dose as deaths have occurred.

6. Celecoxib

NSAID

400 mg tab BID

arthritis, pain, menstrual cramps, and colonic polyps

blocks the enzyme that makes prostaglandins (cyclooxygenase 2), resulting in lower concentrations of prostaglandins

headache,abdo minal pain, dyspepsia, diarrhea, nausea , flatulence, and insomnia.

Bleeding, ulceration and perforation of the stomach or intestines.

ASSESSMENT

DIAGNOSIS

PLANNING

INTERVENTION

RATIONALE

EVALUATION

Subjective: Medyo sumasakit ang tagiliran ko as verbalized by the patient Objective BP: 170/110

Acute pain related to presence of renal calculi as manifested by flank pain

To provide pain relief through independent and dependent nursing actions To prevent further recurrence of renal stones

Administer pain medications as prescribed Monitor and evaluate pain level accordingly Encourage proper positioning Increase fluid intake Follow prescribed diet such as low salt, low fat diet Provide quiet and calm environment Instruct relaxation techniques such as deep breathing exercises, listening to music Provide non pharmacological pain management such as back rub, change position

To provide immediate pain relief To properly plan future actions for pain relief Proper position proved to provide pain relief Concentrated urine can form renal calculi Proper diet can prevent the recurrence of renal calculi Less environmental stimuli can decrease pain To provide comfort

After a series of nursing actions, the patient will verbalized decreased pain, have less recurrence of kidney stones

ASSESSMENT S Hindi ko alam na mataas ang BP ko, Nalaman ko lang nung nag punta ako sa Ospital ng pakil as verbalized by the patient. O BP:170/110

DIAGNOSIS Deficient Knowledge regarding condition may be related to lack of information as evidence by

PLANNING After 8 hours of duty the patient will gain enough knowledge regarding her condtion. Was able to verbalize understanding of disease process and treatment regimen.

INTERVENTION Assessed readiness and blocks to learning. Include significant other (SO).

Defined and stated the limits of desired BP. Explain hypertension and its effects. Assisted patient in identifying modifiable risk factors(obesity,diet high in sodium, saturated fats, and cholesterol, sedentary lifestyle, stressful lifestyle.

RATIONALE Misconceptions and denial of the diagnosis because of long-standing feelings of wellbeing may interfere with patient/SO willingness to learn about disease, progression, and prognosis. Provides basis for understanding elevations of B.

EVALUATION After 8 hours of nursing interventions the patient gain enough knowledge regarding her condition and able to verbalized understanding regarding the disease process.

These risk factors have been shown to contribute to hypertension and cardiovascular and renal disease.

ASSESSMENT

DIAGNOSIS

PLANNING

INTERVENTION Reinforced the importance of adhering to treatment regimen and keeping followup appointments.

RATIONALE Lack of cooperation is a common reason for failure of antihypertensive therapy.

EVALUATION

Instructed and demonstrated technique of BP selfmonitoring.

Encouraged patient to established an individual exercise program incorporating aerobic exercise (walking) within patients capabilities.

Monitoring BP at home is reassuring to patient because it provides visual/positive reinforcement for efforts in following the medical regimen and promotes early detection of deleterious changes.

Helping to lower BP, aerobic activity aids in toning the cardiovascular system.

ASSESSMENT S> Dahil mahirap maospital, magastos, iiwasan ko na ang pagkain ng sobrang maaalat at matataba as verbalized by the patient. O> Good eye contact >able to repeat the instructions given >compliance to health teachings or health instructions given (such as drinking lots of fluid and limiting salty foods)

DIAGNOSIS Readiness for enhanced self-care related to previous hospitalization experience as evidenced by verbalization of disadvantages of being hospitalized

PLANNING To maintain responsibility for planning and achieving self-care goals/ general well being To promote optimum wellness

INTERVENTION Assessed for potential barriers (lack of information, catastrophic event, etc) that may affect self-care Provided with accurate/ relevant information regarding current health condition

RATIONALE To enhance participation in selfcare So that she may have discipline regarding her diet

EVALUATION After 8 hours of shift, the pt. gained understanding about her health condition The pt. gained eagerness to modify her behavior by stating iiwas na ako sa maalat at iinom na din ako ng maraming tubig

DIET

ACTIVITIES

MEDICATIONS advised to take home medications as prescribed by the doctor. home meds: Cefuroxime 500mg tab 3x/day Celecoxib 400mg tab 2x/ day return for a follow up check up on June 9, 2012 at 3pm at Laguna Doctor's Hospital

advised to drink encouraged exercise atleast adequate(6-8 glasses/day) 30mins a day if possible amount of water encouraged to eat foods with low in sodium and low in fat avoid caffeinated beverages