N512-19A Module Five: Disorders of the Urinary System Across the Life Span DQ 5

N512-19A Module Five: Disorders of the Urinary System Across the Life Span DQ 5 N512-19A Module Five: Disorders of the Urinary System Across the Life Span DQ 5 Discussion 5 – Louis Johnson, a 48 y.o., gay, partnered, Caucasian male presents to the emergency department with unremitting right flank pain. He denies dysuria or fever. He does report significant nausea without vomiting. He has never experienced anything like this before. On examination he is afebrile, and his blood pressure is 160/80 mm Hg with a pulse rate of 110/min. He is writhing on the gurney, unable to find a comfortable position. His right flank is mildly tender to palpation, and abdominal examination is benign. Urinalysis is significant for 1+ blood, and microscopy reveals 10–20 red blood cells per high-power field. Nephrolithiasis is suspected, and the patient is intravenously hydrated and given pain medication with temporary relief. N512-19A Module Five: Disorders of the Urinary System Across the Life Span DQ 5 In this discussion: Discuss with your colleagues the pathophysiological development of nephrolithiasis. Provide a rationale for whether this patient should be further evaluated for renal surgery at this time. Describe and discuss your plan of care for this patient until he leaves the hospital and for the first two weeks following discharge. Include citations from the text or the external literature in your discussions. Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria. Permalink: https://nursingpaperessays.com/ n512-19a-module-…e-life-span-dq-5 / Example Approach Louis Johnson is unfortunately suffering from nephrolithiasis. Nephrolithiasis is when there are crystalline stones in the urinary system that causes a blockage (BMJ, 2020). This is why Mr. Johnson is experiencing such an immense amount of flank pain. This stones start in the kidneys and pass down to the ureters. The probable cause of why he is not experiencing dysuria is more thank likely the stone has not passed down the ureter yet. These stones collect from the microscopic crystals in the loop of henle, distal tubules or the collecting duct (BMJ, 2020). The reason why this happens is because there is usually an elevated level of uric acid and sodium and not enough stone inhibitor levels to break the build up down (BMJ, 2020). When it comes to treatment for Mr. Johnson I think it is important to further evaluate blood testing, urine testing and do imaging to determine how bad the kidney stones are, and if it has caused any damage to the kidneys. A CT scan would be best to evaluate how big the kidney stones are (Mayo Clinic, 2020). Since Mr. Johnsons urine lab work did come back with blood in it I think it would be beneficial to discuss the different treatment options he has like, surgery to remove the large stones or the use of sound waves to break up the stones so he can then see if he is able to pass them and his options if he is unable to. The first thing in my plan of care for Mr. Johnson is pain management. Kidney stones are painful, so ensuring adequate pain relief would be beneficial to this patient. Second would be hydration, and determining if the patient is able to pass the stone. If the patient is sent home to pass the stone, education on using a strainer when peeing would be beneficial to know if the stone has been passed. “Nephrolithiasis.” Nephrolithiasis – Symptoms, Diagnosis and Treatment | BMJ Best Practice US, 2020, bestpractice.bmj.com/topics/en-us/225. “Kidney Stones.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 5 May 2020, www.mayoclinic.org/diseases-conditions/kidney-stones/diagnosis-treatment/drc-20355759. 358 words Permalink In reply to Carrie Re: Dean Discussion 5 – N512-19A Module Five: Disorders of the Urinary System Across the Life Span DQ 5 by Lorri – Wednesday, August 19, 2020, 2:27 PM Hi Carrie, Thanks for the great post. I think you’re right about the importance of ensuring that Mr. Johnson’s pain is under control. I found it interesting that the newest EBP recommends NSAIDs over opioids. I’m always glad when there’s an appropriate alternative in the treatment of acute pain. I read that even though NSAIDs are now the recommendation, most hospitals still treat with an opioid because it’s a standard of practice. UpToDate recommends an oral NSAID such as diclofenac 100 mg once initially, then 50 mg 3 times daily for pain. (Curhan et al., 2020). If the stones aren’t small enough to pass spontaneously, but are still <10 mm, I would probably try an alpha blocker like tamsulosin to pass the stone before moving forward with lithotripsy (Curhan et al., 2020). Thank you! Lorri Curhan, G. C., Aronson, M. D., & Preminger, G. M. (2020). Diagnosis and acute management of suspected nephrolithiasis in adults. In S. Goldfarb & M. P. O’Leary (Eds.) UpToDate. https://www.uptodate.com 167 words Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10