Question

Mollie Stone, a 22-year-old female client, presents to the emergency department with colicky pain in her flanks. She is doubled over with the pain, stating that the pain is worse than when she gave birth to her son last year. She stated that she has bloody urine but is not on her period. The vital signs are T, 99 °F; BP, 140/90 mm Hg; HR, 90 beats/minute; RR, 22 breaths/minute; pain is 9/10; colicky intermittent pain in her flanks bilaterally. A urinalysis is positive for red blood cells. A renal profile was sent to the lab. The physician ordered a KUB and IVP for R/O renal calculi; strain all urine for renal calculi. The client as you the LPN the following questions.

a. What is the purpose of a KUB? What is an IVP and what is the purpose?

b. The client states "I am very concerned about my blood pressure, why is it so high?"

c. What can I have for pain?

d. What is the purpose of straining the urine for renal calculi?

The RN wants to know if the LPN knows the answers to the following questions:

e. If the client is diagnosed with uric acid stones, what types of food do they need to avoid? Provide three examples.

f. If the client is diagnosed with calcium oxalate stone, what types of food should they avoid? Provide three examples.

g. What are the procedures that can be done if the client cannot pass the stone? Think of surgical and nonsurgical procedures. Explain the procedure. Explain the nurse's role in the procedure.

Answer 1

(A) KUB stands for kidney, ureter and bladder. It's a type of X-ray In which urinary system is assessed for diagnostic procedures.

IVP stand for intravenous pyelogram. It is an X-ray diagnostic test in which contrast dye is injected to evaluate kidney, ureters and bladder abnormalities.

(B) patients BP is increased because kidney contain renin hormone which converts angiotensinogen to angiotensin 1 which regulates BP in our body. In case of kidney failure this is malfunctioned and thus bp increases.

(C) for pain opioids like fentanyl, hydrocodone are given as they are considered safe.

(D)straining Urine specimen is important, because a stone may pass into your bladder during the It may appear  like a grain of sand or a small piece of gravel.

(E) foods avoided in urine acid stone are the foods that contain purine such as red meat, shellfish and organ meat, beef, chicken , eggs.

(F) foods to avoid in calcium oxalate stone are nuts, peanuts, spinach , white bran

(G) various procedure to remove stone are :

• Shock wave lithotripsy: physician used shock waves to blast out the stones into small pieces.
• Percutaneous nephrolithotomy: stones are removed using small telescopes I steered through small incision made in back.
• Extracorporeal shock wave lithotripsy: shock waves are administered using an external device that resembles an X-ray machine and suited for small stones.

management for all:

• In the initial period, monitor vital signs frequently because kidney is highly vascularise  therefore, hemorrhage and resulting shock are potential complications of lithotripsy.
• Monitor amount color, and clarity of urine output. Urine is often bright red initially, but bleeding should diminish within 48 to 72 hours. Cloudy urine may indicate the presence of an infection.
•Maintain placement and patency of urinary catheters. Anchor ureteral catheters or nephrostomy tubes securely. Irrigate gen- tly if ordered. A kinked or plugged catheter may resultinhydroureter,hydronephrosis.
• Prepare for discharge by teaching care of indwelling catheter, urine-collection device, and incision site . Teach signs and symptoms to report: urine leakage from incision for more than 4 days, symptoms of infection, pain, bright hematuria.
• teach measures to further reduce risk of lithiasis.