Admission for Urolithiasis/ Kidney Stones Patient History and Nurse's Notes: Cal Stone, age 52, is admitted to the hospi

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Admission for Urolithiasis/ Kidney Stones Patient History and Nurse's Notes: Cal Stone, age 52, is admitted to the hospital for possible renal or ureteral calculi. His history reveals the following symptoms that began a few hours ago and have intensified over the last hour: Dull ache in back that occasionally radiates around to the abdomen and groin and is not relieved by position changes, nausea with the pain, and occasional difficulty passing urine with dysuria and frequency. He has also noticed pink-tinged urine from time to time. Mr. Stone has a history of hyperlipidemia for which he takes a lipid-lowering agent and has had several episodes of gout. He is a non-smoker. His weight has been stable. He does complain of recent, frequent headaches that he attributes to stress and an achiness in his hands and feet that he thinks is the beginnings of arthritis. He has had one previous surgery ten years ago to reduce a fractured ankle following a fall on the ice. Questions 1-7: 13 points 1. Which conditions can contribute to the development of kidney stones in any individual? Select all that apply (1 point) A. Bedrest B. Being over 60 C. Diet high in calcium D. Overactive parathyroid gland E. Recurring urinary tract infections Page 1

2. Based on knowledge of pathophysiology, which condition likely developed first that then contributed to the development of kidney stones for Cal Stone? (Refer to the patient history portion of the chart.) (1 point) 3. Which patient observations noted for patient Cal Stone requires immediate follow-up by the nurse? (1 point) Select all that apply A. Vomiting B. Pain level C. His blood pressure D. His oral temperature E. Residual urine in bladder 4. What is the relationship between the healthcare provider's prescriptions and the patient's expected outcome? In other words, what is the purpose of the following orders for this patient: (1 point each, a.-e; 5 points total) HCP prescriptions Rationale for this patient a. Expected outcome how will it address or resolve or reveal the problem a. Forcing fluids and IV fluids at 125 cc/ hour b. Urine for UA/UC Page 2 1,069 words

C. BUN, serum creatinine levels d. Strain all urine e. the choice of ketorolac for pain relief 5. What is the expected therapeutic effect of adding lisinopril to this patient's medications? (1 point) A. To increase the patient's heart rate B. To increase cardiac output and urinary output C. To manage blood pressure by forcing the excretion of urine D. To lower blood pressure by preventing the conversion of angiotensin I to angiotensin II 6. Which are potential complications for this patient with urolithiasis? Select all that apply. (1 point) A. Anemia B. Hydronephrosis C. Urinary retention D. Urinary tract infection E. Pretenal acute kidney injury 7. Since approximately half of adults with urolithiasis develop reoccurrences, health interventions for prevention are a priority. Describe at least three nursing interventions to assist the adult in preventing a reoccurrence of renal calculi. (3 points) Page 3 1,069 words c

Case Study Progresses: Slides 14-17: Chronic problem - Admission for Complications Questions 8-16: 17 points . 8. In the admission data collected for Cal Stone, highlight the findings in the patient's admission data below that require immediate follow-up by the nurse? (1 point) C.S. comes into the clinic today because of his discolored urine, recent weight gain, and a general feeling of fatigue. C.S. reports that he was diagnosed with hypertension when he was treated for a kidney stone 6 months ago and prescribed an antihypertensive. However, he stopped taking it, because he did not like the side effects. He also did not keep his follow-up appointments to check on his kidney function. Today's nursing admission assessment reveals: • Abdomen firm, rounded and distended with edema 2+ edema on his ankles and shins bilaterally Urine is rust-colored and the patient reports decreased output over past few days Alert, oriented, reports persistent headache . . . 9. Review Cal Stone's vital signs on this admission. HR RR Lung sounds BP Temp 0900 92, 22 clear 148/96 99 F, oral regular Page 4

Explain what is causing the elevation in his heart rate and respiratory rate (1 point). 10. The nurse reviews the lab data results for Cal Stone. What does the patient's BUN and creatinine lab results tell the nurse about his renal status and fluid status? (2 points) Lab result Clinical significance a. BUN b. Creatinine 11. What explains the rusty color to Cal Stone's urine? (1 point) 12. The patient C.S. asks, "What is glomerulonephritis? Do I have a kidney infection?" Which response by the nurse is correct? (1 point) A. "No, you had an allergic reaction to one of your medications."

A. "No, you had an allergic reaction to one of your medications." Page 5 B. "Yes, glomerulonephritis is a chronic infection of the kidneys." C. "Yes, you had a bladder infection that led to a kidney infection." D. "No, glomerulonephritis is an inflammation of a section of the kidney." 13. For each data collection finding, mark to specify if the finding is consistent with the disease process of chronic glomerulonephritis, acute kidney injury, or a urinary tract infection. Each finding may have more than one answer (more than one disease process). (3 points) Data Collection Finding Chronic Acute Urinary glomerulonephritis Kidney Injury Tract Infection a. Recent and rapid weight gain with peripheral edema b. Discolored urine c. Decreased urine output 1,069 words c

14. What is the relationship between the healthcare provider's prescriptions and the patient's expected outcome? In other words, what is the purpose of the following orders for this patient: (1 point each, a.-d; 4 points total) HCP prescriptions Rationale for this patient Expected outcomel how will it address or resolve or reveal the problem Page 6 a. Type and crossmatch for a possible packed red blood cell transfusion; Oxygen therapy b. Sodium and protein restriction diet: low cholesterol, low purine c. Daily weights, Strict I & O, anti- embolism stockings d. one-time dose of furosemide 1,069 words

15. For each potential nursing intervention, specify whether the intervention is indicated, non-essential or not necessary, or contraindicated. (3 points) Potential Nursing intervention Indicated Nonessential Contra- indicated a. Place client is Semi-Fowler's position b. Support legs on several pillows to elevate them Page 7 c. Place commode at the bedside 16. Which are risks or potential complications to the patient with chronic glomerulonephritis? (1 point) Select all that apply. A. Anemia B. Renal failure C. Hyperkalemia D. Hydronephrosis E. Hypercalcemia