lithotripsy

A patient with a confirmed urinary stone in the proximal left ureter undergoes extracorporeal shock-wave lithotripsy. Which information is most important for the nurse to collect after lithotripsy?

Urine output

A client with cholelithiasis is scheduled for a lithotripsy. Preoperative teaching should include the information that: 1. Opioids will be available for postoperative pain 2. Fever is a common response to this intervention 3. Heart palpitations often occur after the procedure 4. Anesthetics are not necessary during the procedure

1 Painful biliary colic may occur in the postoperative period as a result of the passage of pulverized fragments of the calculi; this may occur 3 or more days after the lithotripsy. 2 Fever may indicate pancreatitis, which is a rare occurrence. 3 The delivery of shock waves during the procedure is synchronized with the heartbeat to avoid initiation of dysrhythmias. 4 Light sedation may be used to keep the client comfortable and as still as possible.

Nurse Joy is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra-high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to: a. limit oral fluid intake for 1 to 2 weeks. b. report the presence of fine, sandlike particles through the nephrostomy tube. c. notify the physician about cloudy or foul-smelling urine. d. report bright pink urine within 24 hours after the procedure.

Answer C. The client should report the presence of foul-smelling or cloudy urine. Unless contraindicated, the client should be instructed to drink large quantities of fluid each day to flush the kidneys. Sandlike debris is normal due to residual stone products. Hematuria is common after lithotripsy.

A patient with a confirmed urinary stone in the proximal left ureter undergoes extracorporeal shock-wave lithotripsy. Which information is most important for the nurse to collect after lithotripsy? a. Urine output b. Pain level c. Appearance of the site d. Patient temperature

Answer: A Rationale: Because lithotripsy breaks the stone into small sand, which could cause obstruction, it is important to monitor the urine output. The patient may have pain as the stones pass and bruising at the site, but these are not unexpected. Extracorporeal shock wave lithotripsy (ESWL) is not associated with a risk for infection.

A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction? a) "Be aware that your urine will be cherry-red for 5 to 7 days." b) "Increase your fluid intake to 2 to 3 L per day." c) "Apply an antibacterial dressing to the incision daily." d) "Take your temperature every 4 hours."

B) Increase your fluid intake to 2 to 3 L per day The nurse should instruct the client to increase his fluid intake. Increasing fluid intake flushes the renal calculi fragments through — and prevents obstruction of — the urinary system. Measuring temperature every 4 hours isn't needed. Lithotripsy doesn't require an incision. Hematuria may occur for a few hours after lithotripsy but should then disappear.

A client with a history of asthma and kidney stones is admitted with a diagnosis of reoccurrence of renal calculi. The client experiences shortness of breath following a lithotripsy. The nurse auscultates the client's lungs and finds decreased air movement but no wheezing. The arterial blood gas (ABG) results are pH 7.31, PaO2 53 mm Hg, PaCO2 50 mm Hg, and O2 sat 82%. Which of the following actions are appropriate for the nurse to take? (Select all that apply) A. Start oxygen via nasal cannula B. Start high flow oxygen via face mask C. Contact the health care provider D. Prepare for possible intubation E. Call respiratory therapy F. Evaluate the use of intercostal muscles G. Increase IV fluids

B, C, D, E, F

A patient is scheduled for a lithotripsy for renal calculi. The purpose of a bowel preparation prior to this procedure is to do which of the following? 1. Ensure maximum visualization of the kidney and the stones. 2. Ensure that there is no evidence of constipation prior to the procedure. 3. Increase comfort. 4. Reduce postoperative pain.

Correct Answer: 1 Rationale: Fecal material in the bowel may impede fluoroscopic visualization of the kidney and stone. Constipation prior to the procedure has no bearing on the procedure if bowel preparation is completed. Bowel preparation would not contribute to patient comfort or reducing postoperative pain.

When the nurse is caring for a pt who has had left-sided extracorporeal shock wave lithotripsy, which assessment finding is most important to report to HCPr?

Drop in urine output

A patient with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). The patient asks the nurse to explain what will be done. What is the nurse's best response?

Shock waves will break the stones in the kidney to the size of sand grains."

Following ureteral lithotripsy, a client has a uretal catheter in place. Which assessment finding indicates that the physician should be notified immediately?

There is no drainage from the uretal catheter for 30 minutes A lack of drainage in a uretal catheter may indicate obstruction of the catheter and require immediate interventions such as irrigation, which may be ordered by the physician. Hematuria, intermittent flank pain, and bruising would not be unusual after uretal lithotripsy and insertion of a catheter.

A client is admitted for extracorporeal shock wave lithotripsy (ESWL). What information obtained on admission is most critical for a nurse to report to the health care provider before the ESWL procedure begins? a. "Blood in my urine has become less noticeable; maybe I don't need this procedure." b. "I have been taking cephalexin (Keflex) for an infection." c. "I previously had several ESWL procedures performed." d. "I take over-the-counter naproxen (Aleve) twice a day for joint pain."

d. "I take over-the-counter naproxen (Aleve) twice a day for joint pain." Because a high risk for bleeding during ESWL has been noted, clients should not take NSAIDs before this procedure. The ESWL will have to be rescheduled for this client.

A patient has been admitted to the renal unit for lithotripsy. After the procedure you instruct the patient on straining their urine to collect stone fragments for analysis. The results of the stone analysis show that the stones are made of urate. What does this finding indicate?

disturbance in uric acid metabolism

The nurse is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra-high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to:

notify the physician about cloudy or foul-smelling urine.