A patient with suspected ureteral obstruction due to a kidney stone presents with flank pain, nausea, dehydration, and decreased urine output. Which nursing intervention is the priority to prevent further complications?

C) Prepare the patient for immediate surgical intervention to relieve the obstruction.

A) Encourage oral fluid intake to promote hydration and urine flow.

B) Administer prescribed antibiotics to address possible infection.

C) Prepare the patient for immediate surgical intervention to relieve the obstruction.

D) Administer prescribed analgesics to manage severe flank pain.

A patient with a ureteral obstruction due to a kidney stone is experiencing increased flank pain, nausea, fever, and decreased urine output. The healthcare team plans for an intervention to relieve the obstruction. Which nursing intervention is the priority while preparing the patient for the procedure?

C) Monitor vital signs and report any further deterioration.

A) Administer prescribed antibiotics to prevent infection.

B) Encourage oral fluid intake to promote hydration.

C) Monitor vital signs and report any further deterioration.

D) Educate the patient about dietary changes to prevent future stones.

A patient with urolithiasis exhibits severe flank pain, fever, dehydration, and decreased urine output. Which nursing intervention should be prioritized to stabilize the patient's condition before ureteral stent placement?

C) Initiate intravenous fluids and antibiotics.

A) Administer oral analgesics to manage pain.

B) Encourage increased oral fluid intake to alleviate dehydration.

C) Initiate intravenous fluids and antibiotics.

D) Monitor urine output every shift.

A patient is being managed for severe flank pain, dehydration, and suspected urosepsis prior to ureteral stent placement. Which nursing intervention is most critical in addressing the patient's immediate needs?

B) Administering intravenous fluids and monitoring urine output

A) Encouraging oral fluid intake to manage dehydration

B) Administering intravenous fluids and monitoring urine output

C) Applying warm compresses to the flank area to relieve pain

D) Delaying antibiotic therapy until culture results are available

A patient with an acute kidney injury due to obstructive uropathy is receiving intravenous fluids and broad-spectrum antibiotics. Although there is an improvement in hydration status, the patient's temperature remains elevated, and the heart rate is still high. Which nursing intervention would be the most appropriate to prioritize in this situation?

C) Collaborate with the healthcare provider to expedite ureteral stent placement.

A) Increase the rate of intravenous fluid administration to improve tissue perfusion.

B) Administer antipyretics to reduce the patient's elevated temperature.

C) Collaborate with the healthcare provider to expedite ureteral stent placement.

D) Reassess the patient’s pain management regimen to ensure optimal comfort.

A patient is being treated for acute kidney injury secondary to obstructive uropathy and dehydration. Despite improvements in hydration status, the patient's creatinine level remains elevated, and lactate levels have increased. What is the most important nursing intervention to prioritize in this situation?

D) Prepare the patient for ureteral stent placement to relieve the obstruction.

A) Monitor the patient’s urine output hourly to assess for kidney function improvement.

B) Administer antipyretics to address the patient’s elevated temperature.

C) Increase the infusion rate of intravenous fluids to improve tissue perfusion.

D) Prepare the patient for ureteral stent placement to relieve the obstruction.

A patient six hours post-intervention is experiencing respiratory distress with mild bilateral pleural effusions and partially compensated respiratory acidosis. Which nursing intervention is most appropriate to address the patient's current respiratory status?

B) Encourage the patient to perform incentive spirometry every hour while awake.

A) Increase the patient's intravenous fluid rate to improve renal perfusion.

B) Encourage the patient to perform incentive spirometry every hour while awake.

C) Position the patient in a supine position to promote venous return.

D) Administer a bronchodilator to alleviate respiratory distress.

A patient is exhibiting signs of respiratory distress with an arterial blood gas analysis indicating partially compensated respiratory acidosis. Additionally, a chest X-ray reveals mild bilateral pleural effusions likely due to aggressive fluid resuscitation. As the nurse, which intervention should you prioritize to address the patient's current respiratory status and prevent further complications?

D) Position the patient in high Fowler’s position to facilitate breathing.

A) Administer a bronchodilator to relieve respiratory distress.

B) Increase the rate of IV fluid administration to improve circulation.

C) Prepare the patient for thoracentesis to remove pleural fluid.

D) Position the patient in high Fowler’s position to facilitate breathing.

A patient with suspected sepsis shows signs of increased heart rate, low blood pressure, delayed capillary refill, and elevated serum lactate levels. Which nursing intervention is the priority to address the patient's current condition?

B) Initiate intravenous fluid resuscitation

A) Administer diuretics to manage pleural effusions

B) Initiate intravenous fluid resuscitation

C) Prepare the patient for a repeat renal ultrasound

D) Start non-invasive ventilation support

A patient with suspected sepsis is being closely monitored for signs of hemodynamic instability. The patient presents with tachycardia, hypotension, confusion, and delayed capillary refill. Laboratory results show an elevated white blood cell count and increased serum lactate levels. Which nursing intervention should be prioritized to address the patient's current condition?

A) Administer intravenous fluids rapidly to improve perfusion.

B) Start non-invasive ventilation to support respiratory function.

C) Prepare for immediate intubation and mechanical ventilation.

D) Administer antipyretics to reduce fever and metabolic demand.

kidney stone - Nursing Case Study

Pathophysiology

• Primary mechanism: Supersaturation of urine with stone-forming substances such as calcium, oxalate, and uric acid can lead to crystal formation. This occurs when the concentration of these substances exceeds their solubility threshold, promoting crystallization in the renal tubules.

• Secondary mechanism: Lack of inhibitors in the urine, such as citrate, which normally prevent crystal aggregation, exacerbates stone formation. A decrease in citrate levels may result from metabolic acidosis or high dietary protein intake, reducing its ability to bind to calcium and inhibit stone development.

• Key complication: Obstruction of the urinary tract by stones can lead to hydronephrosis, increasing pressure on the kidneys and potentially causing renal damage, infection, or impaired kidney function if not promptly managed.

Patient Profile

Demographics:

45-year-old male, construction worker

History:

• Key past medical history: Hypertension, recurrent urinary tract infections

• Current medications: Lisinopril 10 mg daily, Ibuprofen as needed

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Severe right flank pain

• Key symptoms: Hematuria, nausea, vomiting, difficulty urinating, mild fever

• Vital signs: Blood pressure 145/90 mmHg, heart rate 105 bpm, respiratory rate 22 breaths per minute, temperature 100.4°F, oxygen saturation 98% on room air

Section 1

As the clinical team continues to monitor the patient's condition, they notice a change in his status. The patient reports an increase in the severity of his right flank pain, now rating it as 9 out of 10 on the pain scale despite taking ibuprofen. His nausea has worsened, and he is unable to keep fluids down, leading to concerns about dehydration. His vital signs show a slight increase in temperature to 101.0°F, a heart rate of 112 bpm, and a blood pressure of 150/95 mmHg. Upon physical examination, the patient exhibits guarding and tenderness in the right flank area, and there is a noticeable decrease in urine output, raising concerns about possible acute kidney injury due to obstructed urine flow.

The healthcare team orders a series of diagnostic tests to further evaluate the patient's condition. A renal ultrasound reveals significant hydronephrosis in the right kidney, suggesting that the stone is causing a blockage in the ureter, preventing urine from draining properly. Laboratory results show an elevated serum creatinine level of 1.8 mg/dL, indicating compromised kidney function. The complete blood count reveals leukocytosis with a white blood cell count of 15,000/mm³, suggesting an inflammatory response, possibly due to an infection secondary to the urinary tract obstruction.

These findings prompt the team to consider immediate intervention to relieve the obstruction and prevent further renal damage. The patient is prepped for a potential ureteral stent placement or lithotripsy to facilitate stone passage and reduce hydronephrosis. The clinical team discusses with the patient the importance of addressing the obstruction promptly to prevent further complications, emphasizing the need for hydration, pain management, and possibly antibiotic therapy to address any underlying infection. This approach aims to stabilize the patient's condition while planning for longer-term management to prevent future stone formation.

Section 2

As the patient is prepped for the ureteral stent placement, the clinical team notes a further change in his status. Despite the initial analgesic and anti-inflammatory measures, the patient's pain remains severe, and his nausea continues unabated. His vital signs reveal a further increase in temperature to 102.2°F, a heart rate of 120 bpm, and blood pressure now at 155/100 mmHg. The team observes that the patient's skin turgor has decreased, and his mucous membranes appear dry, confirming dehydration. Additionally, his urine output has dropped significantly to less than 20 mL/hour, heightening concerns over potential acute kidney injury progressing due to persistent obstruction and volume depletion.

Given these developments, the team prioritizes the management of the patient's hydration status and potential sepsis. Intravenous fluids are administered to address dehydration and support renal perfusion. Considering the elevated white blood cell count and febrile state, broad-spectrum antibiotics are initiated to cover potential urosepsis until blood and urine cultures return. The clinical team also reassesses pain management strategies, transitioning to intravenous opiates for better control of his severe flank pain, while carefully monitoring for any adverse effects.

These interventions are critical as the team seeks to stabilize the patient before proceeding with the definitive ureteral stent placement. The emphasis remains on maintaining adequate hydration and controlling infection to prevent further renal compromise. The patient's response to these interventions will determine the next steps in his care, and ongoing monitoring is crucial to quickly identify and address any new complications that may arise. This approach not only aims to resolve the immediate crisis but also sets the stage for successful longer-term management of his urolithiasis.

Section 3

As the intravenous fluids and antibiotics begin to take effect, the clinical team closely monitors the patient's vital signs and laboratory results to assess his response to the interventions. Within a few hours, there is a noticeable improvement in hydration status; the patient's skin turgor and mucous membranes begin to normalize, and his urine output increases slightly to 30 mL/hour. However, his temperature remains elevated at 101.8°F, and his heart rate continues to hover around 115 bpm, indicating that the infection is not yet fully under control. The broad-spectrum antibiotics are continued, pending culture results for targeted therapy.

New diagnostic results reveal an elevated creatinine level of 2.1 mg/dL, up from his baseline of 1.0 mg/dL, confirming the presence of acute kidney injury secondary to the obstructive uropathy and dehydration. The team also notes a slight increase in lactate levels at 2.5 mmol/L, suggesting ongoing systemic stress, potentially from the infection or insufficient tissue perfusion. These findings underscore the importance of maintaining aggressive fluid resuscitation and infection control, as well as the urgent need for the ureteral stent placement to relieve the obstruction.

The patient's pain is better managed with intravenous opiates, allowing him some relief and the ability to take deeper breaths, which is crucial for preventing respiratory complications. As his condition stabilizes, the team prepares for the ureteral stent placement, aiming to address the underlying issue of the obstructed kidney. The ongoing challenge will be to ensure that the infection is adequately treated and kidney function is preserved, setting the stage for a successful recovery and longer-term management of his urolithiasis. Continued vigilance and reassessment are necessary to navigate any further complications that may arise during this critical period.

Section 4

As the clinical team continues to closely monitor the patient, they note a change in his status that requires immediate attention. Approximately six hours post-intervention, the patient begins to exhibit signs of respiratory distress, characterized by an increased respiratory rate of 24 breaths per minute and the use of accessory muscles. Auscultation of the lungs reveals diminished breath sounds at the bases, and the patient reports a new onset of mild chest discomfort. Concerned about the possibility of fluid overload or an evolving pulmonary complication, the team orders a chest X-ray and arterial blood gas analysis to investigate further.

The chest X-ray reveals mild bilateral pleural effusions, likely secondary to aggressive fluid resuscitation, while the arterial blood gas analysis shows a pH of 7.32, PaCO2 of 48 mmHg, and HCO3- of 23 mEq/L, indicating a partially compensated respiratory acidosis. These findings suggest that the patient is experiencing a complication related to fluid management, possibly exacerbated by decreased diaphragmatic function due to pain. The team decides to adjust the fluid management strategy, opting for closer monitoring of fluid balance and considering diuretics to manage the pleural effusions, provided the patient's hemodynamics remain stable.

Meanwhile, the patient's urine culture results return, identifying Escherichia coli as the causative organism, susceptible to the current broad-spectrum antibiotics. The team elects to continue with the current antibiotic regimen while reassessing the need for additional supportive therapies. As preparations for the ureteral stent placement continue, the multidisciplinary team remains vigilant, ensuring that each intervention is tailored to address both the immediate complications and the underlying obstructive uropathy. By maintaining a dynamic approach to the patient's evolving condition, the team works to stabilize his respiratory status, support renal recovery, and prevent any further complications on his path to recovery.

Section 5

As the clinical team closely monitors the patient following the adjustment in fluid management, they observe further changes in his clinical status that require prompt attention. Approximately twelve hours after the initial respiratory distress episode, the patient's heart rate has increased to 110 beats per minute, and his blood pressure has dropped to 95/60 mmHg. He appears diaphoretic and slightly confused, raising concerns about potential septic progression or hemodynamic instability. The team performs a thorough physical assessment and notes that the patient's capillary refill time is delayed at four seconds, indicating possible hypoperfusion.

Laboratory investigations reveal a white blood cell count of 16,000/mm³, suggesting an ongoing or worsening inflammatory response. Additionally, serum lactate levels have risen to 3.5 mmol/L, reinforcing the suspicion of sepsis or tissue hypoxia. The team decides to initiate aggressive sepsis management protocols, including the administration of intravenous fluids and vasopressors, while ensuring that fluid resuscitation does not exacerbate the pleural effusions. The patient is also scheduled for a repeat renal ultrasound to assess for any changes in kidney function or obstruction that may be contributing to his deteriorating condition.

In parallel, the team remains vigilant in monitoring the patient's respiratory status. Despite the use of diuretics to manage pleural effusions, the patient continues to experience mild respiratory distress, with a respiratory rate of 22 breaths per minute and persistent use of accessory muscles. Considering the possibility of reduced diaphragmatic excursion due to pain or pleural involvement, the team discusses the potential benefit of initiating non-invasive ventilation support to improve oxygenation and reduce the work of breathing. Through careful coordination and ongoing reassessment, the team aims to stabilize the patient, address the underlying causes of his complications, and prevent further deterioration.