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NCP Group Hicalde

The patient presented with left nephrolithiasis and acute pain rated an 8 out of 10. Nursing interventions included comfort measures, relaxation techniques, rest periods, and administering the medications Acalca and Ciprobay as ordered to relieve pain and prevent infection. The goals of pain reduction and preventing infection progression were partially met, as pain decreased but renal calculi remained, and the patient was discharged without signs of infection but the stones were still present.

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Luci Bernas
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81 views4 pages

NCP Group Hicalde

The patient presented with left nephrolithiasis and acute pain rated an 8 out of 10. Nursing interventions included comfort measures, relaxation techniques, rest periods, and administering the medications Acalca and Ciprobay as ordered to relieve pain and prevent infection. The goals of pain reduction and preventing infection progression were partially met, as pain decreased but renal calculi remained, and the patient was discharged without signs of infection but the stones were still present.

Uploaded by

Luci Bernas
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Assessment S: O: pain scale of 8 (+) flank pain (+) guarding behavior (+) facial grimace (+) irritability x-ray

revealed: left nephrolithiasis

Diagnosis Acute pain related to obstruction of renal calculi.

Planning To relieve pain after 30 minutes of nursing intervention as evidenced by pain scale of 5.

Intervention Independent: 1. Provided comfort measures (e.g. repositioning, touch) 2. Encouraged use of relaxation techniques. (focused breathing) 3. Encouraged adequate rest periods. 4. Provided quite and calm environment. Dependent: Administered Acalca 60CC 4X A DAY as ordered.

Rationale To promote nonpharmacological pain management. To distract attention and reduce tension.

Evaluation Goal partially met. As evidenced by pain scale of 6 and renal calsuli was still present.

To prevent fatigue.

To promote relaxation.

Reduces the tendency for uric acid stone formation by alkalinizing the urine. Promotes diuresis and relaxes urinary tract spasm, thus assisting the passage of stones. The therapeutic effect of the balanced combination of the terpenes reduces

Sambong re-leaf forte 500mg 2 tabs

urinary tract inflammation, stimulating renal blood flow through the kidneys and increasing the output of less concentrated urine. Reduces the tendency for uric acid stone formation by alkalinizing the urine.

Essential Forte 500mg 1 cap P.C.

Assessment S: O: temp = 37 C Laboratory results: WBC: 19.2 x 109/L Segmenters: 0.86 Lymphocytes: 0.21 Urinalysis: Bacteria: few

Diagnosis Infection related to stasis of urine.

Planning To prevent or reduce further progression of infection within hospital stay.

Intervention Independent: 1. Monitored vital signs especially temperature. 2. Performed hand hygiene before and after every procedure. Dependent: Administered Ciprobay XR 500mg 1 CAP BID P.C. as ordered.

Rationale To check presence of hyperthermia, a common sign of infection. To prevent transmission of microorganisms that could add to infection.

Evaluation Goal partially met. Pt. B.R. was discharged last December 14, 2011. Without any signs of infection. However, urinary calculi was still present.

Interferes with DNA replication in susceptibility bacteria preventing cell reproduction.

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