Question

John Lyons has undergone treatment for kidney stones three times in the last year. Today he calls this primary provider with complaints of acute, excruciating, colicky, pain that radiates down the thigh toward the genitalia. The pain started last night, and has become progressively more severe. He also complains of the urge to void but has little urine output, and it is blood tinged. Due to the pain, he has not taken any fluids or food in 24 hours. Mr. Lyons undergoes lithotripsy, and analysis of stone fragments to reveal calcium stones. (Learning Objective 6)

1. Mr. Lyons’ symptoms are most indicative of stones in what area of the renal system?

Mr. Lyons has the following orders:

• Morphine sulfate, 2 mg IVP every 2 hours as needed for severe pain
• Ibuprofen, 600 mg every 6 hours
• Normal saline at 200 mL/hr

b. Discuss the rationales for the above orders?

c. Based on the calcium composition of the stone, what dietary teaching should the nurse include in Mr. Lyons’ plan of care?

Answer 1

MR. LYONS HAVE KIDNEY ( RENAL PELVIS) OR URETER STONE. AS HIS SYMPTOMS APPEAR LIKE compliants of acute excruciating, pain radiation down to thigh towrads genital ( this is known as groin pain). This type of pain called as renal colic. Also the pain become more severe as the time progresses. Also accessory symptoms like urge to voiding (abnormal unstoppable urge of urination, because of urinary bladder involuntary contractions) but little urine , this is also remarkable feature of renal pelvis or ureter stone. Along with these symptoms , lower back pain,nausea, vomiting also present. He also have the history of kidney stone treatment three times , so he has severe form of kidney stone . Most probably he is facing bilateral kidney stone. Lithotripsy also shows calcium stone , calcium oxalate and calcium phosphate are the main reason . When calcium oxalate crystals lodge in the renal pelvis and they forms a large crystal an creat blockage in renal pelvis and these stones can ultimately pass to ureter and forms the renal colic.

b.

Morphine sulfate is given for severe pain ( morphine is a opioid analgesic acts of mu receptor, ) maximum dose of 10 mg a day can be given IVP. also it is helpful in urinary retention by acting on urethral sphincter .

Ibuprofen is use for pain relief ( ibuprofen is a nonsteroidal anti inflammatory drug, which has analgesic effect)

Normal salaine is given as the patient did not take any fluid or food for last 24 hours . So giving the fluid balance and energy normal salaine is given.

c. Dietary teaching to Mr. Lyons--

As the patient had felt kidney stone treatment three times so strict restrictions is needed.

1) as in lithotripsy it was found an calcium stone so he has to avoide those food which have calcium like fruits( canmed fruit salad, strawberries ) , tea, coffee , soft drinks, peanut, chocolate, vegetables ( beets,swest potatoes, spinach,tomatoes).

2) also avoid calcium or vitamin D capsules. Your physician will instruct you.

3) reduce the amount of red meat , keep a balanced diet . Don't take too much protein. Also don't take too much oil , fats.

4) you can take citrus fruits ( like oranges, lemon) as these are beneficial in kidney stone prevention.

5) also limit your calcium intake per day ..limit the taking of milk, cheese,tofu.

6) don't take food which has large amounts of salt., fast food, rolls .

7) most important drink plenty of water as water prevent the stone to lodging in kidney, ureter, urethra. At least 8-10 glass of water is must.