Stones in the Stream:

A Case of Nephrolithiasis in a Middle-Aged Man

Presented to the

College of Nursing

Lara, Rei-An Joy

Lorecha, Cristel Joy

Matutina, Gracell

Micarandayo, Jescille Grace

Morillo, Rizza Angel

Obienda, Kylle

Obligar, Hyiacinth

Onayan, Avegail

Ondillo, Ma. Beatriz Anne

Ortiz, Benjie

BSN-2C GROUP 3

2023
 Learning Objectives

General Objectives:
At the end of 1 hour of case presentation, the students will be able to enhance skills, acquire knowledge,
and show positive attitude in providing nursing care and interventions to patients with Nephrolithiasis.

Learning Objectives Plan of Activity

Cognitive Domain:
 Study and review about Nephrolithiasis.
 Define what is Nephrolithiasis.
 Familiarize the pathophysiology and etiology of
 Explain the pathophysiology and etiology of nephrolithiasis
Nephrolithiasis.
 Research and list for important information’s about
 Identify the necessary information regarding conditions and risk factors.
patient’s condition and its risk factors.
Psychomotor Domain:
 Use step by step procedure to complete a physical
 Accurately perform a thorough general assessment evaluation.
which includes the physical assessment and history
taking.  Perform proper procedure and collect all the data
results.
 Demonstrate the correct method for collecting urine
sample analysis.  Observe to establish an accurate intervention and
 Competently providing post-procedure care, treatment plan that provides best care.
including monitoring vital signs, managing pain,
and ensuring patient comfort.

Affective Domain:
 Build self-confidence and positive mindset.
 Gain confidence in caring for patient
with nephrolithiasis.  Remember the basics of good communication.

 Establish a strong rapport with the patient to  Follow the guidance and feedback to learn
promote improvement of health. new things.

 Be open and receptive to feedbacks

and guidance from the clinical
instructors
 OVERVIEW OF THE ILLNESS AND CONDITION

Introduction
Nephrolithiasis also called kidney stones or renal calculi, is a disease affecting the urinary tract. Kidney
stones are small & hard deposits that build up in the kidneys, which are made of minerals, salts phosphate and
other components of foods. (Nojaba & Grant 2020). Kidney stone formation may result when the urine becomes
overly concentrated with certain substances. These substances in the urine may complex to form small crystals
and subsequently stones (Semilla et.al 2019). According to NIDDK, A small kidney stone may pass through
your urinary tract on its own, causing little or no pain, while larger kidney stone may get stuck along the way
which can cause blockage on your flow of urine, causing severe pain or bleeding.

Mankind has been afflicted by kidney stones since centuries dating back to 4000 B.C and it is the most
common disease of the urinary tract (Lopez et Al 2018). According to Health Research and Development,
Nephrolithiasis is one of the most common disorders among kidney disease amounting to 2.3% of the
Philippine population with increasing prevalence in men over 40 and women over 70 years old. While It is an
increasing urological disorder of human health, affecting about 12% of the world population. It has been
associated with an increased risk of end-stage renal failure. The etiology of kidney stone is multifactorial.
Following an initial stone event, the spontaneous 5-year recurrence rate is 35 to 50 percent. Calcium is present
in 80% of kidney stones, and most commonly in the form of calcium oxalate (60%), with calcium phosphate
accounting for 20% of stones (Bultitude and Rees, 2021).

Initially, Stone formation does not cause any symptom. Later, signs and symptoms of the stone disease
consist of renal colic (intense cramping pain), flank pain (pain in the back side), hematuria (bloody urine),
obstructive uropathy (urinary tract disease), urinary tract infections, blockage of urine flow, and hydronephrosis
(dilation of the kidney). These conditions may result in nausea and vomiting with associated suffering from the
stone event. Thus, the treatment and time lost from work involves substantial cost imposing an impact on the
quality of life & nation's economy (Techman et al 2021). According to Kumar, Prevention of renal stone
occurrence remains to be a serious problem in human health. The prevention of stone occurrence requires better
understanding of the mechanisms involved in stone formation. Therefore, Effcttive kidney stone prevention
depends upon addressing the cause of stone formation, Generally, to prevent the first episodes of kidney stone
formation or its secondary episodes, proper management of diet and the use of medications is required. Primary
prevention of kidney stone disease via dietary intervention is low-cost public health initiative with massive
societal implications. Thus, nutritional management is the best preventive strategy against nephrolithiasis
(Schepers et al 2019). A simple and most important lifestyle change is to drink more water, consuming a healthy
diet, limiting salty & sugar-sweetened foods, & consulting a dietician for proper diet. While, Medical treatment
includes taking alpha blockers medication, NSAIDS, tamsulosin, and certain substances like apple cider vinegar
and lemon juice which aid in pain control and helps in facilitating stone passage and preventing new stone
formation. Without proper treatment, kidney stones can cause blockage of the ureter, blood in the urine, frequent
urinary tract infections, vomiting or painful urination, culminating in the permanent functional damage of the
kidneys.
 CONCEPT MAP
NEPRHOLITHIASIS/KIDNEY STONES

Pre-disposing factors
Risk Factors
• Obesity
 Family History
• Type 2 diabetes
 30 or older
• Inflammatory bowel disease
 Drinking little water
• Gout
 Salty & Sweet foods,
• Hyperparathyroidism
 Obesity, Weight loss
• Urinary Tract Infection
Surgery, Medication (aspirin,
antacids, diuretics)

Pathophysiology
MAIN 1. Urine becomes supersaturated
Clinical Manifestations ETIOLOGY with stone-forming substances such
as calcium, oxalate, or uric acid.
• Fever and chills 2. Tiny crystals begin to form when
urine becomes supersaturated.
• Severe pain in your back Crystals can stick to dust particles or
or side KIDNEY STONE
other debris
The exact cause is not 3. Crystals become larger as they
• Blood in your urine grow and collect more molecules
fully understand, but it from the urine.
• Vomiting. is believed to be 4. Crystals bind to the lining of the
• Urine that smells bad or complex process kidney tubules or other parts of the
looks cloudy. involving multiple urinary tract, forming kidney stones.
factor 5. Kidney stones can irritate and
damage the lining of the urinary
tract, causing pain, bleeding, and
obstruction.
Diagnostic or Lab Test 6. Kidney stones can also block the
• Urinalysis flow of urine, leading to kidney
MANAGEMENT failure. (Burning feeling when you
• Medical history
urinate)
• Blood testing
• Imaging test.

Nursing Complication
• Increase fluid intake • Urinary tract
(8-12 glasses of water obstruction
Surgical • Kidney damage
daily)
Shock wave lithotripsy • Administer IV • Blood in urine
procedure to break up fluids per order (Hematuria)
• Manage pain • Stone recurrence
stones inside the urinary
• Sepsis
tract, bile ducts or • Monitoring of MIO
pancreatic duct with a & patterns of voiding
series of shock waves • Promote ambulation Medical
generated by a machine • Promote Nutrition • Treat with alpha
called a lithotripter (Soft diet) blocker drugs
• Administer Pain
relievers
 Biographical Data
Patient Initials: L.G

Sex: M

Age: 40 yrs old

Birthday: 08/17/1975

Address: Rizal Pontevedra Capiz

Ethnic Background: Asian

Educational Level: College Graduate

Who Lives With The Client: Wife & Daughter

Civil Status: Married

Birthplace: Mindoro

Religion: Roman Catholic

Nationality: Filipino

Occupation: Teacher

Physician: Dr. A

Admission Data:
Date: 10-18-23
Source Of History/Data:
Primary Source: Patient
Secondary Source: Wife
Time: 1:00AM Date of Interview: 10/19/23
Time of Interview: 7:30 P.M
Room/Ward: Señeres
 I. Health History:
A. Chief Complaint:
Hypogastric Pain

B. Admitting Impression:
T/C Nephrolithiasis

C. History of Present Illness:

3 days prior to admission, patient was experiencing Hypogastric pain and difficulty in urinating as
patient verbalized "tatlong araw na medyo masakit ako umihi, pero pa wala-wala naman."8 hours prior
to admission patient verbalized "kaya lang kanina sobrang sakit ng puson ko at masakit na din umihi."
Pain scale 9/10, one (1) hour prior to admission, patient was brought to emergency room via mobile
vehicle due to intolerable pain. Upon arrival, the patient elected to be admitted at the hospital.

D. Past Health History:

Patient L.G had dengue fever at the year 2017, when he was 32 years old, Patient has no allergies to any
drugs or medication. No surgical history.

E. Family History
Patient stated that neither his Mother nor Father had any known illnesses related to his. He also said that
he is the first member of the family who suffered Kidney Stones.

F. Socio-Cultural History
Patient L.G is a college graduate and Roman Catholic, occasionally enjoys beer but does not smoke. He
is married with one daughter and spends his weekends cutting grass as a hobby. During his free time, he
bonds with his daughter, niece, and nephew.

G. Environmental History
Patient L.G lives with his wife and daughter along with 2 pets in a subdivision like street near the
highway

H. Medications and substance used

Patient L.G has been taking Vitamin C, Food supplements and potencee 1x a day after meals at home.
II. Pattern Of Functioning

Pattern Area Before Hospitalization During Hospitalization

Fluids & Nutrition Breakfast: He take coffee every Lugaw, tinapay, water, coffee 3x
morning day
Lunch: He usually takes 2 cups of PNSS 1Lx 125cc/hr
rice with fish and meat along with
vegetables
Dinner: He can consume 1 cup of
rice.
Fluids: Water (1,893cc) per day,
Beer (2-3 bottles or 1,155cc) per
month, and 1 cup of Coffee
everyday

Elimination Urine: He urinates 6-7 times a day Once since admission

Stool: He defecates 3x a week 400-500mL of urine per day since
admission

Activity & Exercise Grass cutting every weekend He watches TV on bed along with
folks while he's awake.

Rest & Sleep He usually sleeps 7 hours a day He has difficulty of sleeping due to
without any problems of his environmental disturbances. He
sleeping pattern. managed to rest for 2 hours since
admission
 III. Laboratory Tests and Diagnostic Examination

Type of Lab Test: Urinalysis Date of Test: 10/18/23

Test Normal Values Px Values Significance

RBC 0-1 8-10 High, Due to kidney and
other urinary tract
problems such as
infections of stones

Pus Cell 0-5 0-2 Normal

Protein Negative ++ High, A large amount of
protein in urine
(proteinuria) may mean
that you have a problem
with your kidneys.

Type of Laboratory Test: Hematology

Test Normal Val Px Val Significance
Hemoglobin Mass 130-170 gms/L 149 Normal
Concentration
Erythrocyte Volume 0.40-0.50 L/L 0.44 Normal
Fraction
Erythrocyte Number 4.5-5.5 10^12/L 4.7 Normal
Concentration
Leukocyte Number 5.0-10.5x10^9L 10.23 Normal
Concentration
Segmenters 0.36-0.66 0.79 High, If your
bloodstream is teeming
with too many
neutrophils, you may
develop leukocytosis or a
high total white blood
cell count. You may have
symptoms such as fevers
or recurring infections
Lymphocytes 0.24-0.40:l 0.21 Normal
Thrombocyte Number 150-450 x10^9 L 338 Normal
Fraction (Side Method)

Type of Diagnostic Exam: Ultrasound Date of Exams: 10/18/24

Result/Impression: Bilateral Multiple Nephrolithiasis, cystitis, Grade 1 prostatic enlargement.

Physical Assessment
Body Parts Inspection Palpation Percussion Ausculatation
Hair, Skin and Hair normal, Skin warm, dry
Nails texture and with good turgor.
distribution. No No lumps noted.
infestations. Skin
no pigmentations,
bleeding, rash or
other lesions. No
nail changes.

Skull and Face No facial Skull and face has

asymmetry. Muscle no present nodules
of facial expression or masses.
and sinuses intact.
No involuntary
movement.

Eyes Conjuctive pink,

sclerae white and
shiny without
jaundice. Pupils
equal, round,
reactive to light
accomodation
(PERRLA).
Ears No deformity, No masses or
external tenderness tenderness felt.
or discharge. Ears
are symmetrical.

Nose and Sinuses Midline on the face, No tenderness

no drainage and noted.
redness.

Mouth and Throat Lips pale and dry .

Teeth present, no
plaque seen, gums
are pink without
inflammation,
bleeding or lesions.
Neck Neck supple with No tenderness, no
full ROM. No inflammatory
visible mass or noted.
lumps,
symmetrical, no
jugular venous
distension.

Breast and Axillae Symmetrical, No tenderness and

normal size, no no masses noted.
dimpling, no nipple
discharge.

Chest and Heart Regular breathing No pain or Hollow sound in Absence of

pattern, respiration tenderness upon normal sound adventitious sound.
rate within normal palpation, skin tissue.
range, chest warm and dry. No
expansion crepitus or masses
symmetrical. noted.

Thorax and Lungs Symmetrical No tenderness. No dull sounds or Bronchial normal

intercostal spaces, Normal chest hyper resonance. lung sound heard.
respiration are expansion.
relaxed and in
regular rhythm.

Abdomen Skin color even and Light palpation Tympany over the Borborygmi sound
uniform. No without feeling any stomach is heard.
surgical scar noted. masses and lumps. hypogastric area
No tenderness and dullness over
noted. the liver.

Extremities No deformities Skin temperature

noted in both upper equal in all
and lower extremities, no
extremities. No discoloration noted
joint swelling. or crepitus felt.

Genitalia N/A N/A N/A N/A

 Nursing Care Plan
CUES Nursing Goals/ Intervention Rationale Evaluation
(S&O) Diagnosis Outcome
Criteria
Subjective: Impaired After 2 hours Independent Independent: Goal Met
urinary of nursing  Perform a  To evaluate  Patient had

“tatlong araw na elimination intervention comprehensive the urinary a normal

medyo masakit ako pattern, the patient assessment of elimination urine
umihi pero pa wala- related to the will urine elimination status. elimination
wala naman. Marami obstruction of experience no pattern and asses  To identify pattern as
naman ako uminom urinary tract signs of the frequency, the amount of evidenced
ng tubig kaya lang from kidney obstruction. consistency, pH, urine output. by absence
kanina sobrang sakit stones. color, volume, of  To monitor of urinary
ng puson ko at Outcomes: urine output. urinary symptoms
masakit na din Rationale:  Patient will  Monitor the elimination like
umihi” as verbalized Impaired manifest intake/output pattern. urgency,
by patient. urinary urine output chart daily.  Regel exercise dysuria,
elimination within the  Advise the patient is both helpful frequent
Objective: related to expected to maintain a for men and elimination,
 Weak urinary kidney stones limits urinary diary each women in etc.
stream can be caused  Patient will time while strengthening
 Presence of post by blocking demonstrate passing urine. the pelvic
void dribbling of the ureters, urination  Educate on pelvic floor muscles
urine. causing urine without floor exercise and
 Intake/output backflow into difficulty, such as Regel preventing
chart shows low bladder, urgency of exercise. urine leakage.
urine output kidney frequency. Dependent: Dependent:
(100cc urine swelling and  Patient will  Administer anti-  Prevent UTI

output for 8 spasms. display microbial agents caused by

hours) clear and like urinary
yellow acetohydroxamine obstruction
urine with acid as and retention.
little to no prescribed.  To alkalinize

odor.  Administer the urine in

potassium citrate case of acidic
as prescribed in urinary ph.
case of struvite Collaborative:
stones.  Chronic

 Insert foley urinary

catheter as elimination
ordered. problems need
further
Collaborative: assessment. A
 Refer to urology urologist can
perform
testing and
provide
treatments to
ease pain,
incontinence,
and retention.
 Cues Nursing Goals/Outcome Intervention Rationale Evaluation
(S&O) Diagnosis Criteria
Independent: Independent: Goal met.
Subjective: Acute Goal  Monitor Vital  Elevation of VS
“tatlong araw na abdominal  After 2hrs of signs. is can indication  After 2hrs of
medyo masakit pain related continuous Evaluate for infection. continuous
ako umihi pero pa to kidney nursing pulses, Indicators of nursing care
wala-wala naman. stones intervention capillary hydration and interventions
Marami naman the client pain refill, skin circulating the client
ako uminom ng Rationale: will be turgor, and volume is sign was able to
tubig kaya lang lessened or mucous of kidney verbalize
kanina sobrang Large kidney alleviated. membrane. stones. relief of pain
sakit ng puson ko stones can  Monitor MIO  Urine dilution is as 3/10 using
at masakit na din cause several Outcomes:  Assess the main pain scale.
umihi” as symptoms,  Client pain patient pain recommendation  Absence of
verbalized by including reduces from using pain to prevent grimace,
patient. pain in the 10/10 to 3/10 scale (0-10) kidney stones discomfort,
side of your using pain and recurrence. restlessness
Objective: tummy scale. COLDSPA.  Provide comfort and able to
 Pain Scale 9/10 (abdomen)  Client body  Encourage and affectively stay engaged
severe pain temperature use of relieve pain. in
 Pale lips and that comes and BP returns focused  Monitor the pain conversation.
dry skin and goes, normal from breathing, to determine  Absence of
feeling sick 38C to 36.8C guided whether the pale lips, and
 Facial Grimace or vomiting. and 140/90 to imagery, and underlying dry skin.
110/80. diversional disease or  Patient
 Appears tired Reference:  No grimacing activities. disorder is return to its
and restless. www.nhs.uk discomfort  Encourage improving or normal state.
and pain patient to deteriorating,  VS returned
 Temperature: observed in walk if and whether the to normal
38c patient. possible. pain treatment is values.
 Demonstrate  Promote working.
 BP: 140/90 use of sufficient  Redirect
relaxation intake of attention and
techniques fluids. helps in muscle
such as deep  Assist to a relaxation.
breathing. position of  To facilitate
 Patient will be comfort spontaneous
able to sleep passage.
and rest  Increase
properly. hydration
Dependent: flushes bacteria,
 Administer blood, and
IV fluids as debris and may
per order by facilitate stone
physician. passage.
 Administer
 tramado Dependent:
50mg IV prn  To prevent or
and treat
tamsulosin as dehydration.
per ordered  To help alleviate
by physician. the intense pain
 Conduct caused by stone
catheterization movement and
as per to evaluate the
physician’s effects of meds.
order.  When there are
symptoms of
Collaborative: urinary
 Refer to a retention,
dietitian or catheters can
nutritionist relieve the
pressure in your
bladder.

Collaborative:
 A dietitians or
nutritionist can
customize a diet
plan to help
prevent the
return of kidney
stones.

Cues Nursing Goals/Outcome Intervention Rationale Evaluation

Diagnosis Criteria
(S&O)
 Independent: Independent: Goal met.
Subjective: Risk for The patient will  Identify an  After 8 hrs of
infection remain free of infection in the continuous
“tatlong araw  Performing early stages nursing
related to infection, as
na medyo assessment and enables health intervention
kidney stones evidenced by
masakit ako early detection. care client was
normal signs
umihi pero pa professionals to free from any
and absence of Assess for the
signs &

wala-wala prescribed the
Rationale: signs and presence of appropriate
naman. symptoms
symptoms of local infections antimicrobial related to
Marami naman A risk for infection processes in the agents or Infection.
ako uminom ng infection can
skin or mucus interventions to
tubig kaya lang be identified Vitals signs
membranes. target the 

kanina sobrang when there is a specific pathogen are within

Outcomes:
sakit ng puson potential for  Monitor and causing the normal range
ko at masakit the client to 1. Px will report any infection. especially BP
na din umihi” develop an remain free of signs of of 110/80,
as verbalized Sign and and Body
infection due infection symptoms of 

symptoms temperature
by patient. to various processes, such infection such
include localized of 36.8°C,
factors or as elevated as the swelling, RBC is 0 and
circumstances. temperature, or appearance of redness, pain or no any
Objective: The diagnosis drainage from urine. tenderness, loss discharges
is based on surgical sites or of function in seen.
Lab Result: Dependent:
comprehensiv access sites. affected area and
RBC=8-10 palpable Client was
e assessment  Administer 

1. Px will able to
PR-105 of client health anti-infective
demonstrate Dependent: increase fluid
history, and agents as
RR-28 measures to intake and
risk factors ordered.  Antibiotic
prevent void 4 times
BP-140/80 thus can treatment might
infection such within the
compromise start with an shift and
TEMP as hand washing
the immune Collaborative: empiric maintained
or proper
system. approach until urinary out
hygiene. Review

the culture put
2. Px red blood appropriateness results
of lines and  Client was
cell count will
drain. Collaborative: able to
remain within verbalize
normal Collaborate The earlier lines
with a understanding
or drains can be of individual
physician about removed the better or risk
posibly for the patient. causative
discontinuing Fewer invasive factors
lines and drains lines and devices
that are pose a lesser risk
necessary for infection
anymore.
Drug Characteristics
Generic Name:
Blumea balsamifera
L.
Brand Name:
Sambong
Classifications:
Sambong Blumea
genus, Asteraceae
family
Available Forms:
Capsule, tablet
Drug Indications
Blumea balsamifera
L. Sambong Leaf
(Remoston) Tablet is
an antiurolithiasis in
patients with urinary
tract stones with
normal kidney
function. It is a
diuretic in patients
with edema.
Mechanism of Action
It is a natural diuretic or a
"water pill" for it induces
urination and helps
prevent the retention of
excess body fluid in our
body. It has an anti-
urolithiasis effect which
helps reduce the size and
number of urinary tract
stones and, in some cases,
helps dissolve kidney
stones so they can pass out
through the urine. through
this, it also helps delay the
progression of disease
among renal patients.
Drug
Administration
Route: Oral
Dosage: 500mg
Frequency: BID
Timing:
Adverse Effects
Sambong can cause
allergic reaction for
people sensitive to
ragweed plants and
its relatives. Side
effect may include
itching and skin
irritation
Special Consideration
If the patient is allergic to
any ingredient of the
product. Special
precaution needed for
patients with excretory
urogram showing signs of
renal obstruction. Not
enough is known about
the use of sambong during
pregnancy and breast
feeding. Stay on the safe
side and avoid use.
Consult a doctor: If any
undesirable effect occurs
and if symptoms persist.
Nursing Rationale
Responsibilities
 Avoid using with  Sambong promotes diuresis
other diuretics. One of the sambong benefits
worth noting is diuresis.
 Do not miss a dose.
Diuresis means increased
 Monitor for potential urination.
side effects and
adverse reaction.  In case you miss a dose, use
it as soon as you notice. If it
 Provide teaching is close to the time of your
points such as next dose, skip the missed
possible reactions. dose and resume your
dosing schedule. Do not use
extra dose to make up for a
missed dose. If you are
regularly missing doses,
consider setting an alarm or
asking a family member to
remind you. Please consult
your doctor to discuss
changes in your dosing
schedule or a new schedule
to make up for missed
doses, if you have missed
too many doses recently.
 To promote patient safety by
preventing adverse
interactions and ensuring that
sambong is a suitable and
effective option for the
patient's specific health needs.
 For patients/folks to be aware
of what they should do when
there’s an adverse effect.
 Drug Characteristics Drug Administration Nursing Responsibilities Rationale
Generic Name: Route: oral  Monitor patients vital  If you have low blood
Levofloxacin signs. potassium or an
abnormally slow
Encourage patient to heartbeat, levofloxacin
Brand Name: 

Dosage: 750mg drink medications with may increase your risk

Levaquin, Quinsair
food. of having a fast, slow,
or irregular heartbeat,
Classification: Explain to the patient

loss of consciousness,
Fluoroquinolones Frequency: OD the possible side effects or fainting spells. If
Available Forms: oral and adverse effects that these symptoms occur,
tablets and solution and he/she may experience. tell your doctor right
intravenous away.
administration Timing: 8  Report if patient has
any rash, visual  To avoid abdominal
Drug Indications Adverse Effects changes, severe GI distress
problems, weakness Levofloxacin may
Levofloxacin is FDA- 

approved for the treatment of

and tremors cause some people to
nosocomial pneumonia, CNS: SEIZURES, dizziness, become dizzy,
 Maintain hydration,
community-acquired drowsiness, headache, insomnia, lightheaded, drowsy,
pneumonia, acute bacterial agitation, confusion. Reduce caffeine or less alert than they
rhinosinusitis, acute bacterial are normally
exacerbation of chronic CV: QTc prolongation,
bronchitis, acute bacterial ARRHYTHMIAS.  This is an indication
prostatitis, acute that a patient had an
pyelonephritis, urinary tract GI: HEPATOTOXICI TY, allergic reaction to the
Inhibition skin
infection, of or skin PSEUDOMEMBRANOUS drug
topoisomerase
structure (DNA
infections, COLITIS, abdominal pain,
gyrase) enzymes, which
prophylaxis, diarrhea, nausea, vomiting  Drinking extra water
inhibits relaxation of will help prevent some
Mechanism
supercoiled DNAof Action
and Special Considerations unwanted effects of
promotes breakage of levofloxacin. Caffeine
. double stranded DNA. Prolongation of QT interval; may have an
avoid concurrent use with intensified effect in
other drugs that prolong QT people taking
interval and in patients with levofloxacin.
risk factors for torsades de
pointes (hypokalemia,  Reference:
significant bradycardia, my.clevelandclinic.org,
cardiomyopathy) Patients www.mayoclinic.org,
with glucose 6-phosphate www.occhd.org,
dehydrogenase deficiency
Diabetes mellitus;
disturbances of blood glucose
have been reported, usually in
diabetic patients receiving
concomitant treatment with an
oral hypoglycemic agent or
with insulin
Drug Characteristics Drug Administration Nursing Rationale
Responsibilities
Generic Name: Route: P.O  Advise the patient to  Taking it after meals will
POTASSIUM CITRATE take this medication help prevent the side effects
Dosage: 1080mg with a meal or such as nausea, vomiting,
Brand name: Urocit K. bedtime snack, or diarrhea and stomach pain.
Frequency: TID within 30 minutes
Classification: Urinary  The patient should become
after a meal.
alkalinizers Timing: very familiar with the list
of foods to eat or avoid to
 The treatment may
Available forms: Tablet, help control his/her
include a special
Capsule condition.
diet. It is very
important to follow  To diagnose or monitor
Drug Indication Adverse Effects the diet plan created kidney disease.
Potassium citrate is used confusion, increased for the patient by
his/her doctor or  This test will help the
to treat kidney stone thirst, black or tarry
nutrition counselor. doctor determine how long
condition called renal stools, irregular
to treat the patient with
tubular acidosis. heartbeat, leg Patients’ blood may
 potassium.
discomfort, muscle need to be tested
weakness, coughing up often.  Exposure to light, humidity,
blood. and extreme temperatures
 Regular checked of can break down both
heart rate may also prescription and over the
be done using an counter drugs, making
Mechanism of Action Special Consideration electrocardiograph or them less effective and in
When given orally, the You should not use
metabolism of absorbed potassium citrate if you
citrate produces an alkaline have kidney failure, a
load. The induced alkaline urinary tract infection,
load in turn increases urinary
uncontrolled diabetes, a
pH and raises urinary citrate
peptic ulcer in your
by augmenting citrate
stomach, Addisons
clearance without
measurably altering ultra disease, severe burns, or
filterable serum citrate. other tissue injury, if you
Thus, potassium citrate are dehydrated, if you
therapy appears to increase take certain diuretics
urinary citrate principally by (water pills), or if you
modifying the renal handling have high level of
of citrate, rather than by potassium in your blood
increasing the filtered load (hyperkalemia). You
of citrate. The increased
should not take potassium
filtered load of citrate may
play some role, however, as
tablet if you have
in small comparisons of oral problems with your
citrate and bicarbonate, esophagus, stomach, or
citrate had a greater effect on intestines that make it
urinary citrate. difficult for you to
swallow or digest pills
Drug Characteristics Drug Administration
GenericName: Route: IV
TRAMADOL
Dosage: 50 mg
Brand name: ULTRAM
Frequency: PRN
Classification: Opioid
analgesic Timing: PRN
Available forms: IV
Drug Indication Adverse Effects
This medication is used Sweating, dizziness,
to help relieve moderate nausea, vomiting, dry
mouth, fatigue, asthenia,
to moderately severe
somnolence, confusion,
pain. Tramadol is similar
constipation, flushing,
to opioid analgesics. It
headache, vertigo,
works in the brain to
tachycardia, palpitations,
change how your body miosis, insomnia,
feels and responds to
orthostatic, hypotension,
pain. seizures, CNS stimulation.
ECG (sometimes rare cases even toxic.
called EKG) to
measure electrical
activity of the heart.
Teach patient to store

potassium citrate at
room temperature
away from moisture
and heat. Keep the
medication in a
closed container.
Nursing Rationale
Responsibilities
 Note for any  To check the patient for any
hypersensitivity drug allergies and record
reaction. the details of the allergic
reaction. Use 10 rights of
 Reassess patients’
save administration of
level of pain at least
medication to ensure a safe
30 minutes after
and quality patient care.
administration.
 To monitor the patient’s
 Monitor
response to the medication
Cardiovascular and
throughout the course of
respiratory status.
treatment to ensure that the
 4Monitor bowel and medication is effectively
bladder function. managing the patient’s pain
and to make any necessary
Monitor patients at

adjustments to the dosage
risk for seizures
or treatment plan.
Early detection of

abnormalities allows
prompt intervention,
preventing further
deterioration.
 Mechanism of Action Special Consideration  Regular monitoring
helpsprevent complications
Acts on the mu-opioid associated with bowel and
receptor to procedure pain
bladder dysfunction.
relief. Opioid receptors are Hypersensitivity to
located in the brain and there This to enhance safety,
tramadol, opioids, or any 
are three types of which the promote early intervention,
mu-opioid receptor is one. component of the
formulation; opioid- optimize medication
Normally, when a painful
stimulus occurs, a neuron dependent patients; acute management, and identify
communicates to the brain intoxication with alcohol triggers.
and the person feels pain. hypnotics, centrally
When person take tramadol, acting analgesics, .
it acts on the mu-opioid
opioids, or psychotropic
receptor, blocking the
neuron from communicating drugs.
pain to the brain.

Discharge Plan
DISCHARGE INSTRUCTION SHEET

Patient: L.G Sex: Male Age: 40 y.o Physician: Dr. A

Date Admission: 10/18/23 Date Discharged: 10/20/23 Check Up: 11/20/23 Time: 9 am Place: CEH

TAKE HOME MEDICATION AND INSTRUCTIONS

MEDICINE DOSAGE AM NOON PM NIGHT REMARKS

(Bulong) (Pamaagi) (Aga) (Udto) (Hapon) (Gab-i)

Levofloxacin 750 mg 1 tablet 1x a day 12 To complete 7

days

Sambong 2 tablest 3x a day 8 1 6 For 2 months

Potassium Citrate 1080 mg 1 tablet 3x a day 8 1 6 For 1 month

Diet
- Follow a soft diet plan containing soft vegetables, fruits, tender meat, mashed potatoes, porridge, breads, and
low-fat dairy products. Advice px to Limit sugar-sweetened foods, salty foods, alcohol, and short-term diets.
Advice to increase oral intake/fluid, drink water (10-12 glasses a day) to dilute urine substances.

Observe Urine

- Observe changes in urine color, hematuria, and foul-smelling urine, possibly due to UTI or kidney stones.
Filter urine for small stones, keep them, and send them for analysis. Strain urine for two to three weeks post-
lithotripsy

Activities

- Recommend low-intensity exercise like walking, jogging, and cycling which can help to pass the stone easily
from your urinary tract. Discourage excessive physical strain that could exacerbate symptoms. do not lift, push
or pull any heavy objects until after your doctor says it is OK. Get adequate rest & sleep (6-8hrs) and if ever a
short nap in the afternoon.

Monitor vital signs for infection

-Provide patient a clear list of signs and symptoms that patients can watch out for and explain what to do if they
occur (Fever, chills, vomiting, SOB, burning, blood or pain when urination). Provide contact information for
emergency situations or for questions.

OPD
- Advice patient on her follow up check up on November 20, 2023 at the OPD ward of CEH.