Staghorn Calculi Manuscript

MEDICAL COLLEGES OF NORTHERN PHILIPPINES
Alimannao Hills, Peñablanca, Cagayan

Telefax No.: (078) 304 -1010
Website: www.mcnp.edu.p h E-Mail Address: adminoffice@mcnp. edu.ph
A Case Study Presented to the

Faculty of the College of Nursing
in Partial Fulfillment of the Requirement
for the Degree Bachelor of Science in Nursing
STAGHORN CALCULI
By:
Dela Cruz, Lowen King Aglado
Duldulao, Maurin Galla
Gallamoy, Clyrie Faith
Gammaru, Ma. Conception
Lacerna, Jerica Mae Guillermo
Laciste, Devine Maraiah Catigggay
Magannon, Xatty Kae Ga-oy
Mahoy, Kyla Mae Angdason
Manuel, Alpha Bunnao
Manuel, Crizelle Jean Servan
June 2023
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TABLE OF CONTENT
Introduction ------------------------------------------------------------------------------------
Statistics ----------------------------------------------------------------------------------------
Nursing Health History -----------------------------------------------------------------------
Patient’s Profile -----------------------------------------------------------------------------
History of Present Illness -----------------------------------------------------------------
Past Health History -------------------------------------------------------------------------
Family Health History ----------------------------------------------------------------------
Personal and Social History ---------------------------------------------------------------
Gordon’s Functional Health Pattern -----------------------------------------------------
Nursing Physical Assessment -----------------------------------------------------------------
Head to Toe-Physical Assessment ---------------------------------------------------------
Diagnostic and Laboratory Examination Result ------------------------------------------
Anatomy and Pathophysiology ----------------------------------------------------------------
Related Treatments ------------------------------------------------------------------------------
Clinical Practice Guidelines -------------------------------------------------------------------
Course in the Ward -----------------------------------------------------------------------------
Nursing Care Plans -------------------------------------------------------------------------------
Discharge Care Plan -----------------------------------------------------------------------------
References ----------------------------------------------------------------------------------------
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I. INTRODUCTION
A. Clinical Abstract
Staghorn Calculi
Staghorn calculi are branched stones that occupy a large portion of the collecting
system. Typically, they fill the renal pelvis and branch into several or all of the calices. The term
"partial staghorn" calculus designates a branched stone that occupies part but not all of the
collecting system while "complete staghorn" calculus refers to a stone that occupies virtually the
entire collecting system. Unfortunately, there is no consensus regarding the precise definition
of staghorn calculus, such as the number of involved calices required to qualify for a
staghorn designation; consequently, the term "staghorn" often is used to refer to any branched
stone occupying more than one portion of the collecting system, renal pelvis with one or more
caliceal extensions.
CAUSATIVE AGENT
Family enterobacteriaceae compromises the majority of urease-producing pathogens.
The most commonurease-producing pathogens are:

 Proteus
 Klebsiella
 Pseudomonas
 Staphlylococcus species
 Proteus mirabilis- the most common organism associated with infection stones.
 Bacterial urease can be detected by Urea-Rapid-Test
 E-coli and Proteus, may alter the activity of UROKINASE AND SIALIDASE.
RISK FACTORS
1. Family history of kidney stones

2. Dehydration
3. Recurrent Urinary tract infections
4. Anatomical abnormalities
5. Diet
6. Obesity
7. Hypertension
CAUSES
1. Urinary tract obstructions

2. Metabolic disorders
3. Medications
4. Blockages in the urinary tract
5. Long-term use of urinary catheter
6. Having had an earlier urinary diversion procedure
7. Having neurogenic bladder
8. Long-term untreated kidney stones
SIGNS AND SYMPTOMS
1. Pain in the back, side, or abdomen

2. Blood in the urine
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3. Nausea and vomiting

4. Fever and chills
5. Urinary tract infections
6. Difficulty urinating
7. Cloudy or smelly urine
DIGNOSTIC EXAM
1. CT Scans
2. GRF
3. Ultrasound
4. CBC with PC
5. X-ray (KUB)
MEDICAL MANAGEMENT
 Diet: low salt and low fat
 Continue present management and medication
 To relieve the pain until its causes can be eliminated
 To eradicate the stone
 To prevent nephron destruction
 To control infection
 To relieve any obstruction
PHARMACOLOGICAL MANAGEMENT
ANTIBIOTICS, ANALGESICS, DIURETICS, NSAIDs,
 CEFTRIAXONE – To treat bacterial infections or preventing their growth in many

different parts of the body.
 PARACETAMOL – To relieve mild to moderate pain and fever
 ROSUVASTATIN – It uses along with a proper diet to reduce the amount of cholesterol
made by the liver.
 PIPERACILLIN TAZOBACTAM – Used with care in patients with renal impairment or in

hemodialysis patient.
 HYDROCORTISONE – To treat the symptoms of low corticosteroid levels And Major

surgical stress adrenal insufficiency, hemodynamic instability, and the possibility of
adrenal crisis
 TRAMADOL- To relief of moderate to severe pain
TREATMENT
The primary goal of staghorn stone management is complete stone eradication.
Various modalities of treatment are:
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SURGICAL MANAGEMENT:
 CYSTOSCOPY RETRO PROCEDURE INTRADERMAL SURGERY REPAIR

 PERCUTANEOUS NEPHROSTOLITHOMY (PCNL)
 EXTRACORPEAL SHOCKWAVE LITHOTRISPY (ESWL)
 OPEN & LAPAROSCOPIC SURGERY
 NEPHRECTOMY
NON-SURGICAL:
 Antibiotics
 Urease inhibitors
 Urinary acidification
 Dietary modification
NURSING MANAGEMENT
 Provide adequate pain relief

 Monitor fluid balance
 Administer medications as ordered
 Explain procedures and treatment to the patient
 Monitor vital signs and urine output
 Promote adequate hydration
 Diet adjustments to prevent reoccurrence
 Provide client education regarding the role of diet and medications in the treatment and
prevention
 Provide rest
II. STATISTICS
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MALE FEMALE
16%
14% 15%
12%
10%
10%
8%
6%
6%
6% 6%
5%
4% 5%
3% 3%
2%
2%
0%
ASIA EUROPE SOUTH AMERICA NORTH AMERICA SAUDI ARABIA
25%
20%
15%
10%
5%
0%
IA PE CA
3
IC
A
BI
A
AS R O
R I E R A
R
EU E
AM IA
AM UD
TH R TH SA
U
SO NO
PREVALENCE MALE FEMALE
Based on the graph presented, in the year 2022, according to studies conducted of kidney
stones it was established that it affects the population from ages 40 to 70 for both men and
women. Factors such as dehydration, urinary retention, uncontrolled hypertension, diabetes,
unhealthy lifestyle and obesity can increase the risk of kidneys stones. The most affected of
kidney stones of individual is under the region of Saudi Arabia which has a prevalence rate of
20% and has a total of 14.5% in and 5.5% in women. The second highest is the region of
South America which has a total prevalence of 15% with a total of 10% in men and 5% in
women. Third is South America which has a prevalence rate of 11% and has a total of 5.5% in
men while 4.5% in women. Second is the region of Europe that has a prevalence rate of 9%
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and a has a total of 6% in men and 3% in women. And lastly, Asia has a prevalence 5% and
has a total of 3% in men and 2% in women.
III. NURSING HEALTH HISTORY

A. Patient’s Profile
Patient E.C. is a 58- year old Filipino-female-RPVD, married, and a Roman Catholic. She
is a retired caregiver at the Veterans Memorial Medical Center and is now a full time
housewife. She is from B58 L21 Bry. Santo Cristo, Dasmarinas City and was born on
November 04, 1964. She is a college under graduate and is admitted at VMMC- Urology
Ward on June 8,2023 with a chief complaint of abdominal pain. She was diagnosed with
Obstructive Uropathey Bilateral to Staghorn Calculi Anemia Secondary to Chronic
Disease.
B. History of Present Illness
Patient is a 58 years old , female, RPVD, known case of S.C (R) nephrostomy tube site,
pain (L) S/P nephrostomy tube interim ; bilateral (04/23 VMMC) known hypertensive,
know diabetic, who came in due to pain at nephrostomy tube site, (L).
Two weeks prior to consult, patient noted intermittent crampy, non radiating pain at
nephrostomy tube site, left, aggregated pressure/manipulation, pain scale of 7/10.
Patient took Biogesic which afforded slight relief of pain. No fever, dysuria, bowel
changes noted. No consult was done.
Interim, patient noted persistence of symptoms spontaneous removal of nephrostomy

tube, right was noted with no complication.

Five days prior to consult, still of symptoms, minimal yellowish purulent discharge was
noted be relative during change of dressing at nephrostomy tube site, (L). no consult
was done.
Few hours prior to consult, patient sought at VMMC ER due to persistence of
symptoms, hence was advice admission.
C. Past Health History
(+) S/P Bilateral Nephrostomy Tube Insertion, April 2023 VMMC

(+) Type 2 D.M. 2022 on Linagliptin 5mg/tab OD
(+) Dyslipidemia 2022, on Rosuvastatin 20mg/tab ODHS
(+) Hypertension, 2017 on Amlodipine 5mg/tab OD
(+) Fully vaccinated with COVID 19 vaccine (Pfizer) 2022.
D. Family Health History

GENOGRAM
Maternal Side Paternal Side
x x H S x x
Grandmoth Grandmoth Grandfather

Grandfather
er er
x x x x x x x x x x
Mother Father
H H H S M H H H
H&S H&A
x x
Patient S & DM S S HD

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female
male
X deceased
H hypertension
S stroke
DM diabetes
A arthritis
E. Personal and Social History
HD heart disease
Non smoker
Occasional alcoholic beverage drinker
Denies illicit drug use
Diet: fish and vegetable
Hydration: 1.5L - 2L of water per day
F. Gordon’s Functional Health Pattern
Before hospitalization During hospitalization
I. Health The patient perceives her health The patient stated that she feels
Perception and as good because she can that she is not healthy anymore
Health perform her tasks well at work because she gets easily tired and
Management and at home. Patient viewed sweats profusely. The patient is
healthy as a state in which you also experiencing a drying of the
have a clean body, don’t feel throat. She also observed that after
pain, and perform daily activities eating, she easily gets sleepy.
actively. The patient did not
know if she had received
vaccines when she was young.
She received the Hepa-B vaccine
and tetanus toxoid during her
pregnancy. The last
immunization that she got was
COVID.
The patient has diabetes and
was taking Linagliptin; she also
has hypertension and takes
maintenance medicine, which is
Amlodipine. The patient also
mentioned that she is drinking
MX3 coffee because she believes
it has benefits for her health.
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The patient doesn’t have any

vices because she believes this is
harmful to her health.
The patient doesn’t have any
known allergies to medications,
food, etc.
II. Nutrition and The patient doesn’t have any The patient's weight is 68kg and
Metabolism specific diet but mostly eats her height is 5’1; her BMI is 28.9,
Pattern vegetables and fish and is not which is overweight. The patient's
very fond of meat, specifically diet is low salt, low fat, and a DM
diet. She mostly eats vegetables
fatty meat. The patient can take
and fruits like apples, papaya, and
2–3 cups of rice. The patient
oranges and only eats one cup of
really loves sauces such as soy rice. Patient intake of water is 8
sauce, vinegar, fish paste, and glasses or more. Patient stated
fish sauce when she eats. The that most of the time she doesn't
patient also likes seafood such have appetite.
as crabs, shrimp, seashells, fish,
and dried fish like daing and
tuyo because they are near the
sea when they are still residing
in the province. According to her
husband, the patient's way of
cooking is salty, which was also
agreed upon by the patient.
Patients rarely eat fast food,

processed foods, or noodles. The
patient eats one regular pack of
junk food every day when she is
watching television. The patient
doesn’t have problems
swallowing or eating. Patients
drink more than 8 glasses of
water every day and rarely drink
soft drinks and juices. The
patient also mentioned that she
enjoys eating ripe mangoes.
III. Elimination The patient stated that her urine Before the operation, The patient is
Pattern output is yellow to amber in in an indwelling Foley catheter
color. She usually voids six times attach to urine bag, she is also on
per day, with an estimated nephrostomy tube left with
amount of 1500 ml per day , it yellowish output. Urine is yellow to
was estimated through her orange in color.The patient doesn’t
nephrostomy tube she had 4 have any problems with defecation.
weeks prior to her second She defecates one to two times per
hospitalization. She felt burning day.
sensation/pain during urination. After the operation patient is still
The urine has a foul odor, white on IFC attached to UB and
discharges, and some blood. The nephrostomy tube left but was
patient also noted stones the clamped. Urine is draining well with
size of sand in her urine. The red color urine with an output of
patient also verbalized, "Pag 1700 ml per day.
nasa byahe madalas akong 06/23/2023 patient NT and IFC has
nagpipigil ng ihi.“ been removed.
The patient defecates two times
per day, every morning and at
night with brown and formed
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stool but sometimes she usually

experience constipation. She is
not using any laxatives or stool
softeners, but instead manages it
by drinking more water.
IV. Activity and The patient stated that she plays The patient stated that she gets
Exercise basketball and rides a bicycle easily tired from prolonged
Pattern every day when she is still single.
activities. The patient verbalized,
When she gets married, she "Sa bed lang ako, tatayo kung
becomes a full-time housewife. minsan. Mabilis din akong
She usually prepares food for her mapagod."
family and does household
chores. In 2016, she became a Before the operation, the patient
caregiver at the Veterans can ambulate independently.
Memorial Medical Center and
retired in 2018. The patient After the operation, the patient is
mentioned that she enjoys her always in bed and ambulates from
work and doesn’t have any time to time with assistance. She
problems doing it. also shows evidence of weakness.
V. Cognition and The patient doesn’t have any The patient has no sensory deficits.
Perception problems with her vision, sense She is oriented to people, time and
Pattern of smell, sense of hearing, sense place, responses to stimuli verbally
of taste and sense of touch. The and physically.
patient is oriented to people,
time, and place; she responses Before the operation, patient felt
to stimuli verbally and physically;
pain in her lower back radiating to
she can speak Tagalog and her abdomen.
Bisaya. Her highest educational
attainment is a college under After the operation, the patient
grad. verbalized “sobrang sakit ng opera
ko, dito sa may tubo parang
tinutusok tusok” and rated the pain
on pain scale of 10/10. A facial
grimace and guarding behavior
are observed.
VI. Sleep and Rest The patient usually sleeps for 7 The patient stated that her sleep is
Pattern hours; she goes to sleep at not continuous and that she usually
around 9:00 p.m. and wakes up sleeps for 4 hours because she is
at 4:00 a.m. The patient feels distracted by pain and interrupted
fresh when she wakes up. She due to hospital activities. She goes
does not take a nap at noon. The to sleep at around 10:00 p.m. and
patient does not have any wakes up at 2:00 a.m. Sometimes
difficulties going to sleep and she takes a nap at noon for about
does not use any medication to 30 minutes. The patient does not
promote sleep. have any difficulties going to sleep
and does not use any medication
to promote sleep.
VII. Self-Perception The patient stated that she is an The patient is not satisfied with
and Self – active person. She can express herself. She verbalized "Ang pangit
Concept her feelings and her condition. pangit ko na ngayon hindi ko na
Pattern She is content with herself and nga matignan ang sarili ko sa
her family. salamin". Though the patient is
weak, she still manages to appear
calm and relaxed. She also agreed
to undergo an operation, gave her
trust to the surgical team, and is
hopeful for a successful operation.
VIII. Roles and The patient plays the roles of a The patient is well supported by
Relationship mother to her four children, a her family. Her husband is
Pattern stepmother to her stepchildren, a accompanying her to the hospital.
wife to her husband, and a She still plays the roles despite her
grandmother to her condition by reminding them of
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grandchildren. She described her important matters.

relationship with them as happy.
Even though her stepchildren are
against their relationship with
her husband.
IX. Sexuality and The patient had menarche at the The patient and her husband
Reproduction age of 12 and went into claimed that they are sexually
Pattern menopause at the age of 48. The inactive due to their age and
patient has an OB history stated, "Hanggang tingin tingin
(GTPAL) of 44004. Patient got nalang kami."
married to her first husband at
the age of 35, then became
widowed at the age of 48, and
then got married again at the
age of 51. Patient is sexually
inactive because, according to
her, she is already old and has
been menopausal. She has no
history of sexually transmitted
diseases or any disease affecting
her genitals.
X. Coping and Patient verbalized, "Ang madalas The patient was able to accept her
Stress na problema ko ay yung mga condition by cooperating with the
Tolerance pasaway na anak, wala kaming medical advice and procedures.
Pattern problema sa pera. Siguro yung The patient stated that God and
mga stress ko din yung mga her family are her strength in life.
anak ng asawa ko na di ako
tanggap at yun ang pinaka worse
sa buhay ko yung mga anak
niya." Patient resolved their
problem with communication
with her husband and their
children. She also copes with
stress by praying, watching
television, and keeping silence in
one place while thinking of
solutions.
XI. Values and The patient's religion is Roman The patient stated that she can no
Belief Pattern Catholic; she seldom goes to longer go to church because of her
church due to her job, but she hospitalization. She never blamed
never forgets to pray. Patients God for her condition, and her
believe in quack doctors and relationship with God never
superstitious beliefs. changed. Patient religion doesn’t
bring any restrictions to the
procedure, and her admission and
surgery don’t interfere with her
spiritual practices.
IV. NURSING PHYSICAL ASSESSMENT

A. Head-to-Toe Physical Assessment
ASSESSM METHODS NORMAL FINDINGS ACTUAL REMARKS

ENT FINDINGS
SKIN INSPECTIO  Skin is uniform  Skin is brown in  ABNORMA
N whitish pink or complexion L
brown color  Paper thin over
 No bleeding the hands,
 No area of increased lower It was
vascularity extremities and observe in
 No skin lesions chest the
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present except for  Presence of patient

freckles, birth marks keloid at the skin the
or elevated right lower presence
 Skin is dry with a back with a 2 of
minimum of cm diameter infection
perspiration.  Presence of located at
 Warm and equal nephrostomy nephrosto
bilaterally. tube at the left my site.
 Hands and skin lower back Presence
slightly cooler than of keloid
the rest of the body is also
 Skin surfaces non- noted due
tender to the
Texture: scars of
 Smooth, even and remove
firm except where right
PALPATION there is significant nephrosto
hair growth my tube.
 Skin turgor:
When released, should
return to original
contour rapidly
 Edema not present
SCALP INSPECTIO  Dark black to pale  Hair color is  ABNORMA
AND HAIR N blonde; may turn gray black and may L
or white; may be turn white
chemically changed  No infestation Due to
 Terminal hair found in or lesions aging, the
the eyebrows,  Hair is thick oils that
eyelashes, and scalp, and dry our scalp
and in axilla and pubic relies on
areas after puberty. for
 No signs of nourishme
infestation or nt
lesions. decrease,
resulting
✓ dandruff may be in drier,
present frizzier
PALPATION  Hair may feel hair.
thin, straight,
coarse, thick or
curly. Shiny and
resilient
NAILS INSPECTIO  Have a pink cast in  Nails are  NORMAL

N light skinned and brown, firm,
brown in dark clean and no
skinned. presence of
 Capillary refil present clubbing
(should return to  Capillary refill
normal 2-3 sec) within 2
 Surface is smooth, seconds
and slightly rounded
or flat. Curved nails
are normal.
 Uniform nail
thickness
throughout; no
splintering or brittle
edges
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 Angel approx 160°

 Firm nail base
PALPATION
EYES INSPECTIO  Symmetrical with no  Eyes  NORMAL
N drooping, infection, symmetrical
tumors or other  Visual acuity of
abnormalities 20/20
 Visual acuity: 20/20  Sclera appears
 Sclera : white
White in light skinned  Pupils equally
w/o exudates, lesions or round, reactive
foreign bodies. to and light
 Pupils: equally accommodation
Round, reactive to : approx. 4 mm
light and  No tearing.
accommodation: 2-6 swelling or
mm descharge
 No tearing,
swelling or
discharge
EARS INSPECTIO  Match flesh color  Same color as NORMAL
N of the rest of the face
skin  Central position
 Central position  Proportional
 Proportional  No redness,
 No redness swelling or
PALPATION lesions, swelling, tenderness
tenderness.  No pain
 Should not assessed
complaint of pain
or tenderness
NOSE INSPECTIO  Symmetrical, midline  Symmetrical,  NORMAL

N of the face. midline
 Without swelling,
bleeding, lesions or  No swelling,
masses bleeding,
 Each nostril patent lessions or
PALPATION  No pain or masses
discomfort during  Patent nostrils
palpation  No pain or
discomfort
noted
MOUTH INSPECTIO  Breath smells fresh  Lips color is  NORMAL
N  Lips and membranes brown;no
pink and moist with lesions or
no lesions or inflammation
inflammation  Tongue is
 Tongue is midline midline pink
pink, moist rough and moves
without lesions. freely
 Symmetrical: moves  Teeth are
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freely yellowish
 No swelling or
bleeding
NECK INSPECTIO  Symmetrical with head  Symmetrical  NORMAL
N in central position. with head in
 Able to move head central
without discomfort or position.
noticeable limits  Able to move
PALPATION  Muscles should be head without
symmetrical without discomfort
palpable masses or  No palpable
spasm masses
CHEST INSPECTIO  Without lesions, skin  Presence of  NORMAL
N intact scars below the
 Quiet rhythmic and right clavicle
PALPATION effortless breathing due to dialysis
AUSCULTAT  No pulsations. masses.  Quiet and
ION thoracic tenderness rhythmic
present effortless
 Normal lung tissue breathing
produces resonant  No masses or
sound, diaphragm has tenderness
dull sounds.  Brochovesicular
 Bronchial, or vesicular breath sounds
breath sounds
ABDOMEN INSPECTIO  Abdominal contour flat  Abdominal  NORMAL
T N or rounded. contour
 Symmetrical. rounded.
 Uniform color or  Have scars;
pigmentation. striae
AUSCULTAT  No abdominal scars.
ION  No streaks
 Intermittent gurgling
sounds throughout
PERCUSSIO abdominal quadrants
N  Tympany. predominant
sound heard
PALPATION  No enlargement
palpable, or any
masses, bulges, or
swelling
GENITALI INSPECTIO  Pubic hair distributed in  Presence of  ABNORMA
A N triangular form. Foley catheter L
PALPATION  More coarse than scalp
hair. Presence
 No nits or lice. of Foley
 Penis skin free of catheter
lesions and after
inflammation. surgery
because
of
difficulty
urinating
  
UPPER INSPECTIO  Without lesions, scars or  Without lesions.  NORMAL
EXTREMIT N inflammation scars or
IES inflammation
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LOWER INSPECTIO  Without lesions, scars  Without lesions.  NORMAL

EXTREMIT N scars
IES PALPATION  No edema
B. Diagnostic and Laboratory Examination Result
Diagnostic/laboratory Date Results Normal Analysis and

procedure ordered/Date interpretation
done of results
HEMATOLOGY June 09,2023 Hemoglobin 120-160 -Iron deficiency

93.0 causes low
hemoglobin
Hematocrit 0.28 and hematocrit
0.37-0.47
because iron is
White Blood
a component of
cells 8.7
hemoglobin.
5-10
-Low
DIFFERENTIAL segmenters
COUNT
Not having
enough
neutrophils
Segmenters makes it harder
0.53 for your body
0.60-0.70 to fight germs
Lymphocyte
and prevent
0.29 0.20-0.40
infections.
Monocyte 0.09
- high
Eosinophil 0.08 0.01-0.06 monocyte
count include
Basophil 0.01 infections,
leukemia,
Red blood Cells 0.01-0.05
polycythemia
3.4
vera (an
Mean increase in all
Corpuscular 0.00-.01 blood cells,
Volume 84 especially red
4.2-6-2 blood cells)
Mean
Corpuscular -High
eosinophil
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Hemoglobin 27 86-96 might have

parasitic
RDW 18.0 infection
PLATELET 540 -Anemia is a
problem of not
27-32
having enough
healthy red
blood cells or
12-15 hemoglobin to
carry oxygen to
150-450
the body's
tissues.
-Low MCV
means that
RBC are smaller
than normal
and may
indicate
microcytic
anemia.
-high RDW
means that
there's
variation in the
size of your red
blood cells
beyond what's
considered
normal
-high blood
clots can form
in your blood
vessels. This
can block blood
flow through
your body.
DEPARTMENT OF PATHOLOGY
LABORATORY REQUEST #: Specimen Submission Date & Specimen Type:

Time:
13642350 BLOOD-111
06/09/2023 04:58 PM
Requesting Physician: Perform Date & Time
DEANNE JOY M. DIAZ
License No.0087714
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06/09/2023 05:02 PM MEDICAL TECHNOLOGIST
Date & Time: 06/09/2023 05:10

PM
GERRICK JOSEPH C. DOLOR MAYNEVAR Y. VALERIO, M.D. GODWIN N. HERNAEZ, M.D.
License No. 0057470
VERIFIER License No: 0157979 License No: 0059811
Date & Time: 06/09/2023 VALIDATOR PATHOLOGIST

05:17 PM
COMPLETE BLOOD COUNT
TEST RESULTS UNITS REFERENCE INTERVAL

Hemoglobin 93.0 g/L 120 - 160
Hematocrit 0.28 0.37 – 0.47
White Blood Cells 8.7 x10^9/L 5 – 10
DIFFERENTIAL COUNT
Segmenters 0.53 0.60 – 0.70
Lymphocyte 0.29 0.20 – 0.40
Monocyte 0.09 0.01 – 0.06
Eosinophil 0.08 0.01 – 0.05
Basophil 0.01 0.00 – 0.01
Red Blood Cells 3.4 x10^12/L 4.2 – 6.2
Mean Corpuscular Volume 84 fl 86 - 96
Mean Corpuscular Hemoglobin 27 pg 27 - 32
Mean Corpuscular Hemoglobin 0.33 0.32 – 0.36
Concentration
RDW 18.0 % 12 - 15
PLATELET 540 x10^9/L 150 - 450
Remarks:
Patient Name: (Last, First, Middle)

C, E HEMATOLOGY UNIT
58Y/F 11/04/1964 PACU BED-2 VD00085789
AGE/SEX BIRTHDATE WARD/ROOM CLASSIFICATIONS

Time:
13642350 BLOOD-111
06/09/2023 04:58 PM
DEANNE JOY M. DIAZ
17
Telefax No.: (078) 304 -1010
License No.
Date & Time: 06/09/2023 05:22

PM
GERRICK JOSEPH C. DOLOR MAYNEVAR Y. VALERIO, M.D. GODWIN N. HERNAEZ, M.D.
License No. 0057470
VERIFIER License No: 0157979 License No: 0059811
Date & Time: 06/09/2023 VALIDATOR PATHOLOGIST

05:20 PM
COAGULATION
EXAMINATION RESULTS UNITS REFERENCE INTERVAL

Prothrombin Time (PT)
Patient 14.10 secs 11.7 - 15.3
Percent Activity 91.00 % 70 - 120
Control 12.2 secs
INR 1.06 <1.0
Activated Partial Thromboplastin (APTT)
Patient 27.20 secs 20.0 – 35.0
Control 30.4
Ratio 0.91 Ratio
Remarks:

C, E HEMATOLOGY UNIT
58Y/F 11/04/1964 PACU BED-2 VD00085789

Time:
13642071 URINE 29
06/9/2023 04:39 PM
JACQUELINE C. OBILES
License No: 0082914
Date & Time: 06/09/2023 05:00

PM
18
Telefax No.: (078) 304 -1010
JACQUELINE C. OBILES LARA MAE A. ANGELES, M.D.

MAYNEVAR V. VALERIO, M.D.
License No: 0082914
VERIFIER License No: 0059811

License No: 0157979
Date & Time: 06/09/2023 PATHOLOGIST
05:25 PM VALIDATOR
ROUTINE URINALYSIS
EXAMINATION RESULTS UNITS
PHYSICAL
Color Yellow
Transparency Turbid
Specific Gravity 1.010
pH 6.5
CHEMICAL
Esterase 3+
Albumin 2+
Ketones Negative
Bilirubin Negative
Erythrocytes 2+
Nitrite Positive
Glucose Negative
Urobilinogen NEGATIVE
MICROSCOPIC CELLS
RBC Red Cells 10-15 /HPF
WBC Pus Cells > 10 /HPF
Squamous Cells OCCASIONAL
Transitional SOME
Bacteria ABUNDANT
Mucus Threads FEW
Others

C. E CLINICAL MICROSCOPY UNIT
58Y/F 11/04/1964 PACU BED-2 VD00085789
19
Telefax No.: (078) 304 -1010
20
Telefax No.: (078) 304 -1010
21
Telefax No.: (078) 304 -1010
V. RELATED TREATMENTS
A. Clinical Practice Guidelines
The recommendations made in clinical practice guidelines are developed by synthesizing three
types of information:
1. A systematic review of evidence about efficacy of treatments, where the efficacy data
primarily derive from randomized controlled trials (RCTs; and panels also have the option to
include results of carefully-controlled observational
2.Data about patient preferences and values regarding treatments.
3.Data about applicability of treatments across populations (e.g., gender, ethnic, and age
differences) and settings (e.g., inpatient, outpatient), etc. The systematic review of efficacy is
typically the primary source of data because of the scope and depth of evidence the review
provides, and the methodological rigor used to evaluate the research. Also, there are usually
fewer empirical studies available to provide the other types of information (e.g., limited studies
of patient preferences).
B. Course in the Ward
DATE AND TIME DOCTOR'S ORDER RATIONALE NURSING

RESPONSIBILITIES
06/12/23 Admit patient at ward For further Admitted the patient

9:30AM 9 Urology monitoring, as ordered
Department under management, and
doctor Madrona evaluation of the Prepared and filled
patients condition. out necessary
documents
Obtained initial vital

signs and recorded
Assisted the patient

room of choice
Witness signing of
consent
Secure consent For legal purposes Served as a witness

and to ensure that validated
the patient understanding of the
understands the patient and SO about
nature of the the importance of
treatment signing consent
Monitor VS q6 and For baseline data VS taken and

record recorded.
Explain the
importance of vital
signs monitoring
IVF: PLRS 1L ×80cc Maintenance of fluids Regulated IVF

1hr and electrolytes correctly and labeled
it
22
Telefax No.: (078) 304 -1010
Check the patency of

the IV line
Diet: low salt low fat To reduce the Inform and implement
diet amount of sodium a diet for patients
and fats in the diet
Request for following To confirm or rule Verified doctor's order

diagnostics test: out a condition or
disease Informed the patient
ABG about the diagnostics
exam
Urinalysis
Informed the health
Urine CS care providers about
the exams
Mg
Followed up results
Phos
and attached it to the
HBsAg patients chart
Anti-HCV
Anti-HBS
CXR
12L ECG
Medications:
Ceftriaxone 1g/IV Verified doctor's order

q12 To treat bacterial
Clean the IV port
infections or
prior to administration
preventing their
of drugs
growth in many
different parts of the Observed 14 Rights of
body drug administration
Paracetamol 1g/IV q8 To relieve mild-to- 1. Right drug

moderate pain and
fever 2. Right dosage
3. Right patient
Amlodipine 1g/IV tab It lowers blood 4. Right route

OD pressure by relaxing
the blood vessels so 5. Right time
blood can flow more
6. Right
easily to the heart
documentation
Canagliflozin 5g/IV It used with a proper 7. Right education

tab BID diet and exercise to
lower blood sugar 8. Right assessment
levels in people
9. Right to refuse
10. Right evaluation

Rosuvastatin 20 It used along with a
mg/tab OD proper diet to reduce 11. Right approach
the amount of
23
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cholesterol made by 12. Right principle of

the liver care
13. Right prescription
14. Right nurse

clinician
Monitor patient for

adverse effects
Medication given
Monitor CBG TID and To know if the blood Explain the

record of the patient is importance of CBG
within normal range monitoring
CBG taken and

recorded
4:00PM Monitor intake and To ensure that the Monitored patients I

output q8 and record patient has proper and O q shift, record
intake of fluid and and report any
whether there is an deviations
adequate output of
urine and normal
defecation
06/13/23 7:30AM Continue present For continuity of care To provide measure

management and and complete the for symptoms
medications medication regimen alleviation
8:00AM Monitor VS q6 and For baseline data VS taken and

record recorded.
Explain the
importance of vital
signs monitoring
11.00AM Monitor CBG TID and To know if the blood Explain the
CBG taken and

recorded

adequate output of
urine and normal
defecation
8:15PM Advised for

hemodialysis
tomorrow
Give Epo B, 5000 I.U For the treatment of Verified doctor's order
anemia, especially in
Assess blood
24
Telefax No.: (078) 304 -1010
renal anemia pressure. Report a

resulting from renal sustained increase in
function blood pressure
insufficiency, (hypertension) to the
including physician
hemodialysis and
non-hemodialysis Hematocrit should be
chronic renal checked regularly
Clean the injection

site prior to
administration of
drugs
Observed 14 Rights of
drug administration
1. Right drug
2. Right dosage
3. Right patient
4. Right route
5. Right time
6. Right
documentation
7. Right education
8. Right assessment
9. Right to refuse
11. Right approach
12. Right principle of

care
14. Right nurse

clinician
Monitor patient for

adverse effects
Medication given


record recorded.
Explain the
importance of vital
25
Telefax No.: (078) 304 -1010
signs monitoring
7:00AM Refer to hemodialysis To remove filter Explain the

wastes products and importance of
water from the hemodialysis
blood, if the kidneys procedure to the
don't work as well as patient
they should
Medication given:
Making sure patients
Piperacillin
Used with care in are given the correct
Tazobactam 2.25 g
patients with renal medications ordered
IV q8
impairment or in by their doctors
hemodialysis patients
Clean the IV port
of drugs
drug administration
1. Right drug
2. Right dosage
3. Right patient
4. Right route
5. Right time
6. Right
documentation
7. Right education
8. Right assessment
9. Right to refuse
11. Right approach

care
14. Right nurse

clinician
Evaluating patients
reaction to the
dialysis treatment and
medications
Medication given
11:30AM Monitor CBG TID and To know if the blood Explain the
26
Telefax No.: (078) 304 -1010
CBG taken and

recorded
1:00PM Request for Verified doctor's order

diagnostics test:
Measures the amount Informed the patient
Fe of iron in the blood about the diagnostics
exam
Informed the health

Procalcitonin To detect sepsis and care providers about
severe bacterial the exams
infections
Followed up results
Measures the level of and attached it to the
parathyroid hormone patients chart
iPTH
in the blood
4:00PM Monitor Intake and To ensure that the Monitored patients I

adequate output of
urine and normal
defecation


record recorded.
Explain the
importance of vital
signs monitoring
Placed in a vein to
IVF on heplock administer Before administering
medication or fluid heparin, monitor
into the bloodstream. platelet count,
It contains heparin to hemoglobin, and
thin the blood and serum creatinine
reduce the risk of
blood clots Monitor for signs of
bleeding
Assessing an IV site
7:00AM Facilitate GFR Scan To check how well Verified doctors order
the kidneys are
functioning Explain the
importance of GFR
Scan procedure to the
patient
Informed the nuclear
27
Telefax No.: (078) 304 -1010
medicine technologist
department about the
exam
Assess patients
nutritional status
Assess urine output
Followed up results
patients chart
CBG taken and

recorded
1:00PM Request for Verified doctor's order

diagnostics test:
Most common blood Informed the patient
CBCPC test measures the about the diagnostics
red blood cells, white exam
blood cells, and
platelets Informed the health
care providers about
Measures the level of the exams
Serum electrolytes
electrolytes in the
body Followed up results
patients chart

adequate output of
urine and normal
defecation


record recorded.
Explain the
importance of vital
signs monitoring
CBG taken and

recorded
28
Telefax No.: (078) 304 -1010

adequate output of
urine and normal
defecation


record recorded.
Explain the
importance of vital
signs monitoring
8:30AM Refer to CT Examined the Verified doctors order

stonogram kidneys, bladder, and
ureters that carry Explain the
urine from the importance of CT
kidneys to the stonogram procedure
bladder and test for to the patient
accurately diagnosing
Inform the radiologist
kidney stones
department about the
exam
Position the patient

on an adjustable table
inside an encircling
body scanner, straps
and pillows may be
used to help in
maintaining the
correct position
Instruct the patient to

hold his breath during
the scanning
Assessed carefully for

adverse effects to the
contrast medium
CBG taken and

recorded

Output q8 and record patient has proper and O q shift, record
adequate output of
29
Telefax No.: (078) 304 -1010
urine and normal

defecation
6:00PM Advised for

hemodialysis
tomorrow

6:15AM Give FD 200 ml PNSS For fluid and Regulated IVF

now electrolyte correctly and labeled
replenishment it

the IV line
Hydrocortisone 200
mg/IV and HD was Because patient
put on hold. presented with Hydrocortisone and
difficulty of HD was put on hold
breathing,
hypotensive episode,
and desaturation
Hooked to 02 at 2-3
lpm via nasal cannula
Provide supplemental
Adjust flow rate as
oxygen therapy to
ordered by physician.
people who have
Check the oxygen is
lower oxygen levels
flowing out of prongs
Encourage patient to
breath through nose
with mouth closed
Check nares for

evidence of irrigation
Monitor VS q1 for the or bleeding
next 4 hours and
reassess
For baseline data
VS taken and
recorded.
Explain the
importance of vital
signs monitoring
CBG taken and

recorded

30
Telefax No.: (078) 304 -1010

adequate output of
urine and normal
defecation
10:20PM Remove the oxygen Patient have normal Inform the patient
device oxygen levels and that they remove the
breath comfortably oxygen device


record recorded.
Explain the
importance of vital
signs monitoring
CBG taken and

recorded
1:30PM Advise for follow up To confirm or rule Verified doctors order

repeat labs with out a condition or
following additional disease Informed the patient
diagnostics: about the diagnostics
exam
Fecalysis, FOBT,
APTT, PT Informed the health
care providers about
the exams
Followed up results
patients chart

adequate output of
urine and normal
defecation


record recorded.
Explain the
31
Telefax No.: (078) 304 -1010
importance of vital
signs monitoring
8:00AM Medications: Verified doctors order
Continue Relieve redness, Advise patient to take

hydrocortisone 100 itching, swelling, or oral medication with
mg OD other discomfort food to minimize GI
caused by skin upset
conditions
drug administration
Cetirizine 10mg/tab Antihistamine used to 1. Right drug
ODHS×5 days allergy symptoms
such as watery eyes, 2. Right dosage
runny nose, itching
3. Right patient
eyes/nose, sneezing,
hives, and itching 4. Right route
5. Right time
6. Right
documentation
7. Right education
8. Right assessment
9. Right to refuse
11. Right approach

care
14. Right nurse

clinician
Monitor patient for

adverse effects
Medication given
8:30AM IVF on heplock Placed in a vein to Before administering

administer heparin, monitor
medication or fluid platelet count,
into the bloodstream. hemoglobin, and
It contains heparin to serum creatinine
thin the blood and
reduce the risk of Monitor for signs of
blood clots bleeding
Assessing an IV site
9:15AM Advise for K-post To measures the Verified doctor's order

correction amount of potassium
Informed the patient
32
Telefax No.: (078) 304 -1010
levels in the blood about the diagnostics

exam
Explain the
importance of K-post
correction
Monitor input and

output
Followed up results
patients chart
11:00PM Monitor CBG TID and To know if the blood Explain the
CBG taken and

recorded

adequate output of
urine and normal
defecation


record recorded.
Explain the
importance of vital
signs monitoring
7:50AM Continue ertapenem Treatment of Verified doctor's order

500mg IV Q24 infections of the
abdomen, the lungs, Clean the IV port
the upper part of the prior to administration
female reproductive of drugs
system
drug administration
1. Right drug
2. Right dosage
3. Right patient
4. Right route
5. Right time
6. Right
33
Telefax No.: (078) 304 -1010
documentation
7. Right education
8. Right assessment
9. Right to refuse
11. Right approach

care
14. Right nurse

clinician
Monitor patient for

adverse effects
Medication given
8:30AM Secure 3u PRBC Used to improve Verify doctors order.

blood oxygen- Inform the client and
carrying capacity and explain the purpose
restore blood volume of the procedure
Check for cross

matching and typing
to ensure
compatibility
11:00PM Monitor CBG TID and To know if the blood Explain the
CBG taken and

recorded

adequate output of
urine and normal
defecation
6:00PM Advise for OR

schedule tomorrow
Procedure:
Cystoscopy retro
procedure Imaging test that Verified doctors order
intradermal surgery uses X-rays to look at
repair the bladder, ureters, Explain the
and kidneys importance of
cystoscopy retro
procedure to the
34
Telefax No.: (078) 304 -1010
patient
Anesthesia Pre Op
Orders:
Anticipation of Assess patients prior
NPO at 12 am procedures requiring to surgery (e.g. NPO
sedation or general status) and alleviate
anesthesia their concerns
Use for fluid and Regulated IVF

electrolytes correctly and labeled
IVF: D5NR 1L ×
resuscitation it
90cc/hr using 18
gauge IV cannula Check the patency of
once on NPO the IV line
Improve the gastric
Medications: environment at the Verified doctor’s order
time of induction of
Omeprazole 40mgIV Clean the IV port
anesthesia
of drugs
For major surgical Observed 14 Rights of

Hydrocortisone stress adrenal drug administration
250mgIV one hour insufficiency,
hemodynamic 1. Right drug
prior to OR transfer
instability, and the 2. Right dosage
possibility of adrenal 3. Right patient
crisis 4. Right route
5. Right time
6. Right
documentation
7. Right
education
8. Right
assessment
9. Right to refuse
10. Right
evaluation
11. Right
approach
12. Right principle
of care
13. Right
prescription
14. Right nurse
clinician
Monitor patient for

adverse effects
Medication given
Patients with a
history of asthma
need to take
35
Telefax No.: (078) 304 -1010
Nebulize 30 minutes nebulizers before Explain the

prior to OR transfer surgery importance of
nebulize before
transfer to OR
Make the patient sit in

an upright position
To know if the blood
of the patient is Explain the
CBG q4 while on NPO within normal range
importance of CBG
and prior to OR
monitoring
transfer
CBG taken and
Keeping blood sugar
recorded
in control before,
Hold: OHA 24h prior operation will reduce
to OR the risk of infection
in the incision and Orally administered
will help you heal antihyperglycemic
better (OHA) agents was
hold

7:30AM OR schedule today
Anesthesia Post Op
Orders:
Monitor VS and
record For baseline data VS taken and
recorded.
Explain the
importance of vital
signs monitoring
Monitor I and O and To ensure that the
record patient has proper Monitored patients I
intake of fluid and and O q shift, record
whether there is an and report any
adequate output of deviations
urine and normal
defecation
Reduce or relieve the

pressure on the area
Moderate to high at risk, maintain Position the patient in
back rest muscle mass and moderate high back
general tissue rest
integrity and ensure
adequate blood
supply
Anticipation of Assess patients prior

procedures requiring to surgery (e.g. NPO
36
Telefax No.: (078) 304 -1010
NPO temporarily sedation or general status) and alleviate

anesthesia their concerns
Used to improve Verify doctors order.

Give 1u PRBC now blood oxygen- Inform the client and
carrying capacity and explain the purpose
restore blood volume of the procedure
Check for cross

matching and typing
to ensure
compatibility
Check the label of the

blood pack:
Serial number
Blood component
Blood type
Rh factor
Expiration date
Regulated correctly
Maintenance of fluids
Regulated IVF
IVF: PNSS 1L and electrolytes
correctly and labeled
it

the IV line
Therapeutics:
Verified doctor’s order
Short-term relief of
moderate to severe
Tramadol 50mg IV pain
q8 Clean the IV port
For nausea and prior to administration
vomiting of drugs
Metoclopramide Observed 14 Rights of

10mg IV OD drug administration
1. Right drug
2. Right dosage
3. Right patient
4. Right route
5. Right time
6. Right
documentation
7. Right
education
8. Right
37
Telefax No.: (078) 304 -1010
assessment
9. Right to refuse
10. Right
evaluation
11. Right
approach
12. Right principle
of care
13. Right
prescription
14. Right nurse
clinician
Decreases stress,
increases calm, and Monitor patient for
increases energy adverse effects
Medication given
Encourage deep
Teach the patient in
breathing exercise
deep breathing
exercise
Refer
VI. DRUG STUDY
Brand Name Norvasc
Generic Name amlodipine
Classification Antihypertensive
Dosage/route/ 10 mg/day
frequency
Oral
O.D
38
Telefax No.: (078) 304 -1010
Indication Management of hypertension, chronic stable angina, vasospastic

angina.
Mechanism of Action Management of hypertension, chronic stable angina, vasospastic

angina. Binds to dihydropyridine and nondihydropyridine
cell membrane receptor sites on myocardial and vascular smooth-
muscle cells and inhibits influx of extracellular calcium ions across
slow calcium channels. This decreases intracellular calcium level,
inhibiting smooth- muscle cell contractions and relaxing coronary
and vascular smooth muscles, decreasing peripheral vascular
resistance, and reducing systolic and diastolic blood pressure.
Decreased peripheral vascular resistance also decreases
myocardial workload, oxygen demand, and possibly angina.
Contraindications Hypersensitivity to amlodipine or its components. Hepatic

impairment, aortic stenosis, hypertrophic cardiomyopathy with
outflow tract obstruction.
Side effects Frequent (greater than 1%): Dizziness, palpitations, nausea,

unusual fatigue or weakness (asthenia). Rare (less than 1%):
Chest pain, bradycardia, orthostatic hypotension.
Adverse effects CNS: Anxiety, dizziness, fatigue, headache, lethargy, light-

headedness, paraesthesia, somnolence, syncope, tremor
CV: Arrhythmias, hypotension, palpitations, peripheral edema

EENT: Dry mouth, pharyngitis
ENDO: Hot flashes GI: Abdominal cramps, abdominal pain,

constipation, diarrhea, esophagitis,
indigestion, nausea GU: Decreased libido, impotence, urinary
frequency
MS:Myalgia SKIN: Dermatitis,
RESP: Dyspnea
39
Telefax No.: (078) 304 -1010
flushing, rash Other:Weight loss
Nursing Responsibility Monitor vital signs
Obtain history of patient's previous medication to avoid

interactions.
Monitor blood
pressure while adjusting dosage, especially in patients with heart

failure or severe aortic stenosis
Brand name Invanz
Generic Name Ertapenem
Classification Antibiotic
Dosage/route/ 500mg IV Q24

frequency
Indication Used as perioperative prophylaxis
Mechanism of Action Synthetic carbapenem beta-lactam antibiotic f which inhibits

bacterial cell wall synthesis binding to 1 or more penicillin- binding
proteins (PBPs). It is active t against gram positive and gram
negative aerobic and anaerobic 1 bacteria and stable against
hydrolysis by t dehydropeptidase 1 (DHP 1).
Contraindications Contraindicated in patients hypersensitive to drug, its components,

or other drugs in the same class and in those who have had
anaphylactic reactions to beta- lactams.
Side effects Invanz may cause serious side effects including:
severe stomach pain, diarrhea that is watery or bloody,
tremors, twitching, rigid (very stiff) muscles, seizures, and unusual

changes in your mood or behavior
Adverse effects CNS: asthenia, fatigue, anxiety, altered mental status, dizziness,
headache, insomnia, fever.
40
Telefax No.: (078) 304 -1010
CV: phlebitis, thrombophlebitis, edema, swelling, chest pain,

hypertension, hypotension, tachycardia.
EENT: pharyngitis. GI: abdominal pain, acid regurgitation, oral

candidiasis, constipation, diarrhea, dyspepsia, nausea, vomiting.
Nursing Responsibility Lab tests: Perform C&S tests prior to therapy. Monitor periodically
liver and kidney function.
Determine history of hypersensitivity reactions to other beta-

lactams, cephalosporins, penicillins, or other drugs.
Discontinue drug and immediately report S&S of hypersensitivity.
Monitor for seizures especially in older adults and those with renal
insufficiency.
Brand Name Losec
Generic Name Omeprazole
Classification Proton Pump inhibitors
Dosage/route/ 40 mg
frequency
IV
Indication -Short term treatment of active duodenal ulcer
- Treatment of heartburn and symptoms of GERD
-Short term treatment of benign gastric ulcer
Mechanism of Action Gastric acid- pumo inhibitor: suppresses gastric acid secretion by
specific inhibition of the hydrogen potassium ATPase enzyme
system at the secretory phase of the gastric parietal cells; blocks
the final step of gastric secretion
Contraindications -Contraindicated with hypersensitivity to omeprazole or its

components
-Use cautiously with pregnancy and lactation
-Special precautions to those have hepatic impairment
Side effects -Headache
-Dizziness
-Diarrhea
-Abdominal
41
Telefax No.: (078) 304 -1010
-Nausea/vomiting
-URI symptoms
-Back pain
-Fever
Nursing Responsibility -Administer before meals. Caution patient to swallow capsules

whole-not to open, chew, or crush them. If using oral suspension,
empty packet into a small cup containing 2 tbsp of water. Stir and
have patient drink immediately; fill cup with water and have
patient drink this water. Do not use any other diluent.
-Administer antacids with omeprazole, if needed
Brand Name Acetaminophen
Paracetamol
Generic Name
Analgesic
Classification
Antipyretics
1g
Dosage/Route/Frequency IV
Q4
Treatments of mild to moderate pain

Indication
For fever.
Antipyretics: reduces fever by acting directly on the hypothalamic
heat regulating center to cause vasodilation and sweating, which
helps dissipate heat.
Mechanism of Action Analgesia: by inhibiting CNS prostaglandin synthesis. The
mechanism of morphine is believed to involve decreased
permeability of the cell membrane to sodium, which results in
diminished transmission of pain impulses therefore analgesia.
Contraindicated in known hypersensitivity to paracetamol in hepatic
Contraindications
and renal failure
Liver damage
Skin reaction
Nausea
Side Effects Vomiting
Dark urine
Yellowish skin
Loss of appetite
Headache
Chest pain
Adverse Effects
Dyspnea
Nursing Responsibilities Do not exceed the recommended dosage

/Consideration Reduce dosage with hepatic impairment
42
Telefax No.: (078) 304 -1010
Give drug with GI upset occurs

Discontinue drug if hypersensitivity reaction occurs
Treatment of overdose: monitor serum levels regularly,
N-acetylcysteine should be available as specific antidote.
Brand Name Cetirizine
Generic Name Zyrtec
Classification Antihistamine
Dosage/Route/Frequency 10mg
IV
ODHS
Indication Cetirizine is an antihistamine used to relieve allergy symptoms such as

watery eyes, runny nose, itching eyes/nose, sneezing, hives, and itching
Mechanism of action Cetirizine is a fast-acting, highly selective antagonist of the peripheral

histamine H1 receptor. The H1-receptors inhibited by cetirizine are
primarily on respiratory smooth muscle cells, vascular endothelial cells,
immune cells, and the gastrointestinal tract
Contraindications Cetirizine is contraindicated in anyone with a known hypersensitivity to

hydroxyzine, as cetirizine is a metabolite of hydroxyzine
Side Effects  headaches

 feeling sick (nausea)
 feeling dizzy
 diarrhea
 sore throat
Adverse Effects  sleepiness (drowsiness) and reduced co-ordination, reaction

speed and judgement – do not drive or use machinery after
taking these antihistamines.
 dry mouth.
 blurred vision.
 difficulty peeing.
Nursing Advise patient about the risk of daytime drowsiness and decreased
Responsibilities/Consideration attention and mental focus
Advise patient to avoid alcohol and other CNS depressants because of

the increased risk of sedation and adverse effects
43
Telefax No.: (078) 304 -1010
Instruct patient to report other troublesome side effects, including

severe or prolonged dry mouth or upper respiratory tract irritation
Ceftriaxone
Brand Name: Rocephin
Generic Name: Ceftriaxone
Classification: Antibiotic
Dosage: 1gram
Route: Intravenous
Frequency: q 8 hours
Indication Ceftriaxone is used for the treatment of the infections

(respiratory, skin, soft tissue, UTI, ENT) caused by
susceptible organisms.
Contraindication Hypersensitivity to cefotaxime is an absolute contraindication

to its use. Patients with known allergies to penicillin or other
cephalosporins should also avoid cefotaxime.
Mechanism Of Action Ceftriaxone works by inhibiting the mucopeptide synthesis in

the bacterial cell wall. The beta-lactam moiety of ceftriaxone
binds to carboxypeptidases, endopeptidases, and
transpeptidases in the bacterial cytoplasmic membrane.
Binding of ceftriaxone to these enzymes causes the enzyme
to lose activity; therefore, the bacteria produce defective cell
walls, causing cell death.
44
Telefax No.: (078) 304 -1010
Side Effects Fever, diarrhea, swelling, redness, or pain at the injection site
may occur.
Adverse Effect Seizure, Rashes, Bleeding
Nursing Responsibility Monitor signs of allergic reactions and anaphylaxis, including

pulmonary symptoms (tightness in the throat and chest,
wheezing, cough dyspnea) or skin reactions (rash, pruritus,
urticaria). Notify physician or nursing staff immediately if
these reactions occur.
Monitor for manifestations of hypersensitivity. Report their

appearance promptly and discontinue the drug.
Monitor injection site for pain, swelling, and irritation. Report

prolonged or excessive injection site reactions to the
physician.
Piperacillin Tazobactam
Brand Name:
Zosyn
Generic Name:
Classification:
Antibacterial
Dosage:
2.25
Route:
Intravenous
Frequency:
q 8 hours
45
Telefax No.: (078) 304 -1010
Indication Indicated in adults and pediatric patients for the treatment of

nosocomial pneumonia (moderate to severe) caused by beta-
lactamase producing isolates of Staphylococcus aureus and
by Piperacillin and Tazobactam-susceptible Haemophilus
influenzae, Klebsiella pneumoniae.
Contraindication Hypersensitivity to piperacillin, tazobactam or any other

penicillin-antibacterial agent. History of acute severe allergic
reaction to any other β-lactam active substances (e.g.
cephalosporin, monobactam or carbapenem).
Mechanism of Action Piperacillin is a beta lactam antibiotic that inhibits bacterial

cell wall synthesis.
Side Effects Diarrhea,
Constipation,
Nausea,
Vomiting,
Heartburn,
stomach pain,
fever,
headache.
Adverse Effects Rash, itching, hives, difficulty breathing, swallowing, hives
Nursing Responsibility Monitor signs of allergic reactions and anaphylaxis, including

pulmonary symptoms (tightness in the throat and chest,
wheezing, cough dyspnea) or skin reactions. Notify physician
if it occurs.
Obtain history of hypersensitivity to penicillins,

cephalosporins, or other drugs prior to administration.
Monitor for hemorrhagic manifestations because high doses

may induce coagulation abnormalities.
Brand name: Cortef Brand name: Invokamet, Invokana
Generic name: Hydrocortisone Generic name: Canagliflozin
Classification: Corticosteroids Classification: Antidiabetics, SGLT2 Inhibitors
Dose/Route/Frequency: 100mg/IV/q6 Dose/Route/Frequency: 5g/IV tab BID
46
Telefax No.: (078) 304 -1010
Indication: Replacement therapy in Indication: used in conjunction with diet and

adrenalcortical insufficiency exercise to increase glycemic control in adults
diagnosed with type 2 diabetes mellitus
Hypercalcemia:associated with cancer
Short term inflammatory disorders
Mechanism of Action: Suppress Mechanism of Action: inhibits the SGLT2 co-

inflammation ofthe normal immune transporter. This inhibition leads to lower
response. reabsorption of filtered glucose into the body
and decreases the renal threshold for glucose
Replace endogenous cortisol indeficiency (RTG), leading to increased glucose excretion
states.Also have potent mineral in the urine
corticoid(sodium-retaining)activity
Contraindication: Infections,especially Contraindication:contraindicated in patients

TB,fungal infections,amoebiasis,hepatitis with a severe hypersensitivity reaction to the
B,liver disease,liver cirrhosis,active or latent drug, in individuals with severe renal
peptic ulcer impairment , in those with end-stage renal
disease, and in patients on dialysis.
Side Effects: Side effects:Bladder pain,bloating,bloody or

vertigo,headache,hypotension,shock,thin,fragil cloudy urine,decreased frequency or amount
e skin,petechiae,amenorrhea,muscle weakness of urine,painful urination,frequent urge to
urinate,increased thirst,increased urge to
urinate during the night,loss of appetite,lower
back or side pain,nausea and vomiting
Adverse effects: Adverse effects: rash,hives,itching,difficulty

swallowing,swelling of the face, throat,
CNS: depression, euphoria, headache, tongue, lips, mouth, or eyes,hoarseness.
increased intracranial pressure (children
only), personality changes, psychoses,
restlessness.
EENT: cataracts, increased intraocular

pressure. CV: hypertension
GI: PEPTI CULCERATION, anorexia, nausea,

vomiting
Nursing Responsibilities/Consideration: Nursing Responsibilities:
Ask the patient to rise slowly from a supine Instruct patient to take canagliflozin as
or sitting position to avoid hypotension. directed.
Encourage adequate fluid intake and foods Explain to patient that canagliflozin helps
to provide sufficient bulk and exercise as control hyperglycemia but does not cure
tolerated. diabetes.
Ask patient to avoid performing activities Instruct patient not to share this medication
that require mental alertness. with others, even if they have the same
symptoms; it may harm them.
Encourage patient to follow prescribed diet,

medication, and exercise regimen to prevent
hyperglycemic or hypoglycemic episodes.
Instruct patient in proper testing of blood

glucose and urine ketones.
47
Telefax No.: (078) 304 -1010
Brand Name Creazor
Generic Name Rosuvastatin calcium
Classification Statins
Tablet
OD
Indication Treat high cholesterol, including conditions that are genetic

(passed down through families). It’s also used to prevent
heart disease
Mechanism of action Rosuvastatin acts primarily in the liver. Decrease hepatic

cholesterol concentrations stimulate the upregulation of
hepatic low density lipoprotein receptors which increases
hepatic uptake of LDL. Rosuvastatin also inhibits hepatic
synthesis of very low density lipoprotein
Contraindications Rosuvastatin is contraindicated for use during pregnancy.

Because HMG-CoA reductase inhibitors decrease cholesterol
synthesis and possibly the synthesis of other biologically
active substances derived from cholesterol, rosuvastatin may
cause fetal harm when administered to pregnant women.
Side Effects Feeling sick (nausea)
Headaches
Stomach pain
Constipation
Adverse Effects Muscle pain, tenderness, and weakness
Nursing Monitor for and report promptly S&S of skeletal muscle pain
Responsibilities/Consideration
Do not take antacids within 2 h of taking this drug
Monitor diabetics for loss of glycemic control.
48
Telefax No.: (078) 304 -1010
Brand Name Ultram
Generic Name Tramadol
Classification Opioid analgesics
IV
Q8
Indication Treat moderate to severe pain that is not being relieved by

other types of pain medicines
Mechanism of action Tramadol is a centrally acting synthetic opioid medication

with monoaminergic actions similar to serotonin
norepinephrine reuptake inhibitors (SNRIs). It specifically
acts as a weak mu-opioid receptor agonist and as a serotonin
and norepinephrine reuptake inhibitor
Contraindications Tramadol is contraindicated in patients who have had a

hypersensitivity reaction to any opioid.
Side Effects  sleepiness
 constipation
 sweating
 fatigue
 headache
 dry mouth
 vomiting
Adverse Effects feel dizzy, tired and have low energy
Nursing Monitor vital signs and assess for orthostatic hypotension or

Responsibilities/Consideration signs of CNS depression.
Discontinue drug and notify physician if S&S of

hypersensitivity occur
Assess bowel and bladder function; report urinary frequency
49
Telefax No.: (078) 304 -1010
or retention
Metoclopramide
Brand Name: Reglan
Generic Name: Metoclopramide
Drug Classification: Antiemetic, Prokinetic agents
Dosage: 10mg
Frequency: Once a day
Route: Intravenous
Indication : It is indicated for patients with Gastrointestinal Reflux Disease and Nausea,
vomiting.
Contraindication: Metoclopramide should not be used in those patients with hypersensitivity

to the drug or its components.
Mechanism Of Action: Metoclopramide enhances gastric motility without stimulating gastric

secretions. Peripherally, metoclopramide augments cholinergic activity either by causing the
release of acetylcholine from postganglionic nerve endings or by sensitizing muscarinic
receptors on smooth muscle.
Side Effects: Drowsiness, dizziness, tiredness, trouble sleeping, agitation, headache, and
diarrhea may occur.
Adverse Effects: hepatotoxicity, seizures, tardive dyskinesia
Nursing Responsibility:
Monitor BP carefully during IV administration.
Monitor for extrapyramidal reactions, and consult physician if they occur.
Monitor diabetic patients, arrange for alteration in insulin dose or timing if diabetic control is
compromised by alterations in timing of food absorption.
VII. NURSING CARE PLAN
Assessment Diagnosis Planning Intervention Rationale Evaluation
Acute pain Within 1 hour Within 1 hour

related to of nursing of nursing
Post-surgical interventions, Encourage To promote interventions,
incision the patient patient to cooperation the patient
Subjective verbalize from the
will be able was be able
Data: about pain patient
to: to:
“Masakit Acknowledge
Verbalize Verbalize
yung and convey
50
Telefax No.: (078) 304 -1010
naoperahan pain relief oracceptance Conveying pain is

sa akin” controlled of the acceptance controlled
verbalized by patient’s pain of the patient with a pain
the patient. experience pain scale of 5/10
promotes a from 10/10
Appear
more
relaxed, able
cooperative
Pain scale of to rest/ sleep
nurse patient
10/10 and Appear
relationship
participate in relaxed, able
activities to rest/ sleep
appropriately and
participate in
Objective activities
Assess Fatigue, appropriately
Data:
patient ability anxiety and
Facial to accomplish depression
grimace activities of associated
daily living with chronic
Irritable (ADL’s) pain can limit
the person’s
ability to
complete self
care activities
Encourage
This calms
and assist
and soothes
patient to do
the patient
deep
and it
breathing
contributes
exercises
to pain relief
or reduction
encourage To divert
divertional attention
activities from pain
provide to promote
therapeutic feeling of
touch comfort
Create a comfort and

quiet,no a quiet
disruptive atmosphere
environment promote a
and relax feeling
comfortable and permit
temperature the patient to
when focus on the
possible relaxation
technique
rather than
external
DEPENDENT
distraction
51
Telefax No.: (078) 304 -1010
Administer To relief pain

analgesic as
ordered
Impaired After 4 hours Independent for further After 4 hours

urinary of nursing Data: assessment of nursing
Subjective elimination interventions, and action interventions
Data: related to normal urine the Goal is
presence of elimination met through
Ø Assesed
foley and output exhibition of
patency of
catheter and will be adequate
foley
nephrostomy maintained Prevents or urinary
catheter
Objective tube reduces risk output and
Data: of patent
contaminatio drainage
- Presence of
n of Foley systems
renal calculi
catheter.
Used asepsis
- with Foley and hygiene
catheter in providing
draining to care
yellowish
urine, > 30 Provides
ml/hr and information
with about
nephrostomy adequacy of
tube urine output,
condition and
patency of
Assessed Foley
- Drinks 8 or
color, catheter and
more glasses
volume, odor debris in
of water a
and urine
day
components
of urine
Educate the These are

patient to rich in
avoid oxalate, that
drinking tea, can lead to
the formation
52
Telefax No.: (078) 304 -1010
and eating of calculi

chocolates
It can
Educate the promote
patient to more renal
minimize also calculi
to eat foods formation
rich in
calcium such
as cheese,
milk and
butter
Emphasize
importance
of having To promote
good hygiene wellness
Subjective Impaired Within 8 Independent INDEPENDEN Within 8

Data: skin integrity hours of Data: T hours Of
related to immediate immediat
Pain at the presence of of • Monitor • Elevatio e of
surgical site surgical postoperat and n in vital postopera
wound ive care record sign tive care
Objective
secondary to the vital rates the
Data:
S/P patient signs may patient
S/P cystoscopy cystoscopy will be frequen indicate was be
retrograde intrarenal able to tly infection able to
intrarenal surgery, left verbalize speciall or manifest
surgery, left; supine and y the further intact skin
supine percutaneou experience blood complica integrity
percutaneous s timely pressur tion at as
nephprolithoto nephrolithot healing of e and incision evidence
my,left omy, left wound body site by:
without temper
complicati ature. • To have
ons. a
• Monitor 1.Absence
baseline
The of
intake data of
patient inflammat
and the
will ion
output clients
manifest: manifeste
daily urine
d by
intake
53
Telefax No.: (078) 304 -1010
1.Absence and redness,

of output swelling,
inflammati • Inspect pain and
on surroun • To purulent
manifeste ding assess discharge
d by skin for for on
redness, erythe complica surgical
swelling,p ma or tions incision
ain and inflamm and site.
purulent ation infection
discharge and
on note • To
2.Vital
surgical odors protect
signs will
incision emitted the
be stable
site. from wound
the and
surgical surround
incision ing
2.Vital
tissues.
signs will
be stable • For
• Do immedia
proper te
aseptic replace
wound ment
care and
using prevent
appropr skin
iate breakdo
barrier wn and
dressin contami
g, nation of
wound operativ
coverin e site
g and
skin • To
protecti improve
ve circulatio
agents n and
as reduces
needed. risks
associat
• Give ed with
health immobili
teachin ty
gs and
proper
wound
care
and the
importa
nce of
not
touchin
g the
wounds
54
Telefax No.: (078) 304 -1010
• Encoura
ge early
ambulat
ion or
mobiliza
tion
Assessment Diagnosis Planning Intervention Rationale Evaluating
Subjectiv Risk for Within the • Assess signs • Fever Goal met:
e Data: infection shift the and symptoms may
related to patient Patient
of infection indicate
“Kagabi post will be was free
especially infection
mga alas surgical able to: from any
temperature.
dyes procedur identify • -It signs and
natapos e risk • Emphasize the symptoms
serves as
yung factors of of
importance of a first
operasyon the infection
hand washing Line of
ko“ as infection as
technique defense
verbalized manifeste
against
by the Be free • maintain d by
infection
patient. fro any aseptic absence of
signs and technique • Regular fever
Object symptoms when changing wound
Data: of dressing/carin dressing
infection g wound promote
-T- 36
s fast
-Weak in • keep area healing
appearance around wound and
clean and dry drying of
- clean and
wounds
intact
dressing • Wet area
can be
Dependent : lodge
area
of bacteria
Emphasize necessity
of taking antibiotics as
ordered
Premature
discontinuation
of treatment
when client
begins to feel
well may result
in return of
infection
55
Telefax No.: (078) 304 -1010
Disturbed Following • Assess • High After 3

sleeping a 3 days sleep percentag days of
Subjective patterns of nursing nursing
pattern e of sleep
Data: related to interventio disturba disturbanc interventio
pain, n the nces that es can n the
“ hindi ako
interruptio patient will are affect the patient
makatulog kasi
ns for achieve associate recovery was able
sobrang sakit
therapeuti optimal d with of the to display
ng lower back
cs, and amount of the patient improvem
ko tyaka
monitoring sleep, the environ ent in
nagigising ako
kapag
patient will ment • To sleeping
verbalize determine pattern :
bumibisita
yung nurse”
feeling • Obtain Usual
rested, The
verbalized by feedback sleeping
decrease patient
the patient regardin pattern
the verbalized
g On the and to
Objective presence usual compare if “Medyo
Data: of orbital sleeping there are nakatulog
edema, pattern any na ako.
• Presen and and improvem
ce of improvem usual ents on The
infraor ent of number the presence
bital sleeping of hours sleeping of
edema pattern of sleep pattern of infraorbital
the pair edema
• Irritabil • Do as have been
ity much • To avoid minimize
care as disturbanc
possible es during
without sleep, and
waking also to
up the maximize
pain and the sleep
do as and rest
much of the
care as patient
possible
while the
patient is
still
awake
• Explain
necessity
of
disturba
56
Telefax No.: (078) 304 -1010
nces for
monitori
ng vital
signs
and care
• For the
patient to
when
have an
hospitali
understan
zed
ding of
• Keep the the
linen dry importanc
and e of care
wrinkle being
free done to
her
• To
prevent
discomfort
Fear After 4-5 1.Encourage 1. Provides

related to hours of patient to opportunity for
upcoming nursing acknowledge dealing with
surgery as intervention and express concerns,
Subjective After the
evidenced before the fears. clarify reality
Data: nursing
by settled of fears.
interventions,
“Natatakot expressed operation,
the patient
ako sa concerns the patient
was able to:
pwedeng will be able
2. Knowing
mangyari na to: 2.Acknowledg feelings are
baka hindi e feelings of normal can
maging normalcy 1.To appear
allay
successful feelings in this anxiety/fear relax
1.Appear
yung relaxed. situation that client is
operasyon losing control
ko,, na baka 2.Report
may readiness to
mangyaring 2.Verbalize
undergo
masama at readiness for
surgery
hindi ko na upcoming
makita ang surgery.
mga anak
3.Active-listen 3. Verbalize
ko”
the patient’s 3.Promotes an fear is
verbalizes by 3.Report fear
concerns atmosphere of reduce to a
the patient. is gone or
reduced to caring and more
permits manageable
manageable
level explanation or level.
Objective
correction of
Data:
misperceptions
57
Telefax No.: (078) 304 -1010
Facial
tension
4. Knowing
feelings can
allay
fears/anxiety
4. Explain
that client is
procedures
losing control
and care as
delivered.
5.Provides
opportunity to
5.Encourage
examine
patient to
realistic fears
share
and
thoughts and
misconceptions
feelings
6.Aids in
developng an
internal locus
of control,
6.Assist client reducing fear
to learn and anxiety.
relaxation
VIII. DISCHARGE CARE PLAN
MEDICATION
 Describe the importance of regularly taking of prescribed medications including the

potential unpleasant effects of non compliance.
 Advise the patient to continue and not to miss the intake of medication given by her
physician upon discharge to ensure optimum recovery.
ENVIRONMENT AND EXERCISE
 Maintain a quiet, pleasant, environment to promote relaxation. To provide clean and

comfortable environment.
 Encourage client to continue deep breathing exercises, also instruct the family for
needed. This is to promote circulation of blood, relaxation also.
 Encourage client to get advice from healthcare professionals, such as their therapists, on
what activity they should be. Physical therapist will work with you to design a specific
treatment program that will improve your recovery, including exercise and treatments
that you can do on your own
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Telefax No.: (078) 304 -1010
TREATMENT
 Discuss the purpose of treatments to be performed such as proper medication and

regimen like wound cleaning and wound dressing to be maintained at home. To prevent
further complication and prevent infection.
HYGIENE
 Tell the significant other to assist the patient in maintaining proper hygiene. Instruct
patient to wash hands several times each day (use soap and water every time). Washing
hands can produce significant benefits in terms of reducing the incidence of infection.
OPD
 Make a follow-up appointment as directed by the physician. Instruct patient to return for
the need of regular medical and laboratory follow-up to evaluate disease progression
and response to therapies. Advise patient and significant other to consult doctor if
symptoms do not go away, or they get worse, even after you take medicine. For any
problems or complication encountered. Follow-up visits after discharge is important to
see how patient is doing and ensure there aren't any complications. It's also a great
time to talk a primary care provider about anything else or ask any questions.
DIET
 Encourage the patient to drink water as directed. Liquids keeps your urine diluted and
helps flush away minerals that might form stones.
 Instruct patient to eat healthy foods that include fruits, vegetables, lean meats (poultry,
fish), eggs, unsalted seafood. Helps to build strength and become healthy.
SPIRITUALITY
 Encourage the client to continue to seek God’s guidance and enlightenment. Discuss the
use of relaxation/ meditative activities (prayer). It promotes general well-being and
sense of connectedness with self, nature, and spiritual power.
REFERENCES:
Staghorn Calculus. (2022, May 6). Cleveland Clinic.
Moftakhar, L., Jafari, F., Johari, M. G., Rezaeianzadeh, R., Hosseini, S. V., &
Rezaianzadeh, A. (2022b). Prevalence and risk factors of kidney stone disease
in population aged 40–70 years old in Kharameh cohort study: a cross-
sectional population-based study in southern Iran. BMC
Urology, 22(1). https://doi.org/10.1186/s12894-022-01161-x
Bsn, M. V., RN. (2023). 7 Urolithiasis (Renal Calculi) Nursing Care

Plans. Nurseslabs. https://nurseslabs.com/urolithiasis-nursing-care-plans/
59
Telefax No.: (078) 304 -1010
Nursing Care Plan (NCP) for Renal Calculi | NRSNG Nursing Course . (n.d.).
NURSING.com. https://nursing.com/lesson/nursing-care-plan-for-renal-calculi
Impaired Skin Integrity Nursing Diagnosis & Care Plan . (2023, February 26).
NurseTogether. https://www.nursetogether.com/impaired-skin-integrity-
nursing-diagnosis-care-plan/
60

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES

Alimannao Hills, Peñablanca, Cagayan

A Case Study Presented to the

Dela Cruz, Lowen King Aglado

Duldulao, Maurin Galla

Gallamoy, Clyrie Faith

Gammaru, Ma. Conception

Lacerna, Jerica Mae Guillermo

Laciste, Devine Maraiah Catigggay

Magannon, Xatty Kae Ga-oy

Mahoy, Kyla Mae Angdason

Manuel, Alpha Bunnao

Manuel, Crizelle Jean Servan

Nursing Health History -----------------------------------------------------------------------

Patient’s Profile -----------------------------------------------------------------------------

History of Present Illness -----------------------------------------------------------------

Past Health History -------------------------------------------------------------------------

Family Health History ----------------------------------------------------------------------

Personal and Social History ---------------------------------------------------------------

Gordon’s Functional Health Pattern -----------------------------------------------------

Nursing Physical Assessment -----------------------------------------------------------------

Head to Toe-Physical Assessment ---------------------------------------------------------

Diagnostic and Laboratory Examination Result ------------------------------------------

Anatomy and Pathophysiology ----------------------------------------------------------------

Related Treatments ------------------------------------------------------------------------------

Clinical Practice Guidelines -------------------------------------------------------------------

Course in the Ward -----------------------------------------------------------------------------

Nursing Care Plans -------------------------------------------------------------------------------

Discharge Care Plan -----------------------------------------------------------------------------

Family enterobacteriaceae compromises the majority of urease-producing pathogens.

The most commonurease-producing pathogens are:

1. Family history of kidney stones

1. Urinary tract obstructions

SIGNS AND SYMPTOMS

1. Pain in the back, side, or abdomen

3. Nausea and vomiting

 Diet: low salt and low fat

 Continue present management and medication

 To relieve the pain until its causes can be eliminated

 To eradicate the stone

 To prevent nephron destruction

 To relieve any obstruction

ANTIBIOTICS, ANALGESICS, DIURETICS, NSAIDs,

 CEFTRIAXONE – To treat bacterial infections or preventing their growth in many

 PARACETAMOL – To relieve mild to moderate pain and fever

 PIPERACILLIN TAZOBACTAM – Used with care in patients with renal impairment or in

 HYDROCORTISONE – To treat the symptoms of low corticosteroid levels And Major

 TRAMADOL- To relief of moderate to severe pain

The primary goal of staghorn stone management is complete stone eradication.

Various modalities of treatment are:

 CYSTOSCOPY RETRO PROCEDURE INTRADERMAL SURGERY REPAIR

 Provide adequate pain relief

PREVALENCE MALE FEMALE

III. NURSING HEALTH HISTORY

B. History of Present Illness

Interim, patient noted persistence of symptoms spontaneous removal of nephrostomy

C. Past Health History

(+) S/P Bilateral Nephrostomy Tube Insertion, April 2023 VMMC

D. Family Health History

Grandmoth Grandmoth Grandfather

MEDICAL COLLEGES OF NORTHERN PHILIPPINES

F. Gordon’s Functional Health Pattern

Before hospitalization During hospitalization