Chapter 8

Renal Case Study Answers

1. What are the likely differential diagnoses based on Jacob’s symptoms?

Differential diagnoses based on Jacob’s symptoms include kidney stones, urinary tract infection (UTI), appendicitis, cholecystitis, diverticulitis, and pyelonephritis.

2. Describe the pathophysiology of kidney stones formation.

Kidney stones form when certain substances in urine, such as calcium and oxalate, become concentrated enough to form crystals. Over time, these crystals can accumulate and form stones.

3. What are the key clinical manifestations of kidney stones?

Key clinical manifestations of kidney stones include sudden onset of severe pain in the flank, hematuria, nausea, vomiting, and urinary frequency or urgency.

4. What laboratory tests would you order for Jacob? Explain the rationale for each.

Laboratory tests for Jacob would include urinalysis, complete blood count (CBC), blood urea nitrogen (BUN), creatinine, electrolytes, and calcium levels. These tests help to diagnose kidney stones and assess for dehydration and electrolyte imbalances.

5. What radiological investigations would be indicated in this case?

Radiological investigations indicated in this case may include a plain abdominal X-ray, ultrasound, or CT scan of the abdomen and pelvis.

6. Discuss the role of a nurse in the management of a patient with kidney stones.

The nurse plays a critical role in the management of a patient with kidney stones by providing pain management, monitoring for complications, promoting fluid intake, and providing education on preventive measures.

7. Jacob has a history of recurrent kidney stones. What advice would you provide him regarding prevention of further stone formation?

To prevent further stone formation, Jacob should be advised to drink plenty of fluids, limit salt intake, eat a balanced diet, and avoid foods high in oxalate, such as spinach, nuts, and chocolate.

8. What pharmacological interventions are indicated for pain management in this case?

Pharmacological interventions for pain management in kidney stones include NSAIDs, opioids, and muscle relaxants.

9. Describe the process of lithotripsy. What are the nursing interventions associated with this procedure?

Lithotripsy is a noninvasive procedure that uses shock waves to break up kidney stones into smaller pieces, which can then pass more easily through the urinary tract. Nursing interventions include monitoring vital signs, pain management, and assisting with positioning for the procedure.

10. Jacob is scheduled for discharge. What key education points would you provide to him and his family before discharge?

Key education points for Jacob and his family before discharge include dietary modifications based upon the type of stone, the importance of maintaining hydration, signs and symptoms of complications, and when to seek medical attention.

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