Writing Homework Help

I’m working on a nursing case study and need support to help me understand better.

A 34 year old female patient presenting to the clinic with complaints of sudden, excruciating pain in her flank area is indicative of kidney stones. Kidney stones are a common urinary condition, with a lifetime prevalence in the United States of about 9% in women in 19% in men (Ferraro et al., 2017). Kidney stones, also called renal calculi, nephrolithiasis, or urolithiasis, are hardened deposits composed of minerals and salts that form inside the kidneys (Mayo Clinic, 2020). Kidney stones are caused by an array of different reasons, including diet, excess body weight, medical conditions, and certain medications or supplements (Mayo Clinic, 2020).Differential diagnoses of kidney stones for males and females include urinary tract infection, pyelonephritis, musculoskeletal inflammation, ectopic pregnancy, ruptured ovarian cyst, testicular torsion, or malignancy (Fontenelle & Sarti, 2019).

A thorough assessment of this patient’s symptoms and history is warranted. It is important that the provider asks the patient of the onset, level, duration, characteristics, and alleviating and worsening factors related to her pain. Since kidney stones can produce an intractable colicky pain that may radiate or refer to other areas of the abdomen or groin, a thorough pain assessment is needed. Furthermore, the provider should also ask the patient for the presence of other symptoms, such as nausea, urinary frequency, vomiting, diaphoresis, dysuria, hematuria, and weakness (Dunphy et al., 2019, p. 646). Since this patient is also admitting to nausea with the pain, that is an additional indicator that she is experiencing kidney stones. The patient should also be asked about her health history, and disclose whether she has a history of a recent urinary tract infection, chronic urinary tract infections, previous diagnosis with nephrolithiasis, a diet that is consistent with renal stone formation, or any changes in her voiding patterns (Dunphy et al., 2019, p. 646). The physical exam of the patient should include assessing for flank tenderness on percussion, abdominal distension or guarding with palpation, and decreased or absent bowel sounds (Dunphy et al., 2019, p. 647).Additionally, the patient’s temperature and blood pressure may both be elevated due to the presence of pain (Dunphy et al., 2019, p. 647).

Diagnostic tests that I would order for this patient includes a urinalysis, complete blood count, and a comprehensive metabolic panel. Imaging, such as abdominal x-rays, CT scans, and abdominal ultrasounds, may benefit in determining the size and location of the stones. Furthermore, a 24 hour urine may be initiated to determine the presence of increased levels of creatinine, uric acid, calcium, phosphorus, oxylate, or cystine (Dunphy et al., 2019, p. 647). That being said, the patient should be encouraged to strain her urine during this process, as the collection and testing of the stones may help determine the cause and how to prevent recurrence. This patient should be encouraged to increase her fluid intake to six to eight 8-ounce glasses of water a day (Dunphy et al., 2019, p. 647). This will allow the stone to pass spontaneously, as most stones smaller than 5 mm do not require surgical intervention. If her nausea is not allowing her to do so, or if she begins to vomit, she may have to be referred to the emergency department to receive intravenous fluid administration. In addition to increasing her fluid intake, she should also be started on a pain management regimen. Oral NSAIDs or oral narcotics such as hydrocodone-acetaminophen, acetaminophen-codeine, and oxycodone-acetaminophen are often necessary to control the pain (Dunphy et al., 2019, p. 647). If the stone is unable to pass with these methods, I would refer her to undergo an extracorporeal shock-wave lithotripsy, otherwise known as a ESWL. This is a noninvasive procedure that breaks apart the kidney stone through ultrasonic waves outside of the body (Dunphy et al., 2019, p. 648). If the patient experiences severe nausea and vomiting, dehydration, urinary obstruction, decreased renal function, severe bleeding, intractable pain, or significant infection, she should seek management from an emergency room and be hospitalized (Dunphy et al., 2019, p. 649). To prevent this from recurring in the future, should to be educated on drinking enough water throughout the day, participate in routine exercise as tolerated, avoid caffeine, beer, and wine, and continue on a low oxidate, phosphorus, or purine diet, depending on the source of the stone (Dunphy et al., 2019, p. 649).

References

Dunphy, H. L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2019). Primary care: the art and science of advanced practice nursing – an interprofessional approach (5th ed.). F.A. Davis Company.

Ferraro, P. M., Taylor, E. N., Gambaro, G., & Curhan, G. C. (2017). Dietary and lifestyle risk factors associated with incident kidney stones in men and women. The Journal of urology, 198(4), 858-863.

Fontenelle, L. F., & Sarti, T. D. (2019). Kidney stones: Treatment and prevention. American family physician, 99(8), 490-496.

Mayo Clinic. (2020, May 5). Kidney Stones. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/kidney-stones/symptoms-causes/syc-20355755.