Nursing Management 1

OUR LADY OF FATIMA UNIVERSITY

UROLITHIASIS Nursing Management of a Patient wit UROLIT!IASIS

"rou# $% &'1($)

Mrs* +ennifer %aru,,a RN- RM- MAN . %LINI%AL INSTRU%TOR /

Nursing Management 0 Introduction Mr* L* . Not is rea, name/ a ma,e an1 a 23 'rs* O,1 an1 a geriatri) #atient was reffere1 for an S o)4wa5e T era#' an1 e was a1mitte1 to Fatima Uni5ersit' Me1i)a, %enter in +u,' 0611- is initia, #re(o#erati5e 1iagnosis was uro,it iasis*

Uro,it iasis an1 ne# ro,it iasis refer to stones .)a,)u,i/ in t e urinar' tra)t an1 4i1ne'- res#e)ti5e,'* Urinar' stones a))ount for more t an &06-666 os#ita, a1missions ea) 'ear* T e o))urren)e of urinar' stones o))urs #re1ominant,' in t e t ir1 to fift 1e)a1es of ,ife affe)ts men more in women* A7out a,f of #atients wit a sing,e rena, stone a5e anot er e#iso1e wit in 3 'ears*

Signs an1 s'm#toms of stones in t e urinar' s'stem 1e#en1 on t e #resen)e of o7stru)tion- infe)tion- an1 e1ema* 8 en stones 7,o)4 t e f,ow of urine- o7stru)tion 1e5e,o#s- #ro1u)ing an in)rease in '1rostati) #ressure an1 1isten1ing t e rena, #e,5is an1 #ro9ima, ureter* Stones ,o1ge1 in t e ureter )ause a)ute- e9)ru)iating- )o,i)4'wa5e,i4e #ain- ra1iating 1own t e t ig an1 genita,ia* Often- t e #atient as a 1esire to 5oi1- 7ut ,itt,e urine #asse1- an1 it is usua,,' )ontains 7,oo1 7e)ause of t e a7rasi5e a)tion of t e stone* T is grou# of s'm#toms is )a,,e1 uretera, )o,i)* Nursing Management & A))or1ing to Longmore M .066:/- Ne# ro,it iasis is )ommon- wit a ,ifetime #re5a,en)e of 16; in men an1 3; in women* Stu1ies a5e s own t at t e #re5a,en)e is in)reasing in t e Unite1 States* In t e se)on1 Nationa, !ea,t an1 Nutrition E9amination

Sur5e' .1<$$=1<<>/- t e #re5a,en)e in a1u,ts ages 06 to :> was greater t an in t e 1<:2= 1<$6 sur5e' .3*0; 5s &*0;/*T e in)rease was o7ser5e1 in w ites 7ut not in Afri)an Ameri)ans or Me9i)an Ameri)ans- was greater in men t an in women- an1 was greater wit age in ea) time #erio1* Ne# ro,it iasis is a signifi)ant me1i)a, #ro7,em in)urring su7stantia, mor7i1it' an1 )ost* One auto#s' series estimate1 t e #re5a,en)e as 1*10;* In most in1ustria,i?e1 )ountries- 1; to &; of t e #o#u,ation ma' 7e e9#e)te1 to a5e a )a,)u,us at some time- an1 t e

,i4e,i oo1 t at stone 1isease wi,, 1e5e,o# in a w ite man 7' age :6 'ears is a7out 1 in $ .,ifetime in)i1en)e of u# to 1&;/* More im#ortant- t e #re5a,en)e of 4i1ne' stone 1isease as in)rease1 &:; in t e ,ast 06 'ears*

Disease #re5a,en)e was &; 1uring t e #erio1 7etween 1<:2 an1 1<$6 an1 3*0; 7etween 1<$$ an1 1<<>* Furt ermore- t e ma,e(to(fema,e ratio as

) ange1 o5er t e ,ast 03 'ears- from &@1 ma,e to fema,e to ,ess t an 0@1*T e annua, #er )a#ita freAuen)' of os#ita,i?ation for ne# ro,it iasis is estimate1 at 1 in 1-666* T e re)urren)e rate wit out treatment for )a,)ium o9a,ate rena, stones is a7out 16; at 1 'ear- &&; at Nursing Management > 3 'ears- an1 36; at 16 'ears* In t e out#atient setting- t e #rimar' # 'si)ian ma' en)ounter #atients wit a istor' of rena, )a,)u,i- as'm#tomati) ematuria or urinar'

ne# ro,it iasis- or a)ute )o,i)* Ot ers ma' #resent wit

tra)t infe)tion* One nee1s to i1entif' t e nature of t e stone an1 an' #re)i#itating fa)tors- #re5ent furt er stone formation- an1 4now w en referra, for surgi)a, inter5ention or ,it otri#s' is nee1e1*

A))or1ing to !arrison .0663/- Ne# ro,it iasis .4i1ne' stones/ is a 1isease affe)ting t e urinar' tra)t* Bi1ne' stones are sma,, 1e#osits t at 7ui,1 u# in t e 4i1ne's- ma1e of )a,)ium- # os# ate an1 ot er )om#onents of foo1s* T e' are a )ommon )ause of 7,oo1 in urine* Ne# ro,it iasis refers to t e )on1ition of a5ing 4i1ne' stones* T e stones areso,i1 )on)retions or )a,)u,i .)r'sta, aggregation/ form in t e 4i1ne's from 1isso,5e1urinar' minera,s* T e stones are so,i1 an1 are )ommon in #remature infants* A7out 3; of women an1 16; of men wi,, a5e at ,east one e#iso1e 7' age :6* Bi1ne' stones affe)t a7out 0 out of e5er' 1666 #eo#,e* Re)urren)e is )ommon- an1 t e ris4 of t e re)urren)e is greater if 0 or more e#iso1es of 4i1ne' stones o))ur*

Nursing Management 3 Pathophysiology A))or1ing to Su?anne Sme,t?er .0663/- stones )an a,so form w en t ere is urinesu) as )itrate- magnesium- ne# ro)a,)in- an1 uro#ontin* T e f,ui1 5o,ume status of t e #atient . stones ten1 to o))ur more often in 1e '1rate1 #atients / is anot er fa)tor #,a'ing a 4e' ro,e in stone 1e5e,o#ment* %a,)u,i ma' 7e foun1 an'w ere from t e 4i1ne' to t e 7,a11er* T e' 5ar' in si?e from minute granu,ar 1e#osits- )a,,e1 san1 or gra5e,- to 7,a11er stones as ,arge as an

orange* %ertain fa)tors fa5or t e formation of stones- in),u1ing infe)tion- urinar' stasisan1 #erio1s of immo7i,it' . s,ows rena, 1rainage an1 a,ters rena, meta7o,ism /* In a11ition- in)rease1 )a,)ium )on)entrations in 7,oo1 an1 urine #romote #re)i#itation of )a,)ium an1 formation of stones . a7out :3; of a,, rena, stones are )a,)ium( 7ase1 /* For #atients wit stones )ontaining uri) a)i1- stru5ite- or )'stine- a t oroug # 'si)a, e9amination an1 meta7o,i) wor4u# are in1i)ate1 7e)ause of asso)iate1 1istur7an)es )ontri7uting to t e stone formation* Uri) a)i1 stones ma' 7e seen in #atient wit gout or m'e,o#ro,iferati5e 1isor1ers* Pre1is#osing fa)tors for stru5ite stones are )ommon,' )a,,e1 infe)tion stones in),u1e neurogeni) 7,a11er- foreign 7o1ies- an1 Nursing Management 2 re)urrent UTICs* %'steine stones o))ur e9),usi5e,' in #atients wit a rare in erite1 1efe)t in rena, a7sor#tion of )'steine* Urinar' stone formation ma' a,so o))ur wit inf,ammator' 7owe, 1isease an1 in#atien)e wit an i,eostom' or 7owe, rese)tion 7e)ause t is #atients a7sor7 more

o9a,ate* Some me1i)ations t at are 4nown to )ustoms in some #atient in),u1e anta)i1sas)eta,o?ami1e . Diamo9 /- 5it* D- ,a9ati5es- an1 ig 1oses of as#irin* T e o))urren)e of urinar' stones o))urs #re1ominant,' in t e t ir1 to fift 1e)a1es of ,ife an1 affe)ts men more t an women* A7out a,f of #atients wit a sing,e rena, stone a5e anot er e#iso1e wit in fi5e 'ears* Most stones )ontain )a,)ium or

magnesium in )om7ination wit # os# orus or o9a,ate* Most stones are ra1io#aAue an1 )an 7e 1ete)te1 7' 9(ra' stu1ies*

History Mr* L* a1 a #resent i,,ness of DM for 16 'ears an1 .D/in EP! an1 7een 19 for rig t eterout iasis- no ast ma- goiter an1 no e,e5ation of EP t e #atient is e9#erien)ing a,so a f,an4 #ain on t e rig t #rior to is #resent i,,ness* T e #atient a1 a #resent 9 of 1 1a' PTA an1 a1 an e9#erien)e1 of f,an4 #ain .rig t/- ra1iation to t e rig t ,ower Aua1rant of Nursing Management : t e a71omen an1 rig t testi),e-:F16 in #ain s)a,e t is was asso)iate1 8Furinar' freAuen)' an1 1 e#iso1e of 5omiting* To note1 fe5er- ) i,,s- DOE- an1 ) est #ain* Patient se,f me1i)ation wF met o1o#romi1e .#,asi,/ 16mg ta7 wF) re,ie5e1 t e 5omiting no )onsu,t 1ose few our #rior to a1mission of #atient sti,, wF rig t f,an4 #ain- # #atient a,so a5e a maintenan)e of insu,in for is 1ia7etes* )onsu,t * t e

Patients fami,' istor' are '#ertension- 1ia7etes me,,itus- an1 eart 1isease t e #atient a1 #ast istor' of smo4ing for 06 'ears an1 un1ergo in surger' of

a##en1e)tom'-t e #atient a,so a1 ga,,stone an1 as treate1 wF t e use of ,a9atine #ow1er mi9 wFsoft1rin4s or #inea##,e Gui)e an1 mot a##,e.a7out 3 ga,,on/ Dia7etes me,,itus is often sim#,' referre1 to as 1ia7etes- it is a grou# of meta7o,i) 1isease wF) a #erson as ig 7,oo1 sugar 7e)ause t e 7o1' 1oes not #ro1u)e enoug insu,in or 7e)ause )e,,s 1o not res#on1 to t e insu,in t at is #ro1u)e1*

!eart 1isease is t e )enter of )ar1io 5as)u,ar s'stem t roug t e 7o1'Cs 7,oo1 5esse,- t e eart #um#s 7,oo1 to a,, of t e 7o1' )e,,s- t e 7,oo1 )arries o9'gen- w i) t e )e,,s ,ea1 to )ar1io 5as)u,ar 1isease a

Nursing Management $ grou# of #ro7,em t at o))urs w en t e eart an1 7,oo1 5esse,s arrent wor4ing t e wa' t e' s ou,1*

F,an4 #ain refers to t e #ain in one si1e of t e 7o1' 7etween t e u##er a71omen an1 t e 7a)4* Uro,it iasis refer to stone.)a,)u,i/ in t e urinar' tra)t an1 4i1ne' res#e)ti5e,' urinar' atones a))ount for more t an &06-666 os#ita, a1mission ea) 'ear t e o))uran)e of urinar' stones o))urs #re1ominant,' in t e t ir1 or fift 1e)a1es of ,ife an1 effe)ts men an1 t e women

Physical Assessment Mr* L*- was )ons)ious- )o erent- an1 am7u,ator'* !e is not in )ar1io res#irator' 1istress* !e as a 7rown- warm an1 moist s4in* Vita, Signs were ta4en as t e fo,,owing resu,tsH EP of 1&6F$6H PR of :0H RR of 1<H an1 Tem#erature of &:*1I%* A))or1ing to Ei)4,e'- 8e7er J Be,,e'- A norma, ora, tem#erature for most #eo#,e is &:*6I% .<$IF/H

owe5er- some 5ariation is norma,* Some #eo#,eCs tem#eratures are Auite norma, at &2*2I% .<$IF/ or &:*& I% .<<IF/* T ere is a norma, 1iurna, 5ariation of 1egree or two in 7o1' tem#erature t roug out t e 1a'H tem#erature is Nursing Management < usua,,' ,owest in t e morning an1 in)reases 1uring t e 1a' to 7etween &:*&I an1 &:*3I .<<I to <<*3IF/-an1 it t en 1e)reases 1uring t e nig t* Mr* L as ani),eri) s),era- #in4 #a,#e7ra, )onGun)ti5a- as no nasoaura, 1is) argeno tonsi# ar'ngea, )ongestion- an1 noni)o,'m# a1eno#at '* !is ) est is s'mmetri)a, e9#an1- t ereCs no retra)tione as 5esi)u,ar 7reat soun1s* !is as an a1'nami)

#re)or1ium wit a norma, rate- regu,ar r 't m- an1 no murmur* !is a71omen is f,a77'as normoa)ti5e 7owe, soun1s- soft an1 non(ten1er* !e as gross,' norma, e9tremitiesno )'anosis an1 no e1ema* !e was 1iagnose1 to a5e A)ute %'stitis an1 Dia7etes Me,,itus II* T is is 7ase1 on is f,an4 #ain- ra1iating to t e ,ower Aua1rant of is a71omenH e as urinar' freAuen)'H 5omitingH an1 as a istor' of DM for 16 'ears*

Related Treatments Mr* L*- a5e ta4en amo9i)i,,in t is Anti7ioti)s are use1 to fig t t e 7a)teria, infe)tion 1ue to sus)e#ti7,e strains of aemo# i,us inf,uen?a- E()o,i- Proteus mira7i,is- neisseria gonorr oea an1 S* Pneumoniae* %e# a,os#orins for in i7iting s'nt esis of 7a)teria, )e,, wa,,- )ausing )e,, 1eat in sus)e#ti7,e 7a)teria* Le5of,o9a)in an anti7ioti) or f,uroAuino,one- for interferes wit DNA 7' in i7iting DNA g'rase

re#,i)ation in sus)e#ti7,e gram negati5e an1 gram #ositi5e 7a)teria

Nursing Management 16 #re5enting )e,, re#ro1u)tion* Do9')'),ine for tetra)'),ing anti7ioti) in i7it #rotein s'nt esis of sus)e#ti7,e 7a)teria )ausing )e,, 1eat s* Nitrofurantoin for urinar' tra)t anti infe)ti5e* Ea)teriostati) in ,ow )on)entration #ossi7,' 7' interfering wit 7a)teria,

)ar7o '1rates meta7o,ism* Ea)teri)i1a, in ig )on)entration #ossi7,' 7' 1isru#ting 7a)teria, )e,, wa,, formation )ausing )e,, 1eat an1 Su,fonami1es are anti7ioti) t e' are 7a)teriostati)- )om#etiti5e,' antagoni?e #araamino7en?oi) a)i1- at essentia, )om#onent of fo,i) a)i1 s'nt esis- in sus)e#ti7,e gramnegati5e an1 gram(#ositi5e 7a)teria )ausing )e,, 1eat *

A))or1ing to M) Mur1o- Eisset- Pri)e et*a, 0663- )urrent e5i1en)e of t e effe)ti5eness of 1ai,' inta4e of )ran7err' Gui)e to #re5ent UTI is in)on),usi5e* Nursing care plan Mr* LCs nursing 1iagnosis is #ain re,ate1 to infe)tion an1 inf,ammator' #ro)ess in t e urinar' tra)t* !is ) ief )om#,aint is f,an4 #ain an1 as a #ain s)a,e of : out of 16* F,an4 #ain refers to #ain in one si1e of t e 7o1' 7etween t e u##er a71omen an1 7a)4* A))or1ing to Erunner an1 Su11art s.0616/- a)ute #ain is an un#,easant sensor' an1 emotiona, e9#erien)e asso)iate1 wit a)tua, or Nursing Management 11 #otentia, tissue 1amage* Infe)tion an1 inf,ammator' res#onse attri7utes to t e )ause of #ain*

Mer4s4i .0662/ state1 t at )'stitis is )ause1 7' germs- usua,,' 7a)teria t at enter t e uret ra an1 t en t e 7,a11er* T ese 7a)teria )an ,ea1 to infe)tion- most )ommon,' in t e 7,a11er* T e infe)tion )an s#rea1 to t e 4i1ne's* Most of t e time- 'our 7o1' )an get ri1 of t ese 7a)teria w en 'ou urinate* !owe5er- sometimes t e 7a)teria )an sti)4 to t e wa,, of t e uret ra or 7,a11er- or grow so fast t at some 7a)teria sta' in t e 7,a11er* It )an )ause man' )om#,i)ations in t e 7o1'* T is is t e goa, of ea,t )are #ro5i1ers- to #re5ent an' o))urren)e of )om#,i)ations* In #,anning of )are- t e #atient s ou,1 re#ort re,ief of ,ow 7a)4 #ain an1 7urning on urination* !e s ou,1 regain a norma, 5oi1ing #attern wit out freAuen)'- urgen)'no)turia- an1 a7norma, urine ) ara)teristi)s after t e nursing inter5ention* Nursing inter5ention for t e #atient is to tea) )omfort measures@ warm sit? 7at sa eating #a1 on ,ow eat a##,ie1 to is ,ower 7a)4 or a71omen- rest- in)rease1 f,ui1 inta4e- a5oi1ing )affeinate1 7e5erages* Monitoring 5ita, signs an1 1is)ussing 1ietar' an1 'giene #ra)ti)es to #re5ent UTI is a,so an inter5ention*

Nursing Management 10 After t e inter5ention t e #atient )an re#ort t at is s'm#toms an1 urine ),eare1 wit in a7out a 1a' after starting t e anti7ioti) an1 e as a1 no furt er #ro7,ems* Nursing care plan Mr* L a,so as a nursing 1iagnosis of Im#aire1 urinar' e,imination re,ate1 to #s') ogeni) fa)tors* Urinar' im#airment or urinar' retention after surger' )an o))urs for

5arious reasons KAnaest eti)- anti) o,inergi) agents an1 o#ioi1s interfereL wit

t e

#er)e#tion of 7,a11er fu,,ness an1 t e urge to 5oi1 an1 in i7it t e a7i,it' to initiate 5oi1ing an1 )om#,ete,' em#t' t e 7,a11er.Erunner an1 Su11artCs-0616/* T e ea,t )are #ro5i1ers- goa, is to #re5ent in an' )om#,i)ation* Urine retention )an ,ea1s to ) roni) infe)tions KRena, )a,)u,i*L Nursing inter5ention for t e #atient is en)ourage e,# maintain rena, fun)tion- #re5ent

f,ui1 inta4e u# to &666 or more m,F1a' in),u1ing

infe)tion an1 formation of urinar' stones- a5oi1 en)rustation aroun1 t e )at eter or to f,us urinar' 1i5ersion a##,ian)e* % e)4 freAuen)' for 7,a11er 1istension an1 o7ser5e for o5erf,ow- to re1u)e ris4 of infe)tion an1For autonomi) '#erref,e9ia an1 en)ourage ),ient to 5er7a,i?e1 fearsF)on)erns to o#en e9#ression a,,ows ),ient to 1ea, wit fee,ings an1 7egin #ro7,em so,5ing* After t e inter5ention t e #atient wi,, re,ie5e1 in 1is)omfort an1 s ow some signs of im#ro5ement in urinating* Nursing Management 1& Recommendation T e #atient s ou,1 o#timum a5e a regu,ar ) e)4(u# wit t e # 'si)ian to a) ie5e

ea,t * It is im#ortant to 4now t e gui1e,ines in #re5ention of s#rea1 t e

7a)teria, infe)tion in t e 7,a11er a Lifest',e ) anges ma' e,# #re5ent some urinar' tra)t infe)tions* In t e 7at ing an1 'giene % oose sanitar' #a1s instea1 of tam#ons- w i) some 1o)tors 7e,ie5e ma4e infe)tions more ,i4e,'* % ange t e #a1 ea) time 'ou use t e 7at room* Do not 1ou) e or use feminine 'giene s#ra's or #ow1ers* As a genera, ru,e1o not use an' #ro1u)t )ontaining #erfumes in t e genita, area*Ta4e s owers instea1 of

7at s* A5oi1 7at oi,s* Bee# 'our genita, area ),ean* %,ean 'our genita, an1 ana, areas 7efore an1 after se9ua, a)ti5it'* Urinate 7efore an1 after se9ua, a)ti5it'* 8i#e from front to 7a)4 after using t e 7at room* In ),ot ing- A5oi1 tig t(fitting #ants* 8ear )otton(),ot un1erwear an1 #ant' ose- an1 ) ange 7ot at ,east on)e a 1a'* An1 Drin4 #,ent' of f,ui1s .0 to > Auarts ea) 1a'/*Do NOT 1rin4 f,ui1s t at irritate t e 7,a11er- su) as a,)o o, an1 )affeine* A))or1ing to +atin M* V'as- MD- P D .066$/ Urinating imme1iate,' after se9ua, inter)ourse ma' e,# remo5e an' 7a)teria t at ma' a5e gotten in 1uring inter)ourse* If 'ou 1o not urinate for a ,ong #erio1 of time- t e 7a)teria a5e time to mu,ti#,'* FreAuent urinating ma' re1u)e t e ris4 of uro,it iasis in t ose w o are #rone to urinar' tra)t infe)tions* Nursing Management 1> References Su??ane %* Sme,t?er- Erunner J Su11art Cs Me1i)a,(surgi)a, Nursing 10t E1ition Litt,e P- Moore MV- Turner S- et a,* Effe)ti5eness of fi5e 1ifferent a##roa) es in management of urinar' tra)t infe)tion@ ran1omise1 )ontro,,e1 tria,* BMJ* 0616*&>6@)1<<* 1oi@16*11&2F7mG*)1<<* Norr7' SR* A##roa) to t e #atient wit urinar' tra)t infe)tion* In@ "o,1man L- Ausie,,o D- e1s* Cecil Medicine* 0&r1 e1* P i,a1e,# ia- Pa@ Saun1ers E,se5ierH 066:@) a#*&62*

.Longmore M- 8i,4inson I- Toro4 E* OMFORD !ANDEOOB OF %LINI%AL MEDI%INE* O9for1 Uni5ersit' Press* 0661/ . tt#@FFwww*1o *go5*# F4#Fstatisti)sF,a1ing mota,it' as of 066$/ tt#@FFwww*euro#eanuro,og'*)omFarti),eFS132<(<632;0$16;0<6613>( 3F#1fFE#i1emio,og'-DPat ogenesis-Dan1DPat o# 'sio,og'DofDUro,it iasis