I. Introduction Renal stone are common problem affecting men more frequently than women. Approximately millions are hospitalized each year with kidney stone and an equal number are treated for stone without hospitalization. People in hotter climate are commonly affected. Stone may from any where in the urinary track but most commonly form in the kidney, they frequently move to other parts of the urinary tract, causing pain, infection, and obstruction. Approximately 90% of the stone past spontaneously. Stone may be treated medically, mechanically, or surgically are large stones that fill and obstruct the renal pelvis. Recurrence of stones is a problem; patients face lifelong need for preventative management. This care plan addresses management of the patient hospitalized with kidney stones; it also addresses postoperative and postlithotripsy care. II – A. OBJECTIVE OF THE STUDY At the end of this study the group will be able to: - To identify chief complaints of our client and give its specific interventions. 1
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
I. Introduction
Renal stone are common problem affecting men more frequently than women.
Approximately millions are hospitalized each year with kidney stone and an equal
number are treated for stone without hospitalization. People in hotter climate are
commonly affected. Stone may from any where in the urinary track but most commonly
form in the kidney, they frequently move to other parts of the urinary tract, causing pain,
infection, and obstruction. Approximately 90% of the stone past spontaneously. Stone
may be treated medically, mechanically, or surgically are large stones that fill and
obstruct the renal pelvis. Recurrence of stones is a problem; patients face lifelong need
for preventative management. This care plan addresses management of the patient
hospitalized with kidney stones; it also addresses postoperative and postlithotripsy care.
II – A. OBJECTIVE OF THE STUDY
At the end of this study the group will be able to:
- To identify chief complaints of our client and give its specific
interventions.
- To identify the cause and effect of the main problem through a correct
analysis of the schematic presentation of the family health problems.
- To evaluate the effectiveness of the actual nursing care plan that was
established.
- To give referrals and follow up for the health promotion of the client.
In general, this study aims to develop the skills and learning of the
student, with which the student, exposed and learned the genuine community
setting in every case that student encountered. The student tends to pour out
and search more knowledge to attain the desired goal and intervention for the
wellness of the patient.
1
1
B. SCOPE AND LIMITATIONS
This study encompasses on the condition of the Caudor family and the
environment where they live in. And It also has the following limitations:
1. Limited to two visits only.
2. Data is gathered only in the interview, observation and the family obtained
during the visits.
III . FAMILY HEALTH PROFILE
A.1 – Head of the Family
Name: Carlito Caudor
Age: 41 yrs. old
Birthday: December 8, 1967
Height: 7’7”
Weight: 57 kilos
Occupation: Farmer
Educational attainment: High School level
Allergy: None
Smoking: 1 pack per day
Beverages: None
Elimination pattern: Once a day
Chief complain: Kidney stone
Relationship with the head of the family: Son
2
2
A.2: Family member Profile
Name: Vilma Caudor
Age: 33 years old
Birthday: February 15, 1975
Height: 5’2”
Weight: 58 kilos
Occupation: House wife
Educational attainment: High school graduate
Allergy: None
Smoking: None
Beverages: None
Elimination pattern: Once a day
Relationship with the head of the family: Daughter in-law
A.3:
Name: Carmila Caudor
Age: 10 years old
Birthday: January 10, 1998
Immunization: Complete
Weight: 20 kilos
Height: 4’
Relationship with the head of the family: Grand Daughter
A.4:
Name: Mabelle Caudor
Age: 8 years old
Birthday: May 19, 2000
Immunization: Complete
3
Weight: 15 kilos
Height: 48”
Relationship with the head of the family: Grand Daughter
3
A.5:
Name: Carlo Caudor
Age: 5 years old
Birthday: May 11, 2003
Immunization: Complete
Weight: 11 kilos
Height: 42”
Relationship with the head of the family: Grand Son
A.6
Name: Maeca Caudor
Age: 6 months old
Birthday: December 5, 2007
Weight: 10 kilos
Height: 70 cm
Relationship with the head of the family: Grand Daughter
Baikingon is a part of Cagayan de Oro. It is approximately 30 to 45Baikingon is a part of Cagayan de Oro. It is approximately 30 to 45
minutes drive away from Liceo de Cayayan University. Located south west ofminutes drive away from Liceo de Cayayan University. Located south west of
the city. From Liceo de Cagayan University he hired a jeepney to transport us tothe city. From Liceo de Cagayan University he hired a jeepney to transport us to
Baikingon. The fare cost P50.00 back and fort from Liceo de Cagayan UniversityBaikingon. The fare cost P50.00 back and fort from Liceo de Cagayan University
to Baikingon. to Baikingon.
Our client is from zone – 6 Baikingon. Located north in zone 6 properOur client is from zone – 6 Baikingon. Located north in zone 6 proper
going to the creek. .going to the creek. .
IV. CHIEF COMPLAINT
At the time we did our assessment to our client Mr. Carlito Caudor , we found out that he was suffering painful urination cause by kidney stone.
V. HISTORY OF PRESENT ILLNESS FOR THE FAMILYMEMBER WITH A HEALTH PROBLEM
A. Family History
According to the client the kidney problem is from his family for his father suffered the same illness.
B. Past Medical History
The patient has already experienced painful urination for the past four years and has been prescribed with Co-trimoxazole 500 mg.
5
C. Social History
The patients social life was affected since he is suffering from altered urination, its hard for him to mingle with other people and cannot do his daily task because of his problem and aside from that he feels pain when he walks .
At this point of age, he already knows that he is a boy. In this stage the child detects his gender and the differences of a girl and boy. He keeps comparing his self toward his younger sister. He likes to play with his father than his mother. He sticks with his father. He doesn’t want to see his father hugging his mother in front of him, he feels like ashamed of what they are doing. He finds more attention to his father than to his mother.
Erik Eriksson’s Psychosocial TheoryPreschooler (Initiative versus Guilt)
He belongs to a stage where he starts to develop his motor skills. He likes to hold the hammer and imitate his father in fixing there chair.
Maeca Caudor
6 months old
Psychosocial Development
Sensory Oral or Early Infancy ( Trust vs. Mistrust)
At this time Maeca must be given sufficient amount of feeding, love, care
and attention to develop the child’s ability to display affection, gain confidence,
6
gratification and ability to trust others. She’s a breast fed baby according to his
mother “ wala jud koy problima ani niya kay dili jud hilakon”..
During Sensory oral stage Mouth is the center of pleasure. Lack of
gratification can cause individual to develop negative behaviors such as:
suspicion of others, fears affection, and projection. In the end developing
mistrust.
6
VII. FAMILY SERVICE and PROGRESS RECORDS
A. Head of the family
Carlito Caudor
B. Family Member
Vilma Caudor
Carmila Caudor
Mabelle Caudor
Carlo Caudor
Maeca Caudor
C. Address
Zone 6 Baikingon, Cagayan de Oro
D. Family Member Number
5
E. Name of Family Members
Names of
family
member
Relationship
with the head
Sex Birthday Highest
Educ.
completed
Occupation Type of
work
Place of
work
1.Vilma
Caudor
wife F February 15,
1975
High
school
housewife None Baikingon
7
graduate
2.Carmila
Caudor
Daughter F January 10,
1998
Grade 4 N/A N/A N/A
3.Mabelle
Caudor
Daughter F May 19, 2000 Grade 3 N/A N/A N/A
4.Carlo Caudor son M May 11, 2003 None N/A N/A N/A
7
VIII. DESCRIPTION of HOME and ENVIRONMENT
(ENVIRONMENTAL PROFILE)
HOME AND ENVIRONMENT
The home and environment determines the health status of a family which
is based on the sanitary conditions classified as a safe, intermediate, danger
within the five categories: Home, Water Supply, Kitchen, Waste Disposal,
Domestic Animals and the community in general.
As part of the Family Care Study the group has assessed the Home and
Environment of the family.
Housing
The Caudor family has their own house.
The house is a combination of concrete cement and wood. It is a
two story house that has 3 bedrooms and the living room is
adjacent to the kitchen.
They have Television set, Cd player, Karaoke and a Cabinet.
They have their own source of electric power.
8
They use firewood in cooking their food.
Water Supply
The family source of water is from NAWASA
Kitchen
They use firewood in cooking their food
The cooking area is not well organize and clean
The pots are separated from the utensils
8
Toilet
They used water seal
It is separated from the house
Sanitary Condition
Both the front and the backyard is not cemented thus it becomes
muddy and slippery during rainy days.
Limited stored water in the house
Utensils not properly kept in their places
Inadequate food storage
waste Disposal
9
The family doesn’t have proper garbage segregation
They have no compost in their backyard.
They sometimes burn their garbage also outside their house.
Domestic animals The family has dog
Community
Most of the people living in the community are farmers, barbe- q
stick maker and some were construction workers. Health
awareness is one of the priority problems in zone 6 Baikingon .
9
Pathophysiology
10
10
Pathophysiology
Kidney stone formation is the end result of a physicochemical process that involves nucleation of crystals from a supersaturated solution. The common constituents of kidney stones. The factors that influence crystal generation are urine volume, concentration of stone constituents (a function of urine volume), the presence of a nidus and the balance among various physicochemical factors that inhibit or promote stone
formation.
Most people's urine is supersaturated with the common components of renal stones, including calcium phosphate, calcium oxalate and, frequently, uric acid. Supersaturation of the urine constitutes a driving force within the solution favouring crystal nucleation and growth.
A great deal of attention has been focused recently on the interactions between crystals that are being formed and the cell surfaces in the renal tubules.3,4 The most common constituent of kidney stones, calcium oxalate monohydrate, binds electrostatically to anionic sites on cell surfaces. Thereafter, the crystals may be internalized, or they may remain on the cell surface, which allows further binding and propagation of the crystals. Soluble anions, such as citrate, may inhibit this process, as
may urinary glycoproteins; these compounds thus act as inhibitors of the early phase of stone formation.
There is a fine balance in urine among substances that readily form crystals, such as calcium, oxalate and uric acid; promoters of crystallization, including pH, stasis and low volume; and inhibitors of this process, such as high urine volume and flow, citrate (which forms a complex with calcium to prevent its crystallization with oxalate) and urinary glycoproteins. The following section outlines how various factors affect the formation of stones.
Predisposing factor:a. hypercalcemia and hypercalcuria caused by hyperparathyroidism, renal
tubular acidosis, multiple myeloma, and excessive intake of vitamin D, milk, and alkali.
b. Chronic dehydration, poor fluid intake, and immobility.c. Diet high in purines and abnormal purine metabolism (hyperuricemia and
gout)d. Genetic predisposition for urolithiasis or genetic disorders (crystinuria)e. Chronic infection with urea-splitting bacteria (Proteus Vulgaris)f. Chronic obstruction with stasis of urine, foreign bodies within the urinary
tract.g. Excessive oxalate absorption in inflammatory bowel disease and bowel
resection or ileostomy.h. Living in mountainous, desert, or tropical areas.
11Precipitating factor
For people with a history of kidney stones, doctors usually recommend passing at least 2.5 quarts (2.3 liters) of urine a day. To do this, you'll need to drink about 14 cups (3.3 liters) of fluids every day — and even more if you live in a hot, dry climate.
What should you drink? Water is best. Include a glass of lemonade every day, too. Make your own with real lemons, or use a liquid or frozen concentrate, but avoid powdered lemonade mixes. Lemonade increases the levels of citrate in your urine, and citrate helps prevent stone formation.
In addition, if you tend to form calcium oxalate stones, your doctor may recommend restricting foods rich in oxalates. These include rhubarb, star fruit, beets, beet greens, collards, okra, refried beans, spinach, Swiss chard, sweet potatoes, sesame seeds, almonds and soy products. What's more, studies show that an overall diet low in salt and very low in animal protein can greatly reduce your chance of developing kidney stones.
Target organ
12
kidney urinary bladder
Signs and Symptoms
Colicky pain: "loin to groin". Often described as "the worst pain experienced". Hematuria: blood in the urine, due to minor damage to inside wall of kidney,
ureter and/or urethra.
Pyuria: pus in the urine. Dysuria: burning on urination when passing stones (rare). More typical of
infection. Oliguria: reduced urinary volume caused by obstruction of the bladder or urethra
by stone, or extremely rarely, simultaneous obstruction of both ureters by a stone. Abdominal distention. Nausea/vomiting: embryological link with intestine—stimulates the vomiting
center . Fever and chills.
Complications
If a stone stays inside one of your kidneys, it usually doesn't cause a problem unless it becomes so large it blocks the flow of urine. This can cause pressure and pain, along with the risk of kidney damage, bleeding and infection. Smaller stones may partially block the thin tubes that connect each kidney to your bladder or the outlet from the bladder itself. These stones may cause ongoing urinary tract infections or kidney damage if left untreated.
- Treatment of patients with renal lithiasis and hypocitraturia, chronic formers of calcium oxalate, phospate calculia.- Uric acid lithiasis alone or accompanied by calcium lithiasis
- Renal insufficiency¨ Persistent alkaline urinary infections- Obstruction of the urinary tract- Hyperpotassemia¨Adrenal insufficiency- Respiratory or metabolic alkalosis- Active peptic ulcer- Intestinal obstruction- Patients submitted to anticholinergic therapy- Patients with slow gastric emptying
- Slight gastrointestinal disorders may appear which can be palliated by means of the joint administration of food.
- The tablets must not be masticated or diluted. The active component of Acalka is contained with a porous wax matrix. As this was matrix is insoluble, it can be eliminated in visible form in the feces. The active component, however, has been released in the gastrointestinal tract.- Must not be administered to patients receiving potassium-sparing diuretics (traimterene, spirolactone, or amyloride).- It is advisable to carry out an evaluation of electrolytes (Na-K-Cl) and CO2, creatinine and hemogram
every 4 hrs.- It is recommende
17
d that the patients in treatment with Acalka follow a diet w/o salt and increase the intake of fluids.- The recommended treatment in case of hyperpotassemia is: IV administratioin f 10% dextrose solution, containing 10-12 units of insulin/1000ml. Correction of the possible acidosis with IV sodium bicarboate and hemodialysis or peritoneal dialysis.
Name of Drug
Generic
Name
Classification
Dose/ freque
ncy Route
Mechanism of Action
Specific
Indication
Contraindication
Side/Toxic Effects
Nursing Precaution
cotrimoxazole
Bactrim; Septra
Anti-infective
800 mg/160 mg (capsule)
Sulfamethoxazole (SMZ) inhibits formation of dihydrofolic acid from PABA , trimethoprime (TMP) inhibits dihydrofolate reductase thereby bloking the synthesis of tetrahydrofolic acid, the combination of this drugs block two consecutive
Treatment of renal infections
Patient with marked liver parenchymal damage, hematolic disorder blood dyscracia, megaloblastic bone marrow, severe renal insufficiency.
GI upset, nausea, vomiting, glossitis, stomatitis,anorexia,kin rashes, arthalgia and myalgia.
In case of severe allergy, bronchial ashma,streptococcal paryngitis, impaired renal and hepatic function, folate of G6PD deficiency
Avoid in patient’s receiving oral antiguagulant
18
steps in bacterial synthesis of folic acid
RECOMMENDATIONS
For some patients who form stones, diet is the primary control mechanism for stone formation, while for others proper dietary management enhances the role of medications. In most cases, the diets of stone formers reveal excessive intake of foods and low intake of fluids, both modifiable. Stones are associated with excess in the patient’s diet, namely of salt and protein. The following are common dietary measures patient may take to reduce stone formation:
IDEAL NURSING MANAGEMENT
Assess understanding of factor s that predispose to formation of renal stone
Family history of kidney stoneDietary factor including low fluid intake, intake of food high in purine, calcium and oxalate.
Assess understanding of the possible courses of therapy to treat kidney stone
Assess history of renal stone formation. Recurrences may indicate knowledge deficit regarding prevention
ACTUAL NURSING MANAGEMENT
Health teaching
BIBLIOGRAPHY
Atkinson, Rita et al. Hilgard’s Introduction to Psychology.12 th ed. Harcourt
Brace College Publisher:1996.
Doenges, M.E. And Moorehouse, M.F. Nurses Pocket Guide: Diagnosis,
interventions and rationale. 7 th ed. F.A. Davis Company. Huamark, Bangkok,
Thailand,2000
Maglaya, Araceli S. 2004. Nursing Practice in the Community. 4th edition. Argonauta Corporation, Marikina City. Pp 112-117.
19
Pearson, Durk, et al. Life Extension. A Practical Scientific Approach. USA: Warner Communications Company, 1982.
Reyala, et al. 2000. Community Health Nursing services in the Philippines. 9 th
edition. Community Health nursing section, National League of Philippine Government Nurses, Inc.
Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology, 4th ed., McGraw Hill, 876–9.
Valenti, et al. Lippincott’s Review Series: Critical Care Nursing Lippincott Raven Publisher, 1998 pp 14-30
en.wikipedia.org/wiki/
en.emedicine.comwww.c
Evaluation
After the 2 weeks of the exposure, the student had established rapport to
the family, identifies problems and was able to discuss it with the family. The
family has appreciated the health teachings the student have imparted as well
the interventions done.
On the course of visits the family cooperates very well and was very
hospitable and shared pertinent information about their family. It’s overwhelming
to work with them because they were accommodating and interested with the
actions done. Community nursing is a two way process, we may give this and
that advises to the family but if they failed to see it and put them to action nothing
will happen. It was a seemingly fruitful community exposure for the student have
learned a lot on what is community nursing and that it is a unique field of nursing
where we could dig deeper into the lives of our patients/clients.