CASE STUDY ON

BILATERAL
NEPHROLITHIASIS

RLE GROUP 2
OBJECTIVES
GENERAL OBJECTIVE
• After this case study, We will be able to develop our knowledge,
skills and attitude in managing and dealing patients with Bilateral
Nephroliathiasis.
• SPECIFIC OBJECTIVES
 
• KNOWLEDGE
• To be able to know our responsibilities such as promoting health,
prevent further injury or illness, as well as restoration of health
according to the extent of our knowledge and skills.
• To have knowledge about Bilateral Nephrolithiasis.
• To familiarize ourselves the different treatments and medications
of the disease.
• To learn the pathophysiology, anatomy and physiology, signs and
symptoms, its prevention and those who are at risk of the disease.
SKILLS
• To know how to deal and handle patients who
are suffering from Bilateral Nephrolithiasis.
• To provide nursing care in patients with Bilateral
Nephrolithiasis.
ATTITUDE
• To be able to understand the patient's feeling
towards his condition.
• Empathize with the patients.
INTRODUCTION
• Nephrolithiasis, the process of forming a kidney stone, a stone in the
kidney (or lower down in the urinary tract). Kidney stones are a
common cause of blood in the urine and pain in the abdomen, flank,
or groin. Kidney stones occur in 1 in 20 people at some time in their
life. The development of the stones is related to decreased urine
volume or increased excretion of stone-forming components such as
calcium, oxalate, urate, cystine, xanthine, and phosphate. The stones
form in the urine collecting area (the pelvis) of the kidney and may
range in size from tiny to staghorn stones the size of the renal pelvis
itself. The process of stone formation nephrolithiasis, is also called
urolithiasis.

• "Nephrolithiasis" is derived from the Greek nephros- (kidney) lithos

(stone) = kidney stone "Urolithiasis" is from the French word "urine"
which, in turn, stems from the Latin "urina" and the Greek "ouron"
meaning urine = urine stone. The stones themselves are also called
renal caluli. The word "calculus" (plural: calculi) is the Latin word for
pebble.
• Mortality/Morbidity
• The morbidity of renal calculi is primarily due to
obstruction with its associated pain, although
non obstructing calculi can still produce
considerable discomfort.
• Conversely, patients with obstructing calculi may
be asymptomatic, which is the usual scenario in
patients who experiences loss of renal function
due to chronic untreated obstruction.
• Stone-induced hematuria is frightening to the
patient but is rarely dangerous by itself.
Factors
• Race
• Renal calculi are far more common in Asians and whites than in
Native Americans, Africans, African Americans, and some natives
of the Mediterranean region. Although some differences may be
attributable to geography (stones are more common in hot and
dry areas) and diet. Heredity also appears to be a factor. This is
suggested by the finding that, in regions with both white and
nonwhite populations, stone disease is much more common in
whites.
• Sex
• In general, urolithiasis is more common in males (male-to-female
ratio of 3:1).Stones due to discrete metabolic/hormonal defects
(eg, cystinuria, hyperparathyroidism) and stone disease in
children are equally prevalent between the sexes. Stones due to
infection are more common in women than in men.
• Age
• Most renal calculi develop in persons aged 20-
49 years. Patients in whom multiple recurrent
stones form usually develop their first stones
while in their second or third decade of life.
 VITAL
INFORMATION
 A. Patient’s Data

Name: Mrs. C.D.

Age: 80 y.o
Sex: Female
Address: Capagao Panitan, Capiz
Civil status: Married
Religion: Roman Catholic
Nationality: Filipino
Occupation: Housewife
Date and Time Admitted: Sept. 8,2010 8:10 am
Ward: IHM, Room
Chief Complaint: Bilateral flank pain
Admitting Diagnosis: Obstructive Neuropathy
secondary to Bilateral
Nephrolithiasis; renal cyst.
Dr. R.B
Attending Physician(s): Dr. R.J
Dr. J.A
HISTORY
History of Present Illness
• Before admission. Pt. was already diagnosed with Bilateral
Nephrolithiasis and renal cyst. Right kidney stones were monitored
every 3 mos. and were maintained on acalka and sambong.
• I week pta.pt. had onset of bilateral flank pain with patient
tolerated at home but the pain progressed which prompted
admission.
• Pt. was admitted on Sept. 8, 2010 8:10 am at St. Anthony College
Hospital, IHM ward with the chief compliant of Bilateral Flank Pain
under the service of Dr. RB, Dr. RJ and JA.
• (+) wt. loss
• (+) bowel changes
• (+) low back pain
• (+) dyspnea
• (+) cough
Past Medical History
• Last Feb. 2009 pt. was admitted at doctors
hospital, Iloilo for the operation of her eyes. She
has hypertension, bilateral nephrolithiases and
right renal cyst.
Family History
• Mrs. C.D. and her husband both have history of
Hypertension in the family.
•  
GENOGRAM
Retired Mr. D Mrs. CD
Bus 80y/o 80 y/o
Driver

Mr. E. Mrs. M Mrs. R

58 y/o 54 y/o 50 y/o

OFW Employee Businesswo

man
Legend
Male
 
 
Female
 
 
  Patient

Hypertension
 
Pneumonia

 
Occupation
 PHYSICAL
ASSESSMENT
General Appraisal:
• Body structure: Average
• Movement: Immobile
• Speech: Coherent and can’t speak clearly.
• Level of Consciousness: Lethargic
• Vital Signs:
• Temp: 36.3
• AR: 62
• Pulse: 60
• RR: 25
• BP: 130/80
•
Body Parts Method of Findings Interpretation
Assessment

Skin Inspection Skin is normal in color, warm and moist. Normal

Nails Inspection The nail is pale pink in color. No clubbing, Normal

no lesions.
Good capillary refill.
Head Inspection Head is normocephalic. Hair not evenly Normal
distributed, brown in color with visible
white hair. No lesions, no dandruff.

Eyes Inspection The eyelid covers the top portion of the Normal
iris.
Cornea is clear and without lesion.
Conjunctiva is pinkish in color, no
inflammation, & no discharge.
Sclera is white and no lesion.
PERRLA
Ears Inspection Both ears are symmetric, no signs of Normal
inflammation and infection and there is
no secretions.

Nose Inspection Nose bridge is aligned, nostrils are Normal

symmetric.
No nasal discharge, no lesions.

Mouth Inspection Lips are not dry, no lesion. Normal

The oral mucosa is pink and moist;
gums, pink & moist and tongue is pink,
moist and no lesions.
The uvula is at the middle.
Tonsils are not inflamed, and are pink
in color.

Neck Inspection Neck is symmetric & skin is intact, Normal

there is no lesion, no neck masses,
Palpation
and no enlargement. The trachea is at
the middle and is aligned.
Chest Inspection The chest-wall is Normal
symmetric.
Flabby abdomen.
Abdomen Inspection Urinary Retention
It is soft and nontender; no
masses noted.

Musculoskeletal: Inspection No evidence of swelling or Osteoporosis

deformity. Immobile. Hypertrophic
Degenerative
Osteoarthropathy

Genitourinary Inspection With urinary catheter. Normal

 TEXTBOOK
DISCUSSION
• DEFINITION:
• The term Nephrolithiasis refers to kidney stone. The most common
cause of upper urinary tract obstruction is urinary calculi. Although
stones can form in any part of the urinary tract, most develop in
kidneys. Urinary stones are the third most common disorder of the
urinary tract, exceeded only by UTIs and prostate disorders.
• Kidney stones are crystalline structures made up of materials that
the kidneys normally excrete in the urine.
 TYPES OF KIDNEY STONE
TYPES OF STONE CONTRIBUTING TREATMENT
FACTORS

Calcium(Oxalate and  Hypercalcemia and  Treatment of underlying

hypercalciura conditions
phosphate) Immobilization  Increased fluid intake
 Hyperparathyroidism  Thiazide diuretics
 Vit. D intoxication
 Diffuse bone disease
 Milk-alkali syndrome
 Renal tubular acidosis
 Hyperxoxaluria
Magnesiun  Urinary tract infections  Treatment of urinary tract
infections
Ammonium  Acidification of the urine
phosphate (struvite)  Increased fluid intake

Uric Acid (Urate)  Formed in acid urine with  Increased fluid intake
pH of approximately 5.5  Allopurinol for
 Gout hyperuricuria
 High- purine diet  Alkalinization of urine

Cystine  Cystinuria (inherited  Increased fluid intake

disorder of amino acid  Alkalinization of urine
metabolism
CLINICAL MANIFESTATIONS
• Pain
• 2 types of pain:
• Renal Colic- is the term used to describe the colicky pain that accompanies
stretching of the collecting system of the ureter.
• Noncolicky Renal Pian- is caused by stones that produce distentions of the renal
calices and renal pelvis.

SIGNS AND SYMPTOMS: SIGNS AND SYMPTOMS OF PATIENT:

 Pyelonepritis and UTI  Pain and Discomfort
 Chills  Episode of renal Colic
 Fever  Urinary Retention
 Frequency
 Pain and discomfort
 Hematuria
 Pyuria
 Nausea and vomiting
 Episode of renal colic
 Irritation
 Urinary retention
COMPLICATION:
• Kidney failure
• Renal failure
DIAGNOSIS
• Urinalysis – provides information related to hematuria, infection, the presence of
stone forming, crystals, and urine pH.
• Intravenous pyelography – uses an intravenously injected contrast medium that
is filtered in the ureters and kidneys.
• Abdominal ultrasound – highly sensitive to hydronephrolithiasis, which may be a
manisfestation of ureteral obstruction.
• Retrograde urography and CT scanning – a new imaging technique called nuclear
scintigraphy uses biophosphate markers as a means .
TREATMENT
• Antibiotic therapy
• Increased fluid intake
• Thiazide diuretics
• Removing of kidney stones
• Ureteroscopic removal
• Percutaneous nephrolithotomy
• Extracorporeal shockwave lithotripsy
 Medical
Management
• Percutaneous Nephrolithotomy
• Percutaneous nephrolithotomy, or PCNL, is a procedure for removing medium-
sized or larger renal calculi (kidney stones) from the patient's urinary tract by
means of an nephroscope passed into the kidney through a track created in the
patient's back. PCNL was first performed in Sweden in 1973 as a less invasive
alternative to open surgery on the kidneys. The term "percutaneous" means
that the procedure is done through the skin. Nephrolithotomy is a term formed
from two Greek words that mean "kidney" and "removing stones by cutting.“
Purpose
The purpose of PCNL is the removal of renal calculi in order to relieve pain,
bleeding into or obstruction of the urinary tract, and/or urinary tract infections
resulting from blockages. Kidney stones range in size from microscopic groups
of crystals to objects as large as golf balls. Most calculi, however, pass through
the urinary tract without causing problems.
Preparation
• Most hospitals require patients to have the following tests before a PCNL: a
complete physical examination; complete blood count ; an electrocardiogram
(EKG); a comprehensive set of metabolic tests; a urine test; and tests that
measure the speed of blood clotting.
Aspirin and arthritis medications should be discontinued seven to 10 days
before a PCNL because they thin the blood and affect clotting time. Some
surgeons ask patients to take a laxative the day before surgery to minimize
the risk of constipation during the first few days of recovery.
• The patient is asked to drink only clear fluids (chicken or beef broth, clear
fruit juices, or water) for 24 hours prior to surgery, with nothing by mouth
after midnight before the procedure.
Aftercare
• A standard PCNL usually requires hospitalization for five to six days after
the procedure. The urologist may order additional imaging studies to
determine whether any fragments of stones are still present. These can be
removed with a nephroscope if necessary. The nephrostomy tube is then
removed and the incision covered with a bandage. The patient will be
given instructions for changing the bandage at home.
The patient is given fluids intravenously for one to two days after surgery.
Later, he or she is encouraged to drink large quantities of fluid in order to
produce about 2 qt (1.2 l) of urine per day. Some blood in the urine is
normal for several days after PCNL. Blood and urine samples may be taken
for laboratory analysis of specific risk factors for calculus formation.
Risks
• There are a number of risks associated with PCNL:
• Inability to make a large enough track to insert the nephroscope. In this case, the
procedure will be converted to open kidney surgery.
• Bleeding. Bleeding may result from injury to blood vessels within the kidney as well
as from blood vessels in the area of the incision.
• Infection.
• Fever. Running a slight temperature (101.5°F; 38.5°C) is common for one or two days
after the procedure. A high fever or a fever lasting longer than two days may
indicate infection, however, and should be reported to the doctor at once.
• Fluid accumulation in the area around the incision. This complication usually results
from irrigation of the affected area of the kidney during the procedure.
• Formation of an arteriovenous fistula . An arteriovenous fistula is a connection
between an artery and a vein in which blood flows directly from the artery into the
vein.
• Need for retreatment. In general, PCNL has a higher success rate of stone removal
than extracorporeal shock wave lithotripsy (ESWL), which is described below. PCNL
is considered particularly effective for removing stones larger than 1 in (0.5 cm);
staghorn calculi; and stones that have remained in the body longer than four weeks.
Retreatment is occasionally necessary, however, in cases involving very large stones.
• Injury to surrounding organs. In rare cases, PCNL has resulted in damage to the spleen,
liver, lung, pancreas, or gallbladder.
Ureteroscopic Removal
• A ureteral stent is a thin, flexible tube threaded into the ureter to help urine drain from
the kidney to the bladder or to an external collection system.
Purpose
• Urine is normally carried from the kidneys to the bladder via a pair of long, narrow
tubes called ureters (each kidney is connected to one ureter). A ureter may become
obstructed as a result of a number of conditions including kidney stones, tumors, blood
clots, postsurgical swelling, or infection. A ureteral stent is placed in the ureter to
restore the flow of urine to the bladder.
• Ureteral stents may be used in patients with active kidney infection or with diseased
bladders (e.g., as a result of cancer or radiation therapy). Alternatively, ureteral stents
may be used during or after urinary tract surgical procedures to provide a mold around
which healing can occur, to divert the urinary flow away from areas of leakage, to
manipulate kidney stones or prevent stone migration prior to treatment, or to make
the ureters more easily identifiable during difficult surgical procedures. The stent may
remain in place on a short-term (days to weeks) or long-term (weeks to months) basis.
Diagnosis/Preparation
• A number of different technologies aid in the diagnosis of ureteral obstruction. These
include:
• the interior of the bladder)
• ultrasonography (an imaging technique that uses high-frequency sounds waves to
visualize structures inside the body)
• computed tomography (an imaging technique that uses x rays to produce two-
dimensional cross-sections on a viewing screen)
• pyelography (x rays taken of the urinary tract after a contrast dye has been injected
into a vein or into the kidney, ureter, or bladder)
• Prior to ureteral stenting, the procedure should be thoroughly explained by a
medical professional. No food or drink is permitted after midnight the night before
surgery. The patient wears a hospital gown during the procedure. If the stent
insertion is performed with the aid of a cystoscope, the patient will assume a
position that is typically used in a gynecological exam (lying on the back, with the
legs flexed and supported by stirrups).
Aftercare
• Stents must be periodically replaced to prevent fractures within the catheter wall
or build-up of encrustation. Stent replacement is recommended approximately
every six months; more often in patients who form stones
Risks
• Complications associated with ureteral stenting include:
• bleeding (usually minor and easily treated, but occasionally requiring transfusion)
• catheter migration or dislodgement (may require readjustment)
• coiling of the stent within the ureter (may cause lower abdominal pain or flank pain
on urination, urinary frequency, or blood in the urine)
• introduction or worsening of infection
• penetration of adjacent organs (e.g., bowel, gallbladder, or lungs)
Extracorporeal shockwave lithotripsy
• Lithotripsy is the use of high-energy shock waves to fragment and disintegrate
kidney stones. The shock wave, created by using a high-voltage spark or an
electromagnetic impulse outside of the body, is focused on the stone. The shock
wave shatters the stone, allowing the fragments to pass through the urinary
system. Since the shock wave is generated outside the body, the procedure is
termed extracorporeal shock wave lithotripsy (ESWL). The name is derived from
the roots of two Greek words, litho , meaning stone, and trip , meaning to break.
Purpose
• ESWL is used when a kidney stone is too large to pass on its own, or when a stone
becomes stuck in a ureter (a tube that carries urine from the kidney to the bladder)
and will not pass. Kidney stones are extremely painful and can cause serious
medical complications if not removed.
Diagnosis/Preparation
• ESWL should not be considered for persons with severe skeletal deformities,
people weighing more than 300 lb (136 kg), individuals with abdominal aortic
aneurysms, or persons with uncontrollable bleeding disorders. Women who are
pregnant should not be treated with ESWL. Individuals with
cardiac pacemakers should be evaluated by a cardiologist familiar with ESWL. The
cardiologist should be present during the ESWL procedure in the event the
pacemaker needs to be overridden.
Prior to the lithotripsy procedure, a complete physical examination is
performed, followed by tests to determine the number, location, and size of
the stone or stones. A test called an intravenous pyelogram (IVP) is used to
locate the stones, which involves injecting a dye into a vein in the arm. This
dye, which shows up on x ray, travels through the bloodstream and is excreted
by the kidneys. The dye then flows down the ureters and into the bladder. The
dye surrounds the stones. In this manner, x rays are used to evaluate the stones
and the anatomy of the urinary system. Blood tests are performed to
determine if any potential bleeding problems exist. For women of childbearing
age, a pregnancy test is done to make sure they are not pregnant. Older
persons have an EKG test to make sure that no potential heart problems exist.
Some individuals may have a stent placed prior to the lithotripsy procedure. A
stent is a plastic tube placed in the ureter that allows the passage of gravel and
urine after the ESWL procedure is completed.

The process of lithotripsy generally takes about one hour. During that time, up
to 8,000 individual shock waves are administered. Depending on a person's
pain tolerance, there may be some discomfort during the
treatment. Analgesics may be administered to relieve this pain.
Aftercare
• Most persons pass blood in their urine after the ESWL procedure. This is normal
and should clear after several days to a week. Lots of fluids should be taken to
encourage the flushing of any gravel remaining in the urinary system. Treated
persons should follow up with a urologist in about two weeks to make sure that
everything is progressing as planned. If a stent has been inserted, it is normally
removed at this time.
Risks
• Abdominal pain is fairly common after ESWL, but it is usually not a cause for worry.
However, persistent or severe abdominal pain may imply an unexpected internal
injury. Occasionally, stones may not be completely fragmented during the first
ESWL treatment and further lithotripsy procedures may be required.
• Some people are allergic to the dye material used during an IVP, so it cannot be
used. For these people, focused sound waves, called ultrasound, can be used to
identify where the stones are located.
PATHOPHYSIOLOGY
NEPHROLOTHIASIS/R
ENAL CALCULI
 PREDISPOSING PRECIPITATING FACTORS
FACTORS 1.Metabolic
AGE ( 20-25 Y.O) 3 MAJOR THEORIES Abnormalities
Gender (more common Saturation Theory 2. Climate
in male) Matrix Theory 3. Diet
Race(common in Inhibitor 4. Lifestyle (sedentary
whites)   occupation, immobility)
Genetic  
 

STONE FORMATION Types:

Calcium (oxalate and phosphate)
Magnesium ammonium phosphate
(struvite)
Uric acid (urate)
cystine
Urinary stasis  
Fever, Chills, Nausea, and vomiting

Obstruction by Severe pain, hematuria, hydronephrosis,

stone anuria from bilateral obstruction, ad
abdominal distention
Calculi/stone Hematuria, obstruction and severe pain
traveling down
the ureter

Acute Renal
Failure

DEATH
Laboratory
Results
 Ultrasound KUB
September 8 2010
Interpretation:
Urinary retention, 153.7 ml (66%)
Nephrolithiasis, right kidney with regression in size and numbers
Nephrolithisasis, left kidney with regression
Renal cyst, right kidney, increasing in size

Radiology (x-ray)
September 8, 2010
Thoracolumbar APL
Interpretation:
Osteoporosis
Hypertropic degenerative osteoarthropathy, lumbar spine
Compression fracture, L2
 September 8, 2010

Result Normal Values

Urea 8.45 mmol/L 2.50 – 6.10 mmol/L Renal failure
Creatinine 200.3 mmol/L 62 – 106 Renal disease that has
seriously damaged 50% or
more of the nephrons,
acromegaly.
Sodium 126 mmol/L 137 – 145 mmol/L Dehydration, Impaired
renal function
Potassium 2.93 mmol/L 3.50 – 5.10 mmol/L Liver disease

Radiology (x-ray)
September 9, 2010

Chest AP
Interpretation:
Atheromatous and tortuous aorta
 September 19, 2010

Result Normal Values Significance

Calcium 1.82 mmol/l LO 2.10 – 2.55 Osteoporosis
mmol/L
Albumin 22.7 g/L LO 35 – 50 g/L Kidney dysfunction

Cross Matching Result Slip

September 19, 2010

Blood Type “o” Rh Positive

Serial no. 018634
Cross Matching Compatible
Note Screened @ PNSG 250cc, PRBC
 Urinalysis
September 20,2010
Microscopic

Result Normal Values Significance

Color Pale Yellow Straw Alcohol, large fluid intake
Transparency Slightly Hazy Clear Infection
Reaction pH 6.0 4.5-8 WNL
Sp. Gravity 1.010 1.010 – 1.025 WNL
Protein Negative Negative WNL
Glucose Negative Negative WNL
RBC/hpf 2 0-2 WNL
WBC/hpf 0-3 0-5 WNL
Stool
Physical exam

Color Dark Brown

Consistency Soft
Occult Blood Positive
“ No OVA of intestinal parasite found on
direct smear”
 September 21, 2010
Test Result Normal Value Significance
Sodium 104 mmol/L 136 – 145 mmol/L Dehydration,
Impaired renal
function

September 22, 2010

Test Result Normal Value Significance

Sodium 125.1 mmol/l 136 – 145 mmol/L Dehydration,

Impaired renal
function

Chemistry
September 22, 2010
Test Result Normal Value Significance
SGPT 73 U/L 7–30 U/L Cirrhosis
Muscle inflammation
Obesity
Hepatitis
 September 22, 2010
Test Result Normal Value Significance

Sodium 118.5 mmol/L 136 – 145 mmol/L Dehydration, Impaired

renal function
Potassium 1.94 mmol/L 3.50 – 5.10 Due to diuretics or
kidney problem
Creatinine 121 mmol/L 53 - 115 Renal disease that has
seriously damaged
50% or more of the
nephrons, acromegaly.

Other Result
September 22,2010
Examination desired H Pylori determination
Result: Negative (TV: 0.05)
Interpretation:
TV negative < 0.75
TV equivocal > = 0.75 & < 1.00
TV positive > 1.00
 Hematology
September 22,2010

Result Normal Values Significance

Hematocrit 0.33 vol (fr) 0.36 – 0.45 vol (fr) Anemia, hemodilution, or
massive blood loss

Hemoglobin 110 gms/L 123 – 153 gms/L Anemia, hemodilution, or

massive blood loss

Red cell Count 3.85 x 10^12/L 4.5-5.1 x 10^12/L Anemia, hemodilution, or

massive blood loss

White Cell Count 7.9 x 10^9/L 4.5-11x10^/L WNL

Differential Count
Segmenters 0.83 50 – 65 % Infection
Eosinophils 0.03 1-4% WNL
Lymphocytes 0.13 25 – 30% Infection
Monocytes 0.01 2-5% Infection
Prothrombin time 15.9 seconds 10-16 seconds WNL
 Test Init(September 23, 2010)
Fluid: Serum

Test Result Normal Value Significance

Potassium LO 3.34 mmol/L 3.50 – 5.10mmol/L Due to diuretics or

kidney problem
 Peripheral Blood Smear
September 23,2010

Result Normal Values Significance

Hct 0.24 L/L 0.36 – 0.45 L/L Anemia, hemodilution,
or massive blood loss
Hgb 81 g/L 123 – 153 g/L Anemia, hemodilution,
or massive blood loss
WBC ct. 7.4 x 10 ^ /L 4.5 – 11 x 10^ /L WNL
RBC ct. 2.86 x 10 ^ /L 4.5 – 5.1 x 10^ / L anemia
Segmenters 84% 36-66% Infection
Eosinophils 2% 2-3% WNL
Lymphocytes 12% 24-44% Infection
Monocytes 1% 4-6% Infection
Platelet count 214 x 10^ /L 150 – 450 x WNL
10^ /L
MCV 84 fl 80 – 96 fl WNL
MCH 28.3 pg 27-31 pg WNL
MCHC 336 g/L 320-360 g/L WNL
Bands 0% 5-11%
 September 24, 2010

Test Result Normal Value Significance

Sodium 129.1 mmol/L 136 – 145 mmol/L Dehydration,

Impaired renal
function
DRUG
STUDY
 Generic Drug class Indications Mechanism of Adverse Nursing
(Brand) Name actions reaction responsibilities

Trimetazadine Anti-Anginal Long treatment  Acts by Headache,  Monitor

(Vastarel MR) Drugs of coronary directly dizziness blood
insufficiency counteracting Nausea, pressure
Angina pectoris all the major constipation and heart
metabolic Somnolence rate when
disorders starting
occurring therapy and
within the during
ischemic cell dosage
Calcium adjustment.
channel  Administer
blocker that drug with or
inhibits after meals.
calcium ion
influx across
cardiac amd
smooth muscle
cells,
decreasing
myocardial
contractility
and oxygen
demand
 Generic Drug class Indications Mechanism of Adverse Nursing
(Brand) Name actions reaction responsibilities

Rowatinex  Genito For the ROWATINEX No side effects  Liquid

(Borneol, Urinary treatment of promotes a have been intake
Camphene, Antiseptics urinary tract diuresis and reported should be
Pinene)  Disinfectant spasm and relaxes urinary increased
s inflammation tract spasm, thus during
associated assisting the therapy.
with passage of  Administer
urolithiasis. stones. The drug with
Assists in the therapeutic or after
dissolution effect of the meals.
and expulsion balanced
of stones in combination of
the renal terpenes reduces
system. urinary tract
inflammation,
stimulating renal
blood flow
through the
kidneys and
increasing the
output of less
concentrated
urine.
 Generic Drug class Indications Mechanism of actions Adverse Nursing
(Brand) reaction responsibilit
Name ies
Domperid  Antie •Delayed gastric Domperidone is related to its •Dizziness  Take
one(Motili metic emptying of peripheral dopamine receptor •Headache this
blocking properties. Emesis
um)  Dopa functional origin •Insomia drug
induced by apomorphine,
mener with hydergine, morphine or
•Drowsiness before
gic gastroesophageal levodopa, through th •Belching meal.
blocki reflux/or dyspepsia. estimulation of the •Abdominal  Monitor
ng chemoreceptor trigger zone can distention patient I
agent •Control of nausea be block by domperidone. •Irritability and O
and vomiting of There is indirect evidence that •Twitching
emesis is also inhibited at the
central or local
gastric level, since
origin. domperidone also inhibits
emesis induced by oral
•As antiemetic in levodopa, and local gastric wall
patients receiving concentrations following oral
cytostatic and domperidone are much greater
radiation therapy. than those of the plasma and
other organs. Domperidone
doesnot readily cross the blood
•Facilitates brain barrier and therefore is
radiological not expected to have central
examination of the effects.
upper GI tract.
 Generic Drug class Indications Mechanism of Adverse Nursing
(Brand) Name actions reaction responsibilities
Felodipine  Anti Management Inhibits the Peripheral  Monitor bp
anginal of transport of edema and pulses
 Anti hypertension. calcium into Headache,dizin before
hypertensi myocardial ess theraphy,
ve and smooth during
 Calcium muscle cells doasage
channel resulting in titration and
blockers inhibitions of peridiacally
excitation throughout
contraction theraphy.
and  Administer
subsequent drug with or
contraction. after meals.
 Generic Drug class Mechanism of Indication Adverse Nursing
(Brand) Name actions reaction responsibilities

Omeprazole Proton pump Inhibits acid Short term  Headache  Give drug 30
inhibitor pump and treatment of  Dizziness mins. Before
binds to active  Diarrhea meals
hydrogen duodenal  Abdominal  Explain the
potassium ulcer. pain importance of
adenosine First line  Nausea taking drug
triphosphatas therapy in  Vomiting exactly as
e on secretory treatment of  Constipati prescribed
surface of heartburn or on  Warn the pt not
gastric symptoms of  Flatulence to crush or chew
parietal cells GERD.  Back pain the drug
block  Cough
formation of  Rash
gastric acid
Generic (Brand) Drug class Indications Nursing responsibilities
Name

Sambong Anti- Used to aid the treatment of  Advice patient to increase

urothiliasis kidney disorders it helps fluid intake.
Vitamin disposing excess water and
supplement sodium in the body
 Generic
(Brand) Name Drug class Mechanism of Indications Adverse Nursing
action reaction responsibilities

Alendronate Metabolic Suppresses Treatment of Headache  Use

Bisphosphonat osteoclast osteoporosis Abdominal cautiously in
Cholecalciferol es activity in of post apin, nausea, patients with
newly formed menopausal dyaspepsia, active upper
re absorption women. muscu skelatal GI problems
surfaces, pain.  Give drug
which reduces gastritis with 6 to 8
bone turnover. ounces of
Bone formation water at
exceeds re least 30 min
absorption at first food or
remodeling drink of the
sites, leading day to
to progressive facilitates
gains on bone delivery to
mass. the stomach.
 Generic Drug Class Mechanism of Indications Adverse Contraindic Nursing
(Brand) Action Effect ations Responsibilit
Name ies

Rebapimide antacids, used for Gastric ulcers.  Nausea Patient with  Take this
(Mucosta) antireflux mucosal Treatment of and a history of drug with
and protection, gastric vomiting hypersensit food.
antiulceran healing of mucosal  Heartbur ivity to any  Monitor
ts agents gastro lesions n ingredient pt’ food
duodenal (erosion,  Diarrhea of this drug. intake.
ulcers, and bleeding,  Jaundice  Advise pt
treatment of redness &  Rash not to eat
gastritis. It edema) in  Belching food that
works by acute gastritis  Abdomin can
enhancing & acute al pain irritate
mucosal exacerbation the
defense, of chronic stomach.
scavenging gastritis.
free radicals,
and
temporarily
activating
genes
encoding
cyclooxygena
se.
 Generic Drug Class Mechanism of Indications Adverse Effect Contraindica Nursing Responsibilities
(Brand) Name Action tions

Urinary and A food additive,  Potassium  Nausea and Renal  Do not crush,
Potassium system potassium citrate is vomiting function chew,break or suck
citrate alkanizer citrate is used used to treat  Stomach impairment on extended-release
(Urocit-K) to regulate kidney stone pain with oliguria, tablet. Swallow the
acidity. condition  Dizziness azotemia, tablet. Breaking or
Medicinally, it called renal  Black/blood untreated crushing the pill may
may be used to tubular y stool Addison’s cause too much of
control kidney acidosis.  Rash disease, the drug to be
stones derived  Treatment of  Slow/irregu severe released at one time.
from either uric chronic lar myocardial Sucking on a
acid or cystine. metabolic heartbeat damage, or potassium tablet can
acidosis.  Mental/moo certain irritate your mouth or
 Treatment of d changes situation throat.
pt with  Trouble when pt are  Avoid lying down for
cystine breathing on sodium- atleast 30 mins after
calculi and hyperkalem restricted taking the drug, take
uric acid of ia diet this drug with meal
the urinary or snack or within 30
tract . mins after meal.
 Inform pt not to stop
taking this drug
without the
information of the
doctor, if the pt stop
taking this drug
his/her condition
might worse.
 Generic Drug Class Mechanism of Indications Adverse Effect Contraindicatio Nursing
(Brand) Name Action ns Responsibilities

Sertraline HCL Antidepressant Serotonin is a  Treatment of  Anxiety Contraindicated  Monitor pt

(Zolof) neurotransmitter (a major  Rash ; hives in patients with especially
chemical depressive  Black/blody a when the pt
messenger) disorder in stol hypersensitivity experienced
produced by nerve adults.  Chest pain to sertraline or the adverse
cells in the brain  treatment of  Loss of any of the effect. Always
that is used by the obsessions appetite inactive be alert.
nerves to and  Nausea and ingredients in  Take this drug
communicate with compulsions in vomiting ZOLOFT. with food.
one another. A patients with  Trouble contraindicated  Make sure
nerve releases the obsessive- sleeping with ANTABUSE that the pt is
serotonin it compulsive  Irregular (disulfiram) due comfortable
produces into the disorder (OCD) heartbeat to the alcohol and free of
space surrounding  reatment of a  Irritability content of the worries.
it. The serotonin major  Memory loss concentrate  Advise pt to
either travels across depressive  Fainting relax.
the space and episode  Fever
attaches to  treatment of  Hallucination
receptors on the social anxiety  Panic attacks
surface of nearby disorder, also
nerves or it attaches known as
to receptors on the social phobiain
surface of the nerve adults.
that produced it, to
be taken up by the
nerve and released
again (a process
referred to as re-
uptake).
Nursing Care
Plan
 Assessment Nursing Diagnosis Planning

S: “Naga kinuriit siya kay ga sakit Acute pain related to To demonstrate behaviour
iya kilid” as verbalized by the tissue distension or that shows relief from
folks. trauma. pain such as decrease in
O: facial grimace, moaning,
(+) facial grimace diaphoresis and lower
(+) guarding behaviour down pain scale from 6 to
(+)moaning 5 within the shift.
(+)change in muscle tone
(+)diaphoresis
BP- 130/80 mmHg
RR- 25 bpm
Pain scale of 6.
Ultrasound KUB reveals:
Nephrolithiasis, right kidney with
regression in size and numbers.
Nephrolithisasis, left kidney with
regression.
Renal cyst, right kidney,
increasing in size.
 Intervention Rationale Evaluation

Independent: Goal met.

1. Provide comfort 1. To promote non As evidenced by patient
measures, quiet pharmacological pain demonstrates behaviours
environment and calm management. that show relief from pain,
activities. 2. To divert or distract decreased facial grimace,
2. Encourage diversional attention from pain and moaning, diaphoresis, and
activities such as reduce tension. pain scale lowers from 6 to
watching TV, talking to . 5.
family members or
listening to radio.
 Assessment Nursing Diagnosis Planning
S: “Nasakitan kag gamay Impaired urinary elimination 1. To achieve normal
lang iya ihi sadto muna gin related to mechanical amount of output within
takdan siya catheter” as obstruction of urinary flow. 8 hours.
verbalized folks. 2. To manage care of
O: urinary catheter within
-With foley catheter the shift.
-Urine output: 500ml/day
Ultrasound KUB reveals:
Urinary retention, 153.7 ml
(66%)
Nephrolithiasis, right kidney
with regression in size and
numbers.
Nephrolithisasis, left kidney
with regression.
Renal cyst, right kidney,
increasing in size.
 Intervention Rationale Evaluation

Independent: Goal met.

1. Monitor intake and 1. To provide accurate As evidenced by urine
output strictly. measurement of the output of 300 ml within the
2. Measure urine output exact fluid intake and shift
and drain catheter output.
regularly every hour. 2. To prevent overflowing
of urine and avoid
ascending infection.
 Assessment Nursing Diagnosis Planning

S:“ Indi na sya mayad Impaired Physical mobility Maintain position of

kahulag” as verbalized by r/t decreased muscle function and skin integrity
the folks. strength and loss of as evidenced by absence of
O:Bed ridden integrity. contractures, footdrop and
(+) decreased muscle decubitus within the shift.
strength.
Radiology reveals:
 Osteoporosis
 Hypertropic
degenerative
osteoarthropathy,
lumbar spine
 Intervention Rationale Evaluation

Independent: Goal met. As evidenced by

1. Reposition regularly. 1. To prevent breakage in patient maintain position of
2. Use side rails for the skin integrity. function and skin integrity.
position changes. 2. To prevent any injury.
3. Support affected body 3. To maintain position of
parts using pillows. function and reduce risk
of pressure ulcers.
 Assessment Nursing Diagnosis Planning
S: “Indi siya ka hala” as Impaired verbal Establish method of
verbalized by the folks. communication related to communication in which
O: weakening of muscuskeletal needs can be expressed
Inability to speak system. within the shift.
Absence of eye contact.
 Intervention
Independent:
1. Review history of
neurological condition.
2. Establish relationship with
the client, listening carefully
and attending to client’s
verbal/nonverbal
expression.
3. Maintain eye contact,
preferably at client’s level.
4. Involve family in plan of care
as much possible.
Rationale Evaluation
Goal not met. As
1. Neurological condition evidence by patient
affect speech such as doesn’t establish
stroke. method of
2. Conveys interest and communication in this
concern. needs can be expressed
3. Conveys interest and within the shift.
concern.
4. Enhances participation
and commitment to
communication with
love one.
 Assessment Nursing Diagnosis Planning

O: With foley catheter. Risk for infection r/t To prevent any signs of
invasive procedure. infection within the shift.
 Intervention Rationale Evaluation

Independent: Goal met. As evidenced by

1. Monitor urine output 1. To prevent the backflow no signs of infection
hourly and drain urine of urine, thus preventing occurred during the shift.
regularly. ascending infection.
2. Practice hand washing 2. Prevents transfer of
and other infection microorganisms from
control practices. healthcare providers
and healthcare workers.
 Assessment Nursing Diagnosis Planning

O: Risk for imbalance nutrition Demonstrate behaviours,

In TPN less than body lifestyle changes to
Na-104 mmol/L requirements related to maintain nutritional status
K- 1.94mmol/L food intake restriction within the shift.
Total protein – 49.2g/L
Albumin – 22.7g/L
 Intervention Rationale Evaluation
Independent: Goal met. As evidence by
1. Ascertain understanding 1. To determine patient demonstrate
of individual nutritional informational needs of behaviours, lifestyle
needs. client. changes to maintain
2. Provide diet 2. To provide and meet nutritional status.
modifications: total nutritional needs.
parenteral infusion. 3. To reveal possible cause
3. Evaluate total daily food of malnutrition/changes
intake. Record daily that could be made in
calorie intake, patterns client’s intake.
and times of eating.
 Assessment Nursing Diagnosis Planning

S: “Indi siya maayu Risk for constipation Demonstrate behaviour or

kahulag” as verbalized by related to immobility. lifestyle changes to prevent
the folks. developing problems within
O: the shift.
(+) body malaise
 Intervention Rationale Evaluation
Independent: Goal not met. As evidence
1. Auscultate abdomen for 1. Reflecting bowel activity. by patient doesn’t
presence, location, and 2. To stimulate demonstrate behaviour or
characteristics of bowel contractions of the lifestyle changes to prevent
sounds. intestines. developing problems within
2. Encourage activity or 3. Provides a baseline for the shift.
exercise within limits of comparison, promotes
individual ability. recognition of changes.
3. Ascertain frequency,
color, consistency,
amount of stools.
 Assessment Nursing Diagnosis Planning

S: “Indi siya kahulag” as Risk for impaired skin Demonstrate behaviours/

verbalized by the folks. integrity related to physical techniques to prevent skin
O: immobility. breakdown within the shift.
(+) body malaise
 Intervention Rationale Evaluation
Independent: Goal met. As evidence by
1. Reposition every two 1. To prevent breakage in the patient demonstrate
hours skin integrity behaviours/techniques to
2. Keep bedclothes dry 2. To increase circulation prevent skin breakdown
and wrinkle-free. and limit excessive tissue within the shift.
3. Encourage and assess pressure
to perform range of 3. To enhance circulation
motion exercises. 4. To prevent friction and
4. Maintain meticulous shear injury.
skin hygiene.
DISCHARGE
PLANNING
Medications
• Encouraged client to take medications as prescribed by her physician.
• Teach patient of the different side and adverse effects of the drugs.rse
effects of the drugs.
• Report any unusualities when taking the prescribed drug such as nausea
and vomiting or skin allergies.
• vomiting or skin allergies.
Exercise
• Encourage patient to perform ROM exercises such as hand and leg
flexions.
Treatment
• Encouraged the patient to comply with the medication as ordered by
her physician.
• Explain the importance of adhering to her treatment regimen.
Home management
• Provide safety precaution.
Out patient
• Inform the patient to have follow-up check- up after a week to prevent
possible complications and to update the medical team concerning the
progress of the patient’s condition and to promote continuity of care.
Diet
• Avoid salty foods.
• Must have green leafy vegetables, and fruits during meal.
• Must drink plenty of water.
• Spiritually
• Encourage to have faith with the Lord.
• Explains that Lord has a way of curing her physically and emotionally.
UPDATES
• Mrs. C.D. is still in the hospital at St. Joseph Ward and is still
undergoing treatment.
END......