Urolithiasis (Prep U)
The nurse is evaluating the effectiveness of discharge teaching for a client with an oxalate urinary stone. Which statement by the client indicates the need for further teaching by the nurse? Select all that apply. "I will never have another urinary stone again." "I need to take allopurinol." "Tylenol is best to control my pain." "I need to drink eight to ten glasses of water every day." "I'm so glad I don't have to make any changes in my diet."
"I will never have another urinary stone again." "I need to take allopurinol." "Tylenol is best to control my pain." "I'm so glad I don't have to make any changes in my diet." Nonsteroidal anti-inflammatory drugs are used to treat renal stone pain. Oxalate-containing foods should be avoided. Fluid intake should total 2 to 3 liters, if not contraindicated. Allopurinol (Zyloprim) is prescribed for uric acid stones. Recurrence of stones occurs in about half of individuals.
The nurse is caring for a client recovering from extracorporeal shock wave lithotripsy (ESWL). Which client statement(s) indicates that teaching about self-care has been effective? Select all that apply. "I will take my temperature every day." "I may expect to experience some pain and discomfort." "The bruise on my back is from the treatment." "I need to increase my intake of fluids every day." "Blood in my urine should go away by day 4 or 5."
"I will take my temperature every day." "I may expect to experience some pain and discomfort." "The bruise on my back is from the treatment." "I need to increase my intake of fluids every day." "Blood in my urine should go away by day 4 or 5." The client recovering from extracorporeal shock wave lithotripsy (ESWL) should receive instructions for home care. These instructions are to include measuring the temperature every day and reporting any elevations. Although ESWL usually does not cause damage to tissue, it can cause discomfort and pain. The client should also understand that the bruise on the back is from the treatment. Fluids should be increased to assist with the passage of stone fragments. The client should expect hematuria that should clear within 4 to 5 days after the procedure.
A male client who is admitted with the diagnosis of urinary calculi complains of excruciating pain. The pain is suspected to be caused by increased pressure in the renal pelvis. Which measure would be most appropriate to provide pain relief?
Encourage frequent ambulation. When a client with urinary calculi complains of excruciating pain, the client should be encouraged to ambulate. This is because the supine position increases colic, while ambulation relieves it. Also, adequate fluid intake should be suggested to promote the passage of stones and to prevent urinary stasis, or the formation of new stones. The client should be encouraged to void when there is a risk of infection related to urinary stasis. The suggestion for restricting sodium intake is offered to a client with chronic glomerulonephritis, not urinary calculi. The nurse should promote deep-breathing exercises to provide relief to a client recovering from surgery who has an ineffective breathing pattern.
A client seeks medical attention for a new onset of acute pain in the groin. Which additional finding(s) indicates to the nurse that the client is experiencing ureteral colic? Select all that apply. Hematuria Left shoulder pain Bruising around the umbilicus Pain in midepigastric region Absent urine despite the urge to void
Hematuria Absent urine despite the urge to void Stones lodged in the ureter (ureteral obstruction) cause acute, excruciating, colicky, wavelike pain that radiates down the thigh and genitalia. Often the client has blood in the urine (hematuria) because of the abrasive action of the stone and will have a desire to void, but little urine is passed. Ureteral stones will not cause referred pain to the left shoulder. Bruising around the umbilicus is associated with acute pancreatitis. Pain in the epigastric region is associated with symptoms of the digestive system rather than ureteral colic.
The nurse is educating a patient with urolithiasis about preventive measures to avoid another occurrence. What should the patient be encouraged to do?
Increase fluid intake so that the patient can excrete 2,500 to 4,000 mL every day, which will help prevent additional stone formation. A patient who has shown a tendency to form stones should drink enough fluid to excrete greater than 2,000 mL (preferably 3,000 to 4,000 mL) of urine every 24 hours (Meschi et al., 2011).
A client has been successfully treated for kidney stones and is preparing for discharge. The nurse recognizes the risk of recurrence and has planned the client's discharge education accordingly. What preventive measure should the nurse encourage the client to adopt?
Increasing fluid intake Increased fluid intake is encouraged to prevent the recurrence of kidney stones. Protein intake from all sources should be limited. Most clients do not require a low-calcium diet, but increased calcium intake would be contraindicated for all clients. Eating small, frequent meals does not influence the risk for recurrence.
A client is being treated for renal calculi and suspected hydronephrosis. Which measure should the nurse take to help maintain a record of the kidneys' function?
Monitor the client's intake and output. Monitoring and recording the client's intake and output provides information about the kidneys' function. It also helps identify any arising complications such as hydronephrosis.
What is true about extracorporeal shock wave lithotripsy (ESWL)? Select all that apply. Stones are shattered into smaller particles that are passed from the urinary tract. ESWL is a high-energy blast of pressure. ESWL is a ureteroscopic approach. ESWL is done while the patient is undergoing a percutaneous nephrolithotomy.
Stones are shattered into smaller particles that are passed from the urinary tract. ESWL is a high-energy blast of pressure. Stones are shattered into smaller particles that are passed from the urinary tract. ESWL is a high-energy blast of pressure. ESWL is not a ureteroscopic approach. ESWL is not done while the patient is undergoing a percutaneous nephrolithotomy.
