PMH: Lithotripsy, kidney stone

surgery, gout, nephrectomy (left),

tubal ligation, and recurrent kidney
stones.
FH: Kidney disease, kidney cancer,
kidney stones, uterine cancer, Gout
Pyelonephritis cervical cancer, and ovarian cancer.
Gout is caused by
high amounts of uric
A kidney
acid in the blood,
obstructiondney dney
which can cause
itself.ys ability to Medication: Zyloprim,
crystals to form in
function properly, and PO, 100mg, reduces uric
Medication: Levaquin, joints. Gout is a
can cause irritation acid production by
IVPB, 500mg, inhibits DNA predisposing factor of
and inflammation of inhibiting xanthine
gyrase and prevents DNA kidney stones. Pt had
the renal pare impairs (NR, 34) oxidase
replication, transcription, an undocumented
the kidneys ability to
repair, and recombination in
function properly, Kidney flare up of gout upon
susceptible bacteria admission.
and can cause Obstruction
irritation and
inflammation of the
Pertinent Physical Examination findings: kidney itself. Medication: Dilaudid, IV
Anuria, right flank pain, general overall A kidney obstruction is caused by a 1mg, Binds with opioid
weakness, nausea, and vomiting blockage that prevents urine from leaving receptors in the CNS,
the kidney. altering perception of and
emotional response to
pain

Acute pain related to tissue trauma, edema formation

and/or cellular ischemia, evidenced by reports of pain.
Patient will report pain as being relived by 1200 Psychosocial / Spiritual
8/28/2015. issues and discharge
Nursing interventions you used with rationales: needs: Impaired household
1) Document pain location, duration, intensity, and
radiation. Helps evaluate site of obstruction and role, pt has 4 children to
Pt teaching:
progress of calculi movement.
-Dangers of driving while
look after while husband
2) Administer medication for pain. Opioids and NSAID
combination is often given IV during acute episode to taking pain medication works.
quickly decrease ureteral colic and promote muscle and -Importance of rest and Laboratory/diagnostic tests results:
mental relaxation. adequate fluid intake
3) Provide a restful environment. Promotes relaxation, K: 3.4 low due to dilution from continuous
reduces muscle tension, and enhances coping. saline via IV.
Evaluation: Goal met. Pt reported pain of 0 out of 10 BUN/Creat: 5 low, possibly due to dilution
after receiving pain medication at 1030. from continuous IV
Doenges,M.,Moorhouse,M.,&Murr,A.(2014).Nursingcare WBC: 13.4 elevated due to possible
plans(9thed.).Philadelphia,PA:F.A.Davis infection 1
Company.BUN/Creat: 5 low, possibly due to
dilution from continuous IV
n medication at 10300amse uby reports of
pain. pain.the renal pare
 Guide for Reflection
Guide for Reflection Using Tanners (2006) Clinical Judgment Model

Program Thread: Communication and Collaboration

Yesterday in clinical, I feel I demonstrated effective communication and collaboration with not only my nurses, but
with my patients as well. I was able to effectively discuss patient conditions and work alongside my nurses
throughout the day. I also verbalized and confusion or concerns to my nurses and worked with them to get a better
understanding of things. I was able to help ease tension in one of my patients rooms between a patients husband
and the nurse. There was a miscommunication about the soiled linens and the patients husband asked a question
that came off as rude and condescending to the nurse. Once the question was answered and the nurse left, the
patient brought up the issue with her husband, somewhat scolding him for being rude. In this situation I was able
to validate the husbands concern, while reassuring the nurse, separately, that the husband was not intending to be
rude, he was just confused about the situation. I fell that I also worked well with my nurses in order to ensure
proper, effective care for both my patients and their needs.

Nielsen, A., Stragnell, S., & Jester P (2007). Guide for reflection using the Clinical Judgment
Model. Journal of Nursing Education, 46(11), p. 513-516.

List two goals for the next practicum experience:

1. Perform more patient teaching
2. Engage in more meaningful conversations/active listening with patients.