A Case Study on Ureterolithiasis ppt .pptx

Case study of ureterolithiasis ppt

1. A CASE STUDY ON URETEROLITHIASIS PRESENTED BY: MOISES CLERICK B. BALLOGUING

2. INTRODUCTION Urolithiasis is a condition that occurs when kidney stones exit the renal pelvis and move into the remainder of the urinary collecting system, which includes the ureters, bladder, and urethra. It is a problem, which affects the humanity for centuries and is relatively common, with reported incidences of up to 12% of the world population during their lifetime

3. INTRODUCTION Various studies estimate that 2-3% of all individuals present annually with either a sign or symptom related to urinary tract obstruction secondary to calculus impaction. Ureterolithiasis, is characterized by the formation of mineral deposits within the urinary tract, mostly presents with excruciating flank pain and various associated symptoms.

4. OBJECTIVES STUDENT NURSE-CENTERED General Objective This case study aims to generate an understanding in analysis of "Ureterolithiasis". Even though this is hypothetical, it is a good process for the student nurse, to provide theoretical knowledge that can be applied and utilized if encountered in the actual setting.

5. OBJECTIVES STUDENT NURSE-CENTERED Specific Objectives Ø To present accurately the patient’s profile. Ø To deliberately obtain a comprehensive past, present, and family history of patient’s illness. Ø To assess the condition of the patient using the PEARSON assessment Ø To relate the significance of diagnostic procedures to client’s condition. Ø To present the anatomy and physiology of the organs involved to the condition of the patient. Ø To illustrate a schematic diagram of the pathophysiology of the patient’s disease and explain the mechanisms involved. Ø To broaden one’s idea regarding the medical and surgical management.

6. OBJECTIVES STUDENT NURSE-CENTERED Specific Objectives Ø To skillfully create promotive and preventive management to alleviate the patient’s condition. Ø To efficiently strategize nursing care plans that are specifically in line with the patient’s condition through. Ø Efficient prioritization of proper nursing diagnosis. Ø Formulation of nursing objectives using the SMART criteria. Ø Planning of appropriate and clinically-sound independent, dependent, and collaborative nursing interventions.

7. OBJECTIVES STUDENT NURSE-CENTERED Specific Objectives Ø To Evaluation of the degree of effectiveness for all the goals set at the beginning of the intervention. Ø To identify the indications, mechanism of actions, contraindications, dosages and frequency, adverse effects, and nursing responsibilities of the drugs administered to the patient. Ø To formulate a comprehensive discharge plan that is realistic and suitable to the patient’s needs and compliance.

8. OBJECTIVES PATIENT-CENTERED General Objective After a successful delivery of nursing care, the patient will be able to understand the problem (disease), cooperate actively with the healthcare providers in the course of her hospitalization, and display progressive recovery without the occurrence of severe complications.

9. OBJECTIVES STUDENT NURSE-CENTERED Specific Objectives Ø To establish rapport with the nurse. Ø To participate proactively in the assessment process. Ø To deliberately understand the disease process and the treatments involved. Ø To experience relief of signs and symptoms during nursing care. Ø To verbalize compliance of the health teachings imparted by the nurse.

10. PATIENT’S PROFILE Name: K.J.P. Age: 36 years old Sex: Female Address: Pantay Daya, Vigan City, Ilocos Sur Birthdate: December 21, 1987 Birthplace: Manila Civil Status: Single Religion: Roman Catholic Nationality: Filipino Educational Attainment: College Level MEDICAL PROFILE Date of Admission: May 06, 2024 Time of Admission: 11:32 am Chief Complaint: Severe abdominal pain on the left side Attending Physician: Dr. L. Admitting Diagnosis: t/c ureterolithiasis Final Diagnosis: Ureterolithiasis, Left Proximal

11. HISTORY OF PAST AND PRESENT ILLNESS Past History of Illnesses Prior to admission (PTA), patient had no other significant illnesses, and further attests that she has had no known food or drug allergies.

12. HISTORY OF PAST AND PRESENT ILLNESS Present Illness Patient was admitted last May 06, 2024, at Saint James Hospital – VQR Medical Foundation, with a chief complaint of severe abdominal pain on the left side. During physical assessment patient presented normal vital signs but has positive tenderness on the lower left quadrant of the abdomen, with a GCS of 10, and was given an admitting diagnosis of “t/c ureterolithiasis”. The patient had undergone kidneys, ureters, and urinary bladder (KUB) ultrasound, and an X-ray to consider the admitting diagnosis of ureterolithiasis. Ultrasound revealed mild hydronephrosis, left, while x-ray revealed, mild dextroscoliosis, and muscle spasticity.

13. PEARSON ASSESSMENT

14. PEARSON ASSESSMENT

15. PEARSON ASSESSMENT

16. DIAGNOSTIC PROCEDURES

17. DIAGNOSTIC PROCEDURES

18. DIAGNOSTIC PROCEDURES

19. DIAGNOSTIC PROCEDURES

20. DIAGNOSTIC PROCEDURES

21. DIAGNOSTIC PROCEDURES

22. DIAGNOSTIC PROCEDURES

23. DIAGNOSTIC PROCEDURES

24. ANATOMY AND PHYSIOLOGY The urinary system's function is to filter blood and create urine as a waste by-product. The organs of the urinary system include the kidneys, renal pelvis, ureters, bladder and urethra. The body takes nutrients from food and converts them to energy. After the body has taken the food components that it needs, waste products are left behind in the bowel and in the blood. The kidney and urinary systems help the body to eliminate liquid waste called urea, and to keep chemicals, such as potassium and sodium, and water in balance. Urea is produced when foods containing protein, such as meat, poultry, and certain vegetables, are broken down in the body. Urea is carried in the bloodstream to the kidneys, where it is removed along with water and other wastes in the form of urine.

25. ANATOMY AND PHYSIOLOGY Other important functions of the kidneys include blood pressure regulation and the production of erythropoietin, which controls red blood cell production in the bone marrow. Kidneys also regulate the acid-base balance and conserve fluids. The kidneys remove urea from the blood through tiny filtering units called nephrons. Each nephron consists of a ball formed of small blood capillaries, called a glomerulus, and a small tube called a renal tubule. Urea, together with water and other waste substances, forms the urine as it passes through the nephrons and down the renal tubules of the kidney. Two ureters. The two ureters are narrow tubes that carry urine from the kidneys to the bladder. Muscles in the ureter walls continually tighten and relax forcing urine downward, away from the kidneys. If urine backs up, or is allowed to stand still, a kidney infection can develop. About every 10 to 15 seconds, small amounts of urine are emptied into the bladder from the ureters.

26. ANATOMY AND PHYSIOLOGY The main determinant of the signs and symptoms that are experienced by those affected is the anatomical location of the stone within the ureter. Furthermore, the degree to which the stone obstructs the passage of urine, as well as potential infections that may arise, both contribute to the clinical presentation. Pain associated with ureteric calculi is typically abrupt in onset and is of a colicky nature, typically localized to the lower abdomen and flank, but may radiate to the pelvis and cause vomiting, nausea, and the appearance of blood in the urine.

27. ANATOMY AND PHYSIOLOGY Stones that are impacted at the ureterovesical junction may give rise to increased frequency of urination that is accompanied with pain, while those at the ureteropelvic junction may cause pain that radiates to the lumbar region. Calculi that are trapped at the entry of the ureters into the pelvis as it crosses over the bifurcation of the common iliac artery may cause anterior-inferior radiation of the pain. This can easily be confused with other abdominal pathologies. For instance, left-sided pain may mimic that seen in acute episodes of diverticulitis, while right-sided pain may resemble that of appendicitis.

28. PATOPHYSIOLOGY

29. PATOPHYSIOLOGY The patient’s dietary and lifestyle factors such as, low fluid intake, and increase in purine rich food predisposed the patient to developing crystals in his kidneys. There would be increase sodium urate precipitation resulting to urine chemistry favoring urine crystallization growth. Nephrocalcinosis or build-up of calcium in the kidneys, results an onset of lower back pain. Progression of the stone continues to the Loop of Henle, where there would be accumulation of stones resulting in the increase of size of the stone, which may be manifested as painful urination (dysuria). Urinary calculi may remain within the renal parenchyma or renal collecting system or be passed into the ureter and bladder. Stone matrix progression is triggered as the increase in the size of the calculi in kidneys continue, this causes the formation of a urinary calculus, resulting in slow passage of urine (oliguria), and abdominal spasm, causing lower abdominal pain. During formation in the kidneys, stone may descend in the ureters, calculi may irritate the ureter and may become lodged, obstructing urine flow and causing hydroureter and sometimes hydronephrosis. Blockage of stones in the ureters results in Ureterolithiasis. Blockage in the ureters increases the intra-ureteral contraction, which is then manifested as severe low abdominal pain.

30. MANAGEMENT IDEAL MEDICAL MANAGEMENT ACTUAL MEDICAL MANAGEMENT MEDICATIONS: Analgesia is vital in the initial management of symptomatic ureterolithiasis. Ketorolac has become the standard initial analgesic for patients presenting with acute renal colic.  HNBB is often used where urinary tract smooth muscle spasm is thought to be part of the pathophysiological process. According to the results of the current study, Tramadol was the most effective agent in controlling the pain and is effective and safe routs of controlling pain in acute renal colic secondary to urolithiasis. Ceftriaxone-treated patients may be at an increased risk of kidney stone formation. Stones passed spontaneously in all affected patients so the use of this effective drug can be safely continued. MEDICATIONS: Ketorolac 20mg IV Q8 ANST HNBB 1 amp IV now Tramadol 50mg IV now Ceftriaxone 2g IV OD ANST  

31. MANAGEMENT IDEAL MEDICAL MANAGEMENT ACTUAL MEDICAL MANAGEMENT MEDICATIONS: Blumea balsamifera ( Sambong ) inhibits calcium oxalate stone formation in the kidneys with the 100% and 50% sambong treatment most effective in decreasing number of stones and oxalate content of the kidney homogenate, respectively. Potassium citrate is prescribed to decrease stone recurrence in patients with calcium nephrolithiasis. Citrate binds intestinal and urine calcium and increases urine pH. Citrate, metabolized to bicarbonate, should decrease calcium excretion by reducing bone resorption and increasing renal calcium reabsorption. The use of Febuxostat-SZ in the complex therapy of urinary stone disease showed high efficiency in normalizing urine acidity, the level of daily excretion and serum uric acid level, as well as satisfactory tolerability and a minimal profile of side effects. MEDICATIONS:   Sambong 2 tabs TID   K Citrate 1-tab TID   Febuxostat 40mg OD tab

32. MANAGEMENT IDEAL MEDICAL MANAGEMENT ACTUAL MEDICAL MANAGEMENT DIET: Drink plenty of fluid, this will help produce less concentrated urine and ensure a good urine volume Limit foods with high oxalate content, spinach, many berries, chocolate, wheat bran, nuts, beets, tea and rhubarb should be eliminated from your diet intake Avoid high salt intake, high sodium intake increases calcium in the urine which increases the chances of developing stones, low salt diet is also important to control blood pressure. To prevent uric acid stones, cut down on high-purine foods such as red meat, organ meats, beer/alcoholic beverages, meat-based gravies, sardines, anchovies and shellfish. DIET: Increase fluid intake   Limit foods with high oxalate content Low salt diet      Low purine diet  

33. MANAGEMENT IDEAL MEDICAL MANAGEMENT ACTUAL MEDICAL MANAGEMENT CLINICAL TEST Complete Blood Count Blood Chemistry Urine Analysis  

34. NURSING CARE PLAN

35. NURSING CARE PLAN

36. NURSING CARE PLAN

37. NURSING CARE PLAN

38. NURSING CARE PLAN

39. NURSING CARE PLAN

40. PROMOTIVE & PREVENTIVE Promotive Preventive ACTIVITY AND REST: Balance exercise with rest. Walking is one of the best ways to recover and Renal colic can be worse in the supine position. Vigorous hydration promotes passing of stones, prevents urinary stasis, and aids in prevention of further stone formation. You may find yourself getting tired during the day. When this happens, lie down to rest or take a nap. A good time to take a walk is after your rest or nap. Take medications that are prescribed by the doctor.   Increase fluid intake   Don’t take medications OTC and not prescribed by the doctor.   Observe proper hygiene.   Have an adequate amount of rest.   Eat nutritious foods.   Follow diet plan given.   Frequent ambulation  

41. PROMOTIVE & PREVENTIVE Promotive Preventive DIET AND THERAPY: Eat easily digestible food to ensure hassle-free bowel movements and avoid constipation and indigestion. Increase fluid intake, aim for 8 to 10 glasses of water per day to keep your body well hydrated. Low-purine diet, decreases oral intake of uric acid precursors. Low-calcium diet, reduces risk of calcium stone formation. Note: Research suggests that restricting dietary calcium is not helpful in reducing calcium-stone formation, and researchers, although not advocating high-calcium diets, are urging that calcium limitation be reexamined. Low-oxalate diet, reduces calcium oxalate stone formation.

42. DRUG STUDY

43. DRUG STUDY

44. DRUG STUDY

45. DRUG STUDY

46. DRUG STUDY

47. DRUG STUDY

48. DISCHARGE PLAN

49. DISCHARGE PLAN

50. DISCHARGE PLAN

51. DISCHARGE PLAN

52. UPDATES The incidence of kidney stone disease (urolithiasis) is rising, with a lifetime risk of 10–15%, and a recurrence rate of 50% within 10 years.1 Associated complications include significant pain secondary to renal colic, urinary tract infection (UTI) and urosepsis, and chronic kidney disease. The increasing burden of urolithiasis means that optimizing its management in primary care is important. Dietary advice for recurrent stone formers; Different sub-types of stone have specific guidance; however, general lifestyle advice is helpful for all stone compositions; good hydration — adults should drink 2.5–3 L/day of water and children 1–2 L; it may be helpful to advise drinking to a level where the urine is clear, rather than targeting a specific volume if patients find this difficult;

53. UPDATES avoid carbonated drinks, and drink tea/coffee in moderation; low-sodium diet (<6 g salt for adults and 2–6 g for children); normal calcium intake (700–1000 mg for adults); avoid excess dietary protein, as this acidifies urine and promotes hyperuricosuria, predisposing to stone development; and prevent excess weight gain — obesity is closely related to stone formation.

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