I.

INTRODUCTION

NEPHROLITHIASIS Is a kidney stone disease common to both men and women that affect kidneys. The risk of forming a stone can be minimized by avoiding dehydration. Keeping the urine dilute will not allow the chemical crystals to come out of solution and form the beginning nidus a stone. Kidney stones may not produce symptoms until they begin to move down the tubes (ureters) through which urine empties into the bladder. When this happens, the stones can block the flow of urine out of the kidneys. This causes swelling of the kidney or kidneys, causing pain. A person who has had kidney stones often gets them again in the future. Thus having nephrolithiasis wont allow the kidney to do its function well that helps in maintaining acid-base balance, filters waste products out of the blood, homeostasis and regulating blood pressure.

REASON FOR CHOOSING THE CASE I chose nephrolithiasis as my case because it is a common disorder in the ward that is often neglected as not as complicated as others were. Aside from being common I wanted to explore and understand more the pathology, its anatomy and functions that make the body in balance. Knowing the effects of having kidney stones and its functions and learning the different nursing interventions can really help me in my everyday learning experience especially in my duties in the hospitals. In that way I could be able to impart the knowledge that I gained from having this research and plan for my interventions that could help my patient prevent to any further complications.

II.

CLIENTS PROFILE

A. Socio-demographic data

Patient X is a 48-year-old female who is living with her family at Galope Compound, Balulang, Cagayan de Oro, Misamis Oriental. She has one male child with age 25. She has no allergies reported. She has a chief complaint of flank pain. She has a diagnosis of Nephrolithiasis and is admitted at NMMC last November 09, 2010.

B. Vital Signs

The patients vital signs are the first actions that are immediately done when arrival in the clinical area for it determines the standing of the patients situation and how far does the patients vital signs exceed or decreased from the normal values. The vital signs are taken, monitored and recorded for it is the referral that determines the patients situation.

Patient X had the following vital signs: BP: 120/90 mmHg; PR: 88 bpm; RR: 20 and TEMP: 37

III.

PHYSICAL ASSESSMENT

This portion of the chapter will represent the normal and regressed health functions of Patient X arranged in cephalocaudal approached to present a more organized and convenient documentation.

Health perception and Health Management Pattern (Pre-hospitalization) Patient X had an onset of flank pain.

Nutrition and Metabolic Pattern

Patient X eats 3 times a day and has a fair appetite but when the onset of pain and vomiting the patient loses her appetite.

Elimination Pattern (pre-hospitalization)

She defecates 3 times a week yellow and soft in consistency and urinates 2-3 times a day, yellowish in color and pain when urinating.

Activities of daily living (ADL) (pre-hospitalization)

Patient X can perform her activities of daily living however she needs assistance with a significant other to assist her in performing her daily living routine.

Sleep Rest Pattern (while confined)

She has an irregular sleeping pattern due to pain and vomiting at night time.

Cognitive-Perception (while confined)

Patient X was conscious and coherent.

Role-Relationship Pattern (while confined)

She has a good interaction between her family especially her love ones were the one taking good care of her especially her mother.

Values-Belief Pattern Patient Xs religion is a Roman Catholic. She values her beliefs and stick on to it.

IV.

ANATOMY AND PHYSIOLOGY OF RENAL SYSTEM

The kidneys are located near the vertebral column at the small of the back; the left kidney lying a little higher than the right. Each is identical in

structure and function. They are bean-shaped, about 10 cm long and 6.5 cm wide. Each kidney comprises an outer cortex and an inner medulla. The kidney is supplied with oxygenated blood via the renal artery and drained of deoxygenated blood by the renal vein. In addition, urine produced by the kidney as part of its excretory function, drains out via narro w tubules and the ureter, in turn connected to the bladder. The main functional unit of the kidney is the nephron.

The basic unit of the renal tissue is the nephron. Each kidney contains approximately 1 million nephrons making up 10 to 20 renal pyramids. Each nephron consists of a renal corpuscle and renal tubule that interweave with small blood vessels called capillaries. Nephron function and the determination of which ions are filtered or resorbed are regulated by endocrine hormones. Fluid filtered out of the blood by the nephrons flows into the collecting tubules, which drain in the renal calyces. Peristalsis, the name for consistent muscular contractions, forces the fluid, which is now urine, through a calyx into the funnel-like renal pelvis. Urine drains from the pelvis to the ureter, a vessel that transports urine to the bladder where it is stored for urination.

V.

Neurological Assessment

Skin General Color Texture Turgor Temperature Moisture Pallor Smooth Dehydrated Warm Dry

Head Facial Movements Fontanels Hair Scalp Symmetrical Closed Fine Clean

Eyes Lids Preorbital region Conjunctiva Sclera Reaction to light Reaction to accommodation Visual acuity Peripheral Vision Symmetrical Sunken Pale Anicteric R-brisk; L-brisk Uniform constriction/Convergence Grossly Normal Intact/Full

Nose Septum Mucosa Patency Gross Smell Sinuses Midline Pinkish Both patent Normal/Symmetrical Non-tender

Ears External Pinnae Tympanic Membrane Gross Hearing Normoset; Symmetrical Intact Normal

Mouth Lips Mucosa Tongue Teeth Gums pallor Pinkish Midline Missing teeth Pallor

Neck Trachea Thyroids Others Midline Non-palpable Normal ROM

Pharynx Uvula Tonsils Posterior Pharynx Mucosa Midline Not inflamed Not inflamed Pallor

Abdomen General Configuration Bowel Sounds Percussion Superficial veins Symmetrical Normoactive Tympanic

Back and Extremities Range of Motion Muscle tone and strength Spine Gait Symmetrical Symmetrical in size Midline Coordinated

http://www.healthcentral.com/incontinence/h/pathophysiology-of-nephrolithiasis.html http://www.medscape.com/viewarticle/521366_2 http://bestpractice.bmj.com/bestpractice/monograph/225/basics/pathophysiology.html http://www.symptoms-kidney-stones-treatments.com/kidney-stone-causes.html