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topic : Describe in detail the pathophysiological stages of kidney stones in a working 45-year-old adult male. Explain the clinical manifestations, complications, prognosis, diagnostic tests, and medical treatments and procedures involved. Discuss the nurse’s role in supporting the patient’s psychological, emotional, and spiritual needs. Provide an example integrating concepts from the “Statement of Human Flourishing,” located in Topic 3 Resources.
Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format. Responses to peers or faculty should be 100-150 words and include one reference. Refer to “RN-BSN Discussion Question Rubric” and “RN-BSN Participation Rubric,” located in Class Resources, to understand the expectations for initial discussion question posts and participation posts, respectively.
Example 1 Robison :
Discussion Post: Kidney Stones
Kidney stones, or renal calculi, are a product of the crystallization of minerals and salts, mainly calcium oxalate, in the kidneys (Leslie & Bashir, 2023). Risk factors in a 45-year-old male adult include dehydration, diet, metabolic disorders, and genetic background. The pathophysiological process begins with the supersaturation of urine with stone-forming substances. This supersaturation leads to nucleation, where crystals are formed and aggregate (Leslie & Bashir, 2023). As these crystals grow, they may stick to the renal papillae and thus progressively form stones. If the stones dislodge, they may travel through the urinary tract, causing obstruction and intense pain.
The most common clinical manifestations of kidney stones include severe, colicky flank pain radiating to the lower abdomen and groin, hematuria, nausea, vomiting, and dysuria (Leslie & Bashir, 2023). The pain comes and goes in waves as the stone moves. At times, fever and chills may indicate a simultaneous infection that requires urgent attention.
Patients who develop kidney stones may suffer from significant complications. In addition to obstruction, stones can also infect the urinary tract, often accompanied by hydronephrosis, thus reducing kidney function (Hsiao et al., 2021). Recurrent stones increase the risk of chronic kidney disease.
The prognosis of the condition depends on the stone’s size, location of the stone, and composition. Stones less than 5 millimeters in diameter often pass spontaneously, while stones larger than 5 millimeters respond poorly to conservative management and, hence, usually need intervention. With proper management, however, most patients recover without long-term damage.
Diagnostic tests include urinalysis, which may show hematuria and crystals, and blood tests to identify metabolic abnormalities. Imaging studies are usually the gold standard for diagnosing kidney stones (Leslie & Bashir, 2023). In imaging studies, detailed information regarding the size of the stone and its location can be obtained through an imaging study such as a non-contrast helical CT scan. Other imaging tests that can be used to diagnose include ultrasound and IVP.
Medical treatment of kidney stones focuses on relieving symptoms and promoting stone passage. The patient is advised to manage pain with NSAIDs or opioids (Leslie & Bashir, 2023). Hydration with fluids is key to increasing urine output, aiding stone passage. Medical expulsive therapy with alpha-blockers like tamsulosin could relax the ureter, allowing easier passage of stones (Leslie & Bashir, 2023). Procedures like extracorporeal shock wave lithotripsy, ureteroscopy, or percutaneous nephrolithotomy may be required in more giant or obstructive stones to break them down and remove them.
Nurses support patients with kidney stones for possible complications, provide adequate pain management, and educate patients on preventive measures such as hydration and diet modification to reduce recurrences (Mei et al., 2021). Addressing psychological, emotional, and spiritual needs is also crucial. The nurse can provide active listening and reassurance and act as a liaison between them and support groups or spiritual care services (Mei et al., 2021). Drawing from the “Statement of Human Flourishing,” nurses are well-placed to advocate holistic ways of care, focusing on general well-being and quality of life. For instance, a nurse can encourage the patient to participate in stress-relieving activities that eventually bring about feelings of serenity and resilience during recovery, thus enhancing the patient’s journey toward holistic health.
References
Hsiao, C., Chen, T., Lee, Y., & Wang, M. (2021). Ureteral stone with hydronephrosis and urolithiasis alone are risk factors for acute kidney injury in patients with urinary tract infection. Scientific Reports, 11(1). https://doi.org/10.1038/s41598-021-02647-8
Leslie, S., & Bashir, K. (2023). Hypocitraturia and renal calculi. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK564392/
Mei, G., Jiang, W., Xu, W., Wang, H., Wang, X., Huang, J., & Luo, Y. (2021). Effect of comfort care on pain degree and nursing satisfaction in patients undergoing kidney stone surgery. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8581924/
Example 2 Samuel
Kidney stones develop through stages starting with the formation of crystals from minerals in urine that are too concentrated. These crystals gradually grow as more minerals are added, eventually clumping together to form stones (Pearle et al., 2019). Factors such as not drinking water, dietary choices and genetic factors can contribute to this process. In a 45-year-old man, the pain from kidney stones can be intense and sharp, spreading from the side to the groin or belly. Symptoms like blood in the urine, feeling sick, throwing up, and needing to urinate or with pain are commonly seen in practice. If left untreated, kidney stones can lead to complications like tract infections (UTIs), kidney swelling due to urine blockage (hydronephrosis), and possible harm to the kidneys from prolonged blockage. The outlook for kidney stones is usually good with treatment. They often come back. Tests for diagnosis include checking urine samples, blood tests, and imaging scans such as CT scans or ultrasounds (Pearle et al., 2019). Treatment focuses on managing pain, increasing fluid intake, and using medications to help pass the stone or change urine composition if needed. For stones, procedures like shock wave therapy (ESWL) looking inside the ureter (ureteroscopy) or surgery through an incision in the back (percutaneous nephrolithotomy) may be needed.
Nurses play a role in offering care to individuals dealing with kidney stones by addressing their physical needs, emotional well-being, and spiritual concerns. Providing support entails educating patients about their condition and treatment choices, which can alleviate anxiety and empower them. Establishing an atmosphere where patients feel heard and understood is crucial for managing the stress linked to kidney stones. Emotional support involves listening and empathy, enabling patients to voice their concerns and challenges (Pearle et al., 2019). Nurses can facilitate connections to counseling services—support groups to help individuals cope with the weight of their situation. Spiritual support is also a component of nursing care. Respecting and comprehending a patient’s beliefs can offer solace. Contribute to recovery. Nurses can assist in accessing chaplaincy services or encouraging practices like prayer or meditation that align with the patient’s preferences (Pearle et al., 2019).
The “Statement on Human Flourishing” underscores each person’s design and inherent dignity, suggesting that flourishing encompasses intellectual, moral, emotional, and spiritual aspects (GCU, n.d.). Implementing these concepts in nursing care for a kidney stone patient involves acknowledging and nurturing the individual rather than solely focusing on their symptoms. By creating an environment where patients feel esteemed and valued, nurses assist them in progressing towards flourishing. For instance, a nurse could support patients in contemplating their aspirations and spiritual convictions while recuperating (GCU, n.d.). Conversations about how conquering this health obstacle can enhance their life mission can foster optimism and strength. This comprehensive strategy resonates with the idea of a healthy being, where people prosper and contribute to society. Nurses are crucial in aiding patients in attaining success and contentment across aspects of life by tending to the patient’s emotional and spiritual requirements and physical well-being.
References:
Grand Canyon University. (n.d.). Statement on Human Flourishing. https://www.gcu.edu/sites/default/files/media/documents/about/christian-identity-heritage/statement-on-human-flourishing-4-20-22.pdf
Pearle, M. S., Goldfarb, D. S., Assimos, D. G., Curhan, G., Denu-Ciocca, C. J., Matlaga, B. R., … & White, J. R. (2019). Medical management of kidney stones: AUA guideline. The Journal of Urology, 202(1), 38-45. https://doi.org/10.1097/JU.0000000000000297
Example 3 Timothy
Clinical manifestations of a kidney stone often include pain. Pain can be felt in the belly, flank area, and groin. Other symptoms include abnormal urine color, bloody in urine, nausea and vomiting, fever and chills. The pain can come and go as a stone moves through the ureters or urethra. Sometimes the symptoms will resolve on their own. (Mount Sinai Health System, n.d.).
A complication that kidney stones can cause is a blockage of urine at the ureter or urethra. Urine blockage can cause severe pain and require medical treatment. People with kidney stones are also at increased risk for UTI. Urinary infections can spread to the kidney causing a very serious and painful infection (Mayo Clinic, 2022).
The prognosis for kidney stones varies. Some kidney stones are asymptomatic, and larger stones may require surgical intervention. It is recommended to call the doctor for severe unrelenting pain, sings of an infection, foul smelling urine, bloody urine or difficulty urinating (Mayo Clinic, 2022).
Diagnostic tests for kidney stones include a detailed physical assessment, UA, CBC, XRay, CT or ultrasound and stone analysis. Per UCLA Health (n.d.) “According to the American Urological Association, the current gold standard for confirming kidney stones is a non-contrast CT of the abdomen and pelvis. Once a stone is detected, size and location are established and are key determinants in the best management and treatment options.”
Treatment for kidney stones starts with changing the factors that allow for their formation. Diet changes based off stone analysis and increased water intake are among the first interventions. Some medications may contribute to stone formation. Surgical interventions are available. Laser ureteroscopy is among the most common surgical interventions for kidney stones. This process uses a ureteroscope to vaporize the laser (Whitbourne, 2024). Other treatments include open stone removal, percutaneous nephrolithotomy, shock wave lithotripsy.
The nurse’s role in supporting the patients’ emotional needs can include education about diagnosis, treatment and prognosis regarding kidney stones. Kidney stones can be incredibly painful and difficult for a patient to deal with. In the clinical setting frequent assessment and pain management may be necessary. Patient teaching can provide the patient with the information necessary to prevent further stones (UCLA Health. (n.d.).
Nurses in the peri-operative team demonstrate Christian concepts and the teaching of Jesus Christ through direct care and providing relief from pain, suffering, anxiety and fear. Surgery can be a very scary prospect. The service I try to render to my pre-operative patients is that of comfort, guidance and education.
Mount Sinai Health System. (n.d.). Kidney stones. https://www.mountsinai.org/health-library/diseases-conditions/kidney-stones
Mayo Clinic. (2022) Kidney stones – Symptoms and causes – Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/kidney-stones/symptoms-causes/syc-20355755
UCLA Health. (n.d.) Kidney Stone symptoms & diagnosis. https://www.uclahealth.org/medical-services/urology/kidney-stone/kidney-stone-symptoms-diagnosis
Whitbourne, K. (2024, June 7). Kidney stone surgery: Types, risks, and recovery. WebMD. https://www.webmd.com/kidney-stones/surgery-for-kidney-stone
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