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Urinary Calculi H.C., a 45-year-old man, comes into the ED with severe right flank pain. He...

Urinary Calculi

H.C., a 45-year-old man, comes into the ED with severe right flank pain.
He states that the pain just started this morning.
He also noticed that his urine is pink-tinged.

What questions would you ask H.C.?

H.C. is restless and asks if he can get up and walk, but he requires assistance to do so.

Urinary Calculi Manifestations

What other manifestations of urinary calculi would you assess for?

H.C. undergoes a CT scan, which reveals 2 calculi in the right renal pelvis and one in the right ureter.
He states that he has had urinary calculi once before, about 2 years ago.

What would you ask him about his previous episode?

Formulate questions regarding his health, medications, and lifestyle since his last episode.

Health
Medications
Lifestyle

You explore H.C.’s diet and find that he loves red meats and shellfish.
He works as a computer programmer and does not exercise regularly.
What initial teaching could you provide for H.C. on the basis of these findings?

Teaching Plan

H.C. continues to be in severe pain and is unable to pass any stones.
He is scheduled for a cystoscopy with a flexible ureteroscope for stone removal.

Preoperative teaching care plan.

2. Urinary Tract Infection

E.L. is a 27-year-old woman who complains of urgency to urinate, frequent urination, and urethral burning sensation during urination.
Symptoms began 48 hours ago.
She has a history of recurring urinary tract infections since age 22, when she got married.

What type of UTI does she probably have?

________________________________________________________________________

What is the most likely reason she has recurring UTIs?

E.L. is allergic to penicillin.
Vital signs are as follows:
Temperature 98.6° F orally
Blood pressure 114/64
Dipstick urinalysis indicates WBCs and bacteria.

What is the next step in diagnosis for E.L.?

How will you instruct E.L. to obtain the specimen?

Urinalysis results:
- Color: dark yellow
- pH: 6.5
- Nitrates: positive
- WBCs: large amount
- Occult blood: trace

Urinalysis results:
- Urine culture: E. coli exceeding 106 CFU/mL
- Sensitivity to ampicillin, nitrofurantoin, ciprofloxacin, cephalexin, trimethoprim/sulfamethoxazole
- E.L.’s urine culture is positive for
- E. coli.

Given her history, what is the likely course of treatment?

How will her treatment differ from an uncomplicated UTI?

E.L. states that because of her penicillin allergy, she has taken Cipro for 7-day courses in the past.
She asks about what could be causing the recurring infections.

What other assessment data would you gather regarding her current infection?

What other questions would you ask her about her urinary hygiene?

E.L. is given her antibiotic prescription.
However, she does not think this treatment plan is going to work.

Develop a care plan for E. I.

Solutions

Expert Solution

Question no 1

Question to ask to HC

What is your daily diet ? Rationale of this question is to find out if the pain is due to increase intake of food that cause stones .
Is their any difficulty or interruption in urination
Have you felt nausea , vomiting or pain during urination
Has the frequency of urination increased
Has urine turned cloudy or dark colour
Any history's of renal ccalculi

Question no 2

Manifestations to be assessed for renal calculi

Burning during urination
Frequently urinating
Low volume of urine in urination
Urine with blood
Bad odour for urine
Nausea
Vomiting
Fever if Infection die to injury by renal calculi
Cloudy or dark coloured urine
Pain over belly ,flank or sides

Question no 3

Question on previous episodes

1) what medication or treatment did you do

2)What kind of stones where present.

3) was previous episode similar to this

Question no 4)

1) question on health

Did you experience any difficulty after last episode

Did you had enough Exersice

Were there any other disease after that

Had any urinary tract infections

2)Question on medication

What were the medication

We're We'r specific for the stone

What was the course of medication

Dosage of medication

3) questions on lifestyle

Had enough fluid daily?

What was your diet

Was their any dietary restrictions from last time

Nightingale answered 1 year ago

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