The presentation will help you learn about the case study of Renal.

1. Medical-Surgical
Nursing 1
A Case Presentation
on Nephrolithiasis

2. I. Patient’s Profile
Name:
Age:
Sex:
Address:
Religion:
Occupation:
Attending Physician:
Date of admission:
Date of discharge:
Mrs. R.D
57 years old
Female
36 Luna Street, Lapaz, Iloilo City
Roman Catholic
Housewife
Dr. F.M
December 12, 2012
still on admission
during data gathering.

4. Chief Complaint:
Right Flank Pain
Diagnosis:
Nephrolithiasis with moderate
hydronephrosis and hydroureter
secondary to obstructing proximal
ureterolithiasis, right.
Special procedures:
Human Albumin Transfussion57cc 25%
Operative Procedure:
CVP Insertion

5. II. History of Present Illness
Mrs. RD is apparently well, until in the
morning of the day of admission. She started to
complain of right flank pain accompanied by
terminal dyspnea and urinary frequency. She
took mefenamic acid with no relief of
symptoms.
In the afternoon there was persistence of
symptoms and she had fever and chills, thus
sought consult in the hospital and was
subsequently admitted.
Mrs. RD stopped taking her maintenance
since August 2012.

6. III. Past Medical History
• Hypertension
-on telmisartan + amlodipine 40/5mg,
stopped last August 2012.
• Bilateral Nephrolithiasis
- on potassium citrate, stopped last August
2012.

7. • 3.1 Previous Hospitalization
-TAHBSOO last 2007 secondary to
myoma.
• 3.2 Allergies-none
• 3.3 Habits
-doing all the household chores whenever she
is able to.
• 3.4Family History
-Hypertension (paternal side)
• 3.5 Social/Environmental History-Non-smoker, Non-alkoholic

8. IV. Physical Examination
• TPR on
Admission
o
o
o
o
T- 39.4 °C
P- 122 bpm
R- 22 bpm
BP- 140/80
mmhg
• TPR range during
hospital stay.
o T- 36 °C to 39.4
°C
o P-81 bpm to 122
bpm
o R- 19 bpm to 33
bpm
o BP-90/60mmhg to
140/80 mmhg.

9. General Assessment
• Awake, conscious and coherent, dressed
in clean and comfortable clothing,
conversant with folks. With vital signs
upon assessment of:
• T-36.7 °C
• CR-118bpm
• RR-26bpm
• BP-140/80mmhg

10. • 4.1 Head- normocephalic, symmetrical
and smooth. Absence of depressions,
masses and scars. Hair is smooth,
colored gray and evenly distributed.
• 4.2 Face- oval shaped, absence of
pimples, acne and scars. Edema,
disproportionate structures and involuntary
movements not noted.
• 4.3 Eyes- anicteric, symmetrical, inline
with each other, non-protruding and equal
palpebral fissures. Pupils are equally
round, reactive to light and accomodation.

11. • 4.4 Nose-located symmetrically on the
midline of the face, absence of swelling,
lesions, perforations and discharges. With
pinkish nasal mucosa.
• 4.5 Ears- aligned with the outer canthus of
the eyes, symmetrical and no discharges
nor perforations noted.
• 4.6 Mouth- dry lips and oral mucosa.
Tongue in midline of the mouth. Tooth
decay noted on right canine and frontal
teeth. No halitosis noted.

12. • 4.7 Neck- head is in central position. No
deformities, lesions nor limits in range of
motion. Lymph nodes are non-palpable.
• 4.8 Chest- symmetrical, no masses, lesions
nor retractions noted.
• 4.9 Heart- tachycardic, adynamic
precordium.
• 4.10- Abdomen- uniform in color, no scars
nor lesions noted. Tenderness noted on
hypogastric and epigastric area.

13. • 4.11Genitalia- not assessed, but patient
complains of dysuria and urinary
frequency.
• 4.12 Upper extremities- equal in size and
length. No deformities, lesions nor scars
noted, able to perform full range of motion.
• 4.12 Lower extremities- both legs are
edematous ( plus 2 pitting edema), unable
to perform full range of motion exercises.
Still with full pulses.

14. Laboratory
Results

15. Laboratory Data
December 12, 2012
Hematology
Result
Normal Values
Hemoglobin
103g/L
M: 130-180 g/L
F: 120-160 g/L
Hematocrit
0.34 vol. fr.
M: 0.40-0.54 vol. fr.
F: 0.37-0.47 vol. fr.
RBC Count
5.18 x 10/L
M: 4.6-6.2 x10/L
F: 4.2-5.4 x10/L
WBC Count
19.53 x 10/L
4.5 -11.0 x 10/L
Differential Count
Neutrophil
Segmenter
Stab
Lymphocyte
93%
85%
8%
6%
50-70%
2-5%
20-40%
Platelet Count
72.0 x10/L
150-450 x 10/L

16. December 12, 2012
Urinalysis
Results
Normal Values
Color
Pale straw
Light yellow -amber
Transparency
Hazy
Clear
Reaction
Acidic
Acidic
Specific Gravity
1.030
1.005-1.035
Puss cells
50-60
None
RBC
2-4
None
Sugar
Negative
Negative
Albumin
Trace
negative
Microscopic Findings
Chemical Tests

17. December 12, 2012
ABG
Results
Normal Values
pH
7.41
7.35-7.45
paCO2
28.8 mmhg
35-45 mmhg
pO2
73 mmhg
80-100mmhg
HCO3
18.8 mmol/L
22-26 mmol/L
O2 saturation
95.7%
95-100%

18. December 12, 2012
Chest PA
Impression :
Atherosclerosis; aorta
Subsegmental atelectasis
left lung

19. Decemberv13, 2012
Ultrasound Report
Impressions:
•Diffuse fatty liver
•Nephrolithiasis, with hydronephrosis and
hydroureter
•Normal gallbladder, pancreas, spleen, left
kidney and urinary bladder.

20. December 13, 2012
Results
Normal Values
FBS (Fasting
Blood Sugar)
9.55 mmol/L
4.1-5.9 mmol/L
Uric Acid
497.54 umol/L
155-357 umol/L.
December 14,2012
Result
HbA1C
Normal Value
7.5%
4.8-6.0%

21. December 14, 2012
Miscellaneous Report
Prothrombin Time
Normal Values
% Activity: 80%
70-10%
Patient: 14.8 seconds
11.6-16.0 seconds
INR: 1.15

22. December 16, 2012
Blood Chemistry
Results
Normal Values
Albumin
22.55 g/L
34-50g/L
BUN
13.14 mmol/L
2.5- 6.40 mmol/L
Creatinine
155.59 umol/L
53-88umol/L
Sodium
140.28 mmol/L
136-146 mmol/L
Potassium
3.39 mmol/L
3.5- 5.1 mmol/L

23. December 16, 2012
ABG
Results
Normal Values
pH
7.38
7.35-7.45
paCO2
31 mmhg
35-45 mmhg
pO2
80 mmhg
80-100mmhg
HCO3
18.3 mmol/L
22-26 mmol/L
O2 saturation
95%
95-100%
FULLY COMPENSATED METABOLIC ACIDOCIS
WITH ADEQUATE OXYGENATION

24. Drug
Study

25. • Paracetamol 500mg/tab 1 tab q6h
PRN for fever >/= t. 37.8°C.
• Telmisartan +
amlodipine40mg/5mg/tab OD
• Clonidine (catapress) 75mcg/tab 1
tab SL q6h for BP >/=150/90
• Omeprazole 40 mg OD

26. • Kalium durole TID x 9 doses.
• Midazolam 2g slow IVTT on route to OR
• Dopamine 400mcg in 250cc D5W
• Furosemide 20mg IV with precautions

28. Precipitating Factors
-excesive intake of
calcium/hyperclcemia
-decreased intake of water.
Nephrolithiasis
Predisposing Factors
-male
-family history of renal
disease
Saturation of urine
Decreased urinary flow
May produce excess amounts of mucoprotein in the bladder
Allowing crystallites to be deposited and trapped forming calculi or stones
Urine (upon voiding) moves tiny stones to the ureter
Large stones
tiny stones

29. Large stones
Tiny stones
Blocks the ureter
Becomes
nidus for
bacteria
Causes spasm
Decreased
urine output
Injures the wall
of the ureter
UTI
Increased WBC
count
Painful
urination
Blood combines
with
urine/hematuria
Decreased hgb
count
Makes urine
turbidity cloudy

30. VII. Nursing Diagnosis and Care Plans
Nursing Diagnosis according to priority of care:
• Acute pain related to ureteral contractions secondary to
stones in the kidney.
• Hyperthermia related to infection process.
• Fluid volume excess related to compromised regulatory
mechanism.

31. • Altered urinary elimination related to mechanical
obstruction.
• Altered nutrition less than body requirements related to
nausea and vomiting.
• Risk for decreased cardiac output related to severe
acidosis.
• Risk for infection related to invasive procedures. (Urinary
catheter, CVP insertion.)

32. • Risk for injury related to decreased RBC production.
• Risk for impaired skin integrity related to edema. ( 2+)
• Knowledge deficit regarding condition related to
information misinterpretation

33. Updates on
Nephrolithiasis

34. Home remedies from herbal teas and
grocery foods dissolve kidney stones
and reverse renal failure
October 31, 2012 by: JB Bardot
•
•
•
•
•
•
Lemonade
Apple cider vinegar
Cranberry juice
Parsley and dandelion
Marshmallow root
buchu

35. • lemonade
• Apple cider vinegar

36. • Cranberry juice
• Parsleys and
dandelion

37. • Marshmallow roor
• Buchu

38. Fresh Insight on
Effective Drug
Treatments for Kidney
Stones
New research by scientists at Washington
University School of Medicine in St. Louis
shows evidence to explain why some
people are more prone to develop kidney
stones than others

39. When claudin-14 is idled, the kidney's filtering system
works like it's supposed to. Essential minerals in the
blood like calcium and magnesium pass through the
kidneys and are reabsorbed back into the blood, where
they are transported to cells to carry out basic functions
of life.
But when people eat a diet high in calcium or salt
and don't drink enough water, the small RNA molecules
release their hold on claudin 14. An increase in the
gene's activity prevents calcium from re-entering the
blood, the study shows.