I.

INTRODUCTION

According to Segura, J.W., Stones that fill the greater part of the collecting system are called
staghorn because they resemble the antlers of a male deer. These stones usually fill the pelvis of the
kidney, the infundibula, and most of the calices. Partial staghorn fill a lesser portion of the collecting
system, but lack of agreement as how to define these stones prevents a more exact definition. The
caliceal, infundibular, and pelvic portions of the stone usually are all connected, but the stone occasionally
has been identified before these separate portions have had time to coalesce. Urologists assume that
most staghorn stones are composed of struvite (magnesium ammonium phosphate). This crystal forms
only in the presence of bacteria that produce the enzyme urease; nevertheless, other stones can assume
a staghorn configuration: cystine, calcium oxalate monohydrate, and uric acid all may grow to the point
where they fill the collecting system. With experience, it often is possible to identify the composition of a
staghorn stone on plain film, particularly when armed with the patient's clinical history.

Furthermore, Staghorn calculi refer to branched stones that fill all or part of the renal pelvis and
branch into several or all of the calyces. They are most often composed of struvite (magnesium
ammonium phosphate) and/or calcium carbonate apatite. These stones are often referred to as 'infection
stones' since they are strongly associated with urinary tract infections with urea splitting organisms.
Cystine stones, although much less common, may also develop into staghorn calculi. Small struvite and/or
calcium carbonate apatite stones can grow rapidly over a period of weeks to months into large staghorn
calculi involving the calyces and entire renal pelvis. If left untreated, this can lead to deterioration of
kidney function and end-stage renal disease. In addition, since the stones often remain infected, there is
a risk of developing sepsis. Thus, most patients require definitive surgical treatment. (Preminger, G.M. et.
Al )

Staghorn calculi are the result of recurrent infection and are thus more commonly encountered
in women, those with renal tract anomalies, reflux, spinal cord injuries, neurogenic bladder or ileal
ureteral diversion. The lifetime incidence of kidney stones is nearly 13 percent in men and 7 percent in
women. Once an individual has formed a stone, the likelihood of recurrence is 50 percent or greater at five
years and up to 80 percent at 10 years.

We choose this case because we’ve seen and assessed that it is unfamiliar and interesting study
to be done. We can easily collect data to the fact that the patient is willing to give all information we need
and we will treat it confidentially in return.
 II. OBJECTIVES OF THE STUDY

In general, it will widen our knowledge, skills in the concern of the client with staghorn calculi
utilizing the nursing process.

Specifically, to assess the health status of the client, to recognize nursing problem, create nursing
diagnosis, plan efficient nursing care, to solve identified nursing problems, to implement suitable nursing
care and lastly, to evaluate the effectiveness of nursing care rendered.

NURSING PROCESS

III. Assessment

 Patient’s Profile

Name: Patient Y

Age: 59 yrs. old

Gender: Female

Civil status: Single

Date of birth: June 29, 1958

Nationality: Filipino

Religion: Roman Catholic

Admitting Diagnosis: T/C Pneumonia; T/C Kidney Stone

Date Admitted: May 22, 2018

Time Admitted: 05:35 PM

 Environmental Status

Patient Y lives in Sitio Labut, Lipit, Cabugao Ilocos Sur. Her family is composed of 4 members and her
husband, and 2 daughters. She’s living with her family. According to her their house is made up of concrete
materials. They live in a well-ventilated area. According to her she is the one who cleans their house in
usual basis. Faucet is their main source of water and they buy mineral water for drinking purposes. They
have their own comfort room. Regarding garbage disposal, they just burning the garbage after sweeping
their backyard as means of disposal. There are trees planted on their backyard such as mango, and guavas.
They have cats and dogs that roaming around their house. Their means of transportation is trough
jeepneys and motorcycle. The health center is near their house but she admitted that they don’t used to
go there to seek medical advice.

 Lifestyle

According to Pt. Y she wakes up at around 6:00 o’clock in the morning. She is the one who prepares
their breakfast. She is a plain housewife. Their usual breakfast is fried rice, fried egg with dried fish. At
lunch, they used to buy food in Canteen (carinderia) near their house. According to her, she’s fond of
eating meal with side dish such as “bagoong” “patis” as stated “Di ako kuntento sa lasa ng pagkain”. She
admitted that she usually drinks soda’s instead of water. She only drinks not more than 6 glass of water.

 History of Past Illness

According to Patient Y, she experienced childhood illnesses such measles and chicken pox at the age
of 10, her menstrual cycle started when she was 12 years old and it’s irregular. She’s not sure if she
completed her childhood immunization because she said her mother didn’t talk about it. She sometimes
experiences common colds and cough which are treated with over the counter drugs neozep, biogesic.
She doesn’t have any known allergies in food. She claimed that she’s very healthy during her childhood
and she does not yet experienced hospitalization but she said that she’s sometimes seeking medical advice
because of having scanty urination. Last August 2017 patient have a medical check up because of
experiencing scanty urination and left flank pain. Some diagnostics done and revealed a renal calculi and
they give her Tamsulosin, a medication to pass stones it was advise that she will take this for 3 months.
And after then after 3 months of taking the medicine she doesn’t go to the hospital for her follow up
check-up. February 2018, she went to Hospital near them because of having pain on left flank fever and
chills especially at night. They admitted her with admitting diagnosis of pneumonia. Some laboratory and
diagnostics done it was revealed that her kidney stones did not pass after taking the med that was given
to her last year. She is advised to have surgery for the removal of stone. She was discharged in the hospital
and they decided to talk to her relatives about the surgery first before having it.

 History of Present Illness

May 22, 1018 05:35 PM, patient Y was admitted to Talon General Hospital 2nd floor room 306 she was
admitted with a chief complain of cough for a week and flank pain with fever. She has an admitting
diagnosis of T/C Pneumonia and T/C kidney stone.
GENOGRAM
Physical Assessment
11 GORDON’S FUNCTIONALA HEALTH PATTERN
AREAS OF ASSESSMENT
1. Health Perception
Patient’s perception to herself is that she is healthy. She started feeling pain on her flank
and having scanty urination nine months ago. According to her, she cares that much at that time
that’s why she decided to have medical check-up. They gave her medicine to eliminate stones.
According to her, she doesn’t usually go for a check-up whenever she has medical problems but
buys over the counter drugs wherever he has fever or cough and colds.
2. Nutritional Metabolic

Pt. Y. usually eats fish and vegetables; she doesn’t eat meat that much. Their usual
breakfast is fried rice, fried egg with dried fish. At lunch, they used to buy food in Canteen
(carinderia) near their house. According to her, she’s fond of eating meal with side dish
such as “bagoong” “patis” as stated “Di ako kuntento sa lasa ng pagkain”. She admitted
that she usually drinks soda’s instead of water. She only drinks not more than 6 glass of
water.

3. ELIMINATION PATTERN
Pt. Y said she had normal elimination and urination, with once a day defecation and at
least twice a day of urination. But nine months ago, she experienced pain upon urination and had
a scanty urination. The night of January 26, 2016 he could not handle the pain anymore that is
why he decided to go to provincial hospital.
4. ACTIVITY EXERCISE
PRIOR:
Prior to confinement, Mr. DC is a jeepney driver and does not exercise, because he does
not have the energy to do so. He usually watch T>V> or just rest during his day off.
DURING
During the assessment, Mr. DC is ambulatory without assistance. He usually sits leaning
sideways to avoid pressure on his rectal part.
5. SLEEP REST
PRIOR:
Before admission, Mr. DC stated that he sleeps at around 10pm and wakes up at 4am.
He takes a nap in the afternoon for I hour. He has no sleeping disturbances and has good sleep
daily.
DURING:
The patient verbalized that he is able to sleep the same time around 10pm and wakes up
at around 4am but wakes up during nurses visiting hours.
Norms:
The normal sleep pattern for adults and older adults must have 7-9 hours. (Nursing Care
for the Community Book by Zenaida U. Famorca)
ANALYSIS:
The patient has normal sleeping pattern.

6. COGNITIVE PERCEPTUAL
Mr. DC was able to understand our questions and was able to communicate clearly. He
was attentive in spite of being on pain. On the first day of assessment, he was complaining of
colicky pain right after he eats. He was also complaining of crushing pain during sitting or lying.
Patient has a guarding behavior on his abdomen and is on sitting position leaning sideways during
assessment.
Norms:
Pain is a highly unpleasant sensation that affects a person’s physical health, emotional
health, and well-being. Health care professionals include pain as a component a vital signs
assessment. Pain assessment is identified as the fifth vital sign. An individual’s perception of
pain is influenced by age, gender, culture, and previous experience with pain.
Pain has been defined as “whatever the experiencing person says it is, existing
whenever he or she says its does” (McCaffery and Pasero, 1999,p.5). Pain is a universal
experience. Everyone experiences pain at some time and to some degree. It is a highly
subjective, unpleasant, and personal sensation that cannot be shared with others. This
sensation can be associated with actual or potential tissue damage. Pain can be the primary
problem or associated with a specific diagnosis, treatment, or procedure. (An Introduction to
Health and Physical Assessment in Nursing by D’Amico and Barbarito,(2007)
ANALYSIS:
He was complaining of colicky pain right after he eats. He was also complaining
of crushing pain during sitting or lying. Patient has a guarding behavior on his abdomen and is
on sitting position leaning sideways during assessment.

7. SELF-PERCEPTION/SELF CONCEPT
Mr. DC denies of having a family history of having tumors and cancer. Upon interview
though shows his other family members having tumors, Mr. DC accepts what is going on with him
and agrees with the procedure he is going to have.
Norms
People decide on their own attitudes and feelings from watching themselves behave in
various situations. This is particularly true when internal cues are so weak or confusing them
effectively put the person in the same position as an external observer.Self-concept, strictly
defined, is the totality of our beliefs, preferences, opinions and attitudes organized in a systematic
manner, towards our personal existence. Simply put, it is how we think of ourselves and how we
should think, behave and act out our various life roles. (https://explorable.com/self-concept-
theory)
ANALYSIS:
He accepts the situation that he is having right now and believes everything happens for
a reason although denies that he has a family history of the disease.
8. ROLE RELATIONSHIP
PRIOR:
Patient DC has a nuclear family. He lives with his family on their own house. His family is
supportive of his condition. His wife and family are helping him financially, physically and
emotionally according to him.
DURING:
During the assessment, he verbalized that he is worried about the financial problem that
his wife needs to solve, because he is the breadwinner and suppose to provide for his family.
Norms
Filipino highly values the presence of their families more than anything. Regardless of the
liberal influence they have gotten from the west, the family remained the basic unit of their society.
This trait clearly shows among Filipinos abroad who suffer homesickness and tough work just to
support their families back home in the Philippines. In a traditional Filipino family, the father is
considered the head and the provider of the family while the mother takes responsibility of the
domestic needs and in charge of the emotional growth and values formation of the children. They
both perform different tasks and being remarked separately by the children. Children see their
mothers soft and calm, while they regard their fathers as strong and the most eminent figure in
the. (http://www.philippinecountry.com/philippine_culture/common_family_traits.html)
ANALYSIS:
They have no problem with the unity of the problem but they have a problem on their financially
with the situation they have right now.

9. SEXUALLY REPRODUCTIVE
PRIOR:
Mr. DC is married. He is sexually active according to him. He said he was circumcised
when he was 10 years old.
DURING:
Patient admits that he doesn’t have the sexual drive he used to have when he was 20
years younger due to pain he is having and with the factors of being tired after work and getting
older.
Norms

Tulì is a Filipino rite of male circumcision. It has a long historical tradition and is
considered a rite of passage; boys who have not undergone the ritual are labelled supót and face
ridicule from their peers. Circumcision is not considered a religious rite as some four-fifths
of Filipinos profess Roman Catholicism, which does not require it. A theory posits that the
prevalence of the practise is due to the influence of Islam, which was prevalent in parts of the
archipelago at least 200 years before the arrival of Christianity in the 16th century. More affluent
parents opt to have their children circumcised as neonates in hospital, but the majority prefer that
their sons undergo the tradition at around 5–7 years of age. Boys of the same age group would
either go to government-sponsored missions, hospitals, or to a local circumciser. The Philippines
Department of Health meanwhile sponsors an annual Operation Tuli project to circumcise boys;
others assist and provide the service for free. The traditional circumciser would tell the patient to
chew guava leaves and then simply cut off the foreskin of the boy with a sharp knife. The boy is
then to wash off in the cold waters of a nearby river and to apply the masticated guava leaves as
a poultice on the wound. Newly circumcised boys usually wear housedresses or loose skirts to
help in the healing. The swelling that might occur during this period is
termed pangángamatis (literally, "becoming like a tomato", kamatis) owing to the reddish
appearance of the penis. (https://en.wikipedia.org/wiki/Tuli_(rite))

ANALYSIS:
Patient is sexually inactive.
10. COPING STRESS
Mr. DC biggest change in his life when he started feeling pain on his rectal part during
defecation and having a blood on his stool. He talks to his wife and family about his problem.
Norms
According to Folkman and Lazarus (1991), coping is the cognitive and behavioral effort
to manage specific internal or external demands that are appraised as taxing or exceeding the
resources of the person (kozier and erb’s volume 2).
Analysis
The patient has a confidence and hopes that he will surpass this situation together with
his family and relatives.
11. VALUE BELIEF PATTERN
PRIOR:
Patient is catholic and always prays to God and believes in Him. He believes that
everything has a purpose and especially on his condition. His religion does not interfere with his
health condition and decisions.
During
He stated that he prays to God according to his situation. He also stated that he is very
confident in God that he will guide him for the upcoming procedure which will undergo.
Norms
Spiritual well-being is manifested by a feeling of being generally alive, purposeful and
fulfilled (elison 1983).according to Pitch (1998) spiritual wellness is a way of living a lifestyle that
views the lives life purposely and pleasurable, that seek out life-sustaining and life-enriching
options to be chosen freely at every opportunity and sinks its roots deeply into spiritual value
and/or specific religious beliefs. (kozier and erb’s volume 2)
ANALYSIS:
He has his own belief and trust this belief that it will help him in the situation.
 LABORATORY AND DIAGNOSTIC PROCEDURE

Diagnostic/ Date Indicated / Results Normal Analysis and

laboratory ordered/ purposes interpretation of
procedure date done results

HEMATOLOGY Feb, 02,2016 Used to diagnose HGB: 103 140-170 Hemoglobin and
and manage HCT: 0.296 0.415-0.504 Hematocrit are not
numerous RBC: 3.82 3.50-4.70 in normal range, A
diseases, It can MCV: 77.5 80.0-96.0 low HGB and HCT
show abnormalities MCHC: 34.8 33.4-33.5 count can be
in the production, MCH: 27.0 27.5-33.2 associated with a
life span, and WBC: 6.2 4.5-11.0 disease or condition
destruction of POLYS: 0.603 0.55-0.63 that causes your
blood cells. It can LYM: 0.238 0.230-0.350 body to have too few
reflect acute or MXD: 0.159 red blood cells. And
chronic infection, PLT: 355 150-450 White blood cell
allergies, and LYM are elevated.
problems with
clotting.
(http://www.webmd
.com/)
 Diagnostic/ Date ordered/ Indicated/ Analysis /
date done
laboratory purposes Result Interpretation

Procedure

RADIOLOGY/ Pulmonary
JANUARY, 05 Chest x-rays are the >A 2.7cm round pulmona
nodule right lower lung fibrosis
CHEST X-RAY 2016 most common radiol ry nodule is seen in the rig vs.sub segmental atelectasis , l
eft lower lung
ogy test performed to ht lower lung
day. While some che
> A linear density is seen i
st x-rays are perform
n the left
ed for screening purp
oses, such as pre-op lower lung
erative clearance, m
>heart is not enlarge
any chest x-rays are
performed in respons >both costoprenic sulci an
e to patient symptom d hemedispramg-s are unr
s like cough, fever, or emarkable.
pain. Chest x-ray is a
>the visualized osseous st
n excellent first imagi
ructures are unremarkable
ng test to assess for
pneumonia, pulmona
ry edema, or pleural
effusion.

(http://www.webmd.c
om/)
 Diagnostic/ Date ordered/ Indication/ Analysis/
Laboratory date done Purpose Result Interpretation
procedure

Abdominal ultrasoun Reveals a liver, homo normal size homoge

geneous, within norm neous liver with no m
ULTRASONO-GR Dec. 11, 2016
d is a type of imaging al size and echogenic ass or cyst noted.
test. It is used to look ity with no mass or cy
APHY st noted .the gallblad No calculus seen in t
at organs in the he GB
der is demonstrated
abdomen, including with no calculus seen Common duct and in
the liver, gallbladder, . tra hepatic are not de
spleen, pancreas, GB wall is not thicken tailed.
and kidneys. The ed. The common duc No renal solid mass
t and intra hepatic du or cyst or calculus s
blood vessels that cts are not detailed p een
lead to some of ancreas and spleen a
these organs, such re not enlarged. The Prostate are not enla
abdominal aorta not d rged.
as the inferior vena etailed the kidneys ar
cava and aorta, can e within normal size e Suspicious hypoech
chogenicity with no s oic structure posterio
also be examined r to the urinary bladd
olid mass or cyst or c
with ultrasound. alculus seen. The pro er and prostate , to r
state measure 3.3x2. ule out a recto-sigmo
(http://www.webmd.co 5x2.9cm with an esti id lesion.
mated weight of 13.1
m/) grams .there is a sus
picious hypoechoic st
ructure seen posterio
r to the urinary bladde
r and prostate.
COURSE IN THE WARD

MAY 22, 2018(5:35pm)

Dr.’s Order:

 Pls. admit to room of choice in my service

 Regular diet
 CBC, Typing
 Chest X-ray
 ECG
 Blood Chem in AM (05-23-2018)
 NPO post midnight
 For abdominal UTZ specially renal in AM (05-23-18)
 Pls. notify Ultrasound
 Iberet 500mg/tab. OD pc
 Tuseran Forte 1 cap. TID
 Iterax 25mg. cap. 1 cap tonight
Dr. PJT

MAY 22, 2018(6:30pm)

Dr.’s Order:

 Request for whole abdominal Utz

 PLR 1L x 15gtts/min.
 Refer

Dr. PJT

MAY 23, 2018

Dr.’s Order:

 For plain Abdominal X-ray

Dr. PJT

MAY 23, 2018

Dr.’s Order:

 U/A
 D5LR 1L (10-15gtts)
Dr. PJT

MAY 23, 2018

Dr.’s Order:

 Urine C&S
 IV T/F Lactated Ringer’s Solution 3L 10gtts
 Low Sugar Diet
 Ampicillin/Sulbactam-750mg. IV q12 hrs. ANST
 IV T/F (present IV) Multidex-15gtts(1 bottle) then lactated Ringer’s
Dr. PJT
MAY 25, 2018 (8:00AM)

Dr.’s Order:

 IV T/F Multidex-1 bottle-15 gtts/min.

 T/F Lactated Ringer’s 1L
 Tuseran Forte T/C
Dr. PJT

MAY 25, 2018

Dr.’s Order:

 Iterax 25mg. tab 1 tab. Tonight

Dr. PJT

MAY 25, 2018

Dr.’s Order:

 For referral to Dr. Lacar for co management

Dr. PJT

MAY 25, 2018 (10:15PM)

Dr.’s Order:

 To okay with Dra. Talon will schedule pt. for Left pyelonephrolithotomy once with
consent will schedule on Monday
 CP Clearance c/o internist of choice by AP
 Pls. inform me once CP cleared and if with consent for preop preparation
Dr. Lacar

MAY 25, 2018

Dr.’s Order:

 For referral to Dr. Conrado Genilo for CP clearance

Dr. PJT

MAY 26, 2018

Dr.’s Order:

 CP Clearance granted, PSA II, Goldman I

 May Go with sched Surgery
 Strat Amlodipine 5mg. 1 tab OD
 Kefox 750mg. IV q8 hours ANST
 Will followup
DR. Genilo

MAY 26, 2018 (7;40 AM)

Dr.’s Order:

 Carry out Dr. Geenilo’s order

 t/c Ampicillin + Sulbactam
DR. PJT

MAY 26, 2018( 10:36AM)

Dr.’s Order:

 For Pyelonephrolithotomy Left on Monday(5/28/2018) 8Am

 Secure consent
 Secure 1 unit FWB for OR use.
Dr. Lacar

MAY 26, 2018 (8PM)

Dr.’s Order:

Give Iterax 1 tab. Now at bedtime.

Dr. PJT

MAY 27, 2018(8:55AM)

Dr.’s Order:

 Secure consent for cystoscopy, Left Retrograde Pyelography, open ended

Stenting Left Pyelonephrolithoptomy with arterial control
 Anesthesia c/o Dra. Pat Talon
 OR schedule Tom 8AM
 Notify OR
 NPO post Midnight
 Dulcolax tab 2 tabs tonight
 No skin prep
 Cefoxitin (Monowel) 1gm. IVP ANST on call to OR in AM
 Notify Dr. Ben Pekas for surgical assist
 Inform radiology Department regarding intr-op retrograde pyelography
 Increase present ivf rate to 30gtts.(8hrs)
 FFup availability of blood for or use.
Dr. Lacar

MAY 27, 2018(9:40AM)

Dr.’s Order:

 IVF to Follow: PNSS 1L x 8 hours

 D5LR 1L x 8 hours

DR. Lacar

MAY 27, 2018

Dr.’s Order:

Pre-op orders

 Diazepam (5mg) P.O at 9:00 PM tonight

 NPO post midnight
 Pls. change present iv line (Left) arm with blood transfusion set
 Start another line G18 on right arm early AM
 Midazolam 5mg. IM at 7:00 Am
 To okay at 7:30 AM
 Atropine 0.5mg. IV on call to OR
 Prepare unit of blood(whole) properly typed x matched still ready to use
DR. PJT

MAY 27, 2018

Dr.’s Order:

 D/C cefuroxime after tonight,s dose

DR. PJT

MAY 27, 2018(1:35PM)

Dr.’s Order:

 Insert another line @ right hand D5LR 1L at KVO early AM

DR. PJT

MAY 27, 2018(4:05PM)

Dr.’s Order:

 Prepare another unit of FWB properly typed and x matchedready to use for OR.
 D/C Amlodipine
DR. PJT

MAY 28, 2018

Dr.’s Order:

 Pls. notify Dr. Ramin now.

MAY 28, 2018

Dr.’s Order:

Post-op Order:

 To Pacu with Morphine prec.

 02 2lpm until fully awake
 Flat on bed
 NPO temporarily, diet as ordered
 Monitor VS q 15 x 1hr., q1 till stable
 I & O q1 x 4 hours then q shift and record
 Tramadol 100mg. IV q 8 x 3 doses then celecoxib 200mg I cap q 12.
 Cefoxitin 1 gm IV q8
 IVF as ordered
 BT A+

IV. ANATOMY AND PHYSIOLOGY

A. The kidneys
 The kidneys are part of the urinary system. There are 2 kidneys in the body, one on either side of
the spine under the lower ribs, deep inside the upper part of the abdomen. The ureters are thin tubes
that connect each kidney to the bladder. They are about 25–30 cm (10–12 in) long. The urethra is a small
tube that connects the bladder to the outside of the body. There is an adrenal gland just above each
kidney. The adrenal glands are part of the endocrine system.

Structure

The kidneys are bean-shaped organs. An adult kidney is about 12 cm (4–5 in) long, 6 cm (2–3 in) wide and
3 cm (1–2 in) thick. A layer of fatty tissue holds the kidneys in place against the muscle at the back of the
abdomen.

Gerota’s fascia is a thin, fibrous tissue on the outside of the kidney. Below Gerota’s fascia is a layer of fat.

The renal capsule is a layer of fibrous tissue that surrounds the body of the kidney, inside the layer of fat.

The cortex is the tissue just under the renal capsule.

The medulla is the inner part of the kidney.

The renal pelvis is a hollow area in the centre of each kidney where urine collects.

The renal artery brings blood to the kidney.

The renal vein takes blood back to the body after it has passed through the kidney.

The renal hilum is the area where the renal artery, renal vein and ureter enter the kidney.

The nephrons are the millions of small tubes inside each kidney. Each nephron has 2 parts. Tubules are
tiny tubes that collect the waste materials and chemicals from the blood moving through the kidney. The
corpuscles contain a clump of tiny blood vessels called glomeruli that filter the blood as it moves through
the kidney. The waste products are passed through the tubules to the collecting ducts, which drain into
the renal pelvis.

Function

The main function of the kidneys is to filter water, impurities and wastes from the blood.

The blood from the body enters the kidneys through the renal arteries. Once in the kidney, the blood
passes through the nephrons, where waste products and extra water are removed. The clean blood is
returned to the body through the renal veins.

The waste products filtered from the blood are then concentrated into urine. The urine is collected in the
renal pelvis. The ureters move the urine to the bladder, where it is stored. Urine is passed out of the
bladder and the body through the urethra.

The kidneys also act as endocrine glands. They make these hormones:

 Erythropoietin (EPO) stimulates the bone marrow to make red blood cells.
 Calcitriol, a form of vitamin D, helps the colon absorb calcium from the diet.
 Renin helps control blood pressure.

B. STAGHORN STONES
 A staghorn kidney stone is a term used to describe a large stone that takes up more than one branch
of the collecting system in the renal pelvis of the kidney.

By way of review, the urinary tract begins with the kidneys.

The kidneys, one on each side, sit high in the upper abdomen partially underneath the rib cage.
They filter the blood to extract excess waste products and fluid to form the urine. Urine, once formed in
the kidneys, is collected in the renal pelvis, the first part of the urinary drainage system. Urine travels
through a tube on each side, the ureter, down to the bladder. Urine is constantly being made by the
kidneys and transported through the ureters into the bladder. The bladder stores urine until full and then
empties to the outside through the urethra. The urinary system is the same in both men and women from
the kidneys to the bladder. In men, the urethra is longer and encircled by the prostate which is a gland
that is part of the reproductive system.

Staghorn stones form in the renal pelvis.

Some of the risk factors for staghorn stone formation include long standing history of stones, certain
unique metabolic defects, and repeated urinary tract infections with particular types of bacteria. If a
staghorn stone occurs in association with infection, there may be a pattern of intermittent and recurrent
infection which may persist until the staghorn stone is removed.

Recommendations

A patient with a staghorn stone should be treated.

If a staghorn stone is not treated, then renal deterioration occurs in at least 1 out of 4 patients. Over time,
an untreated staghorn calculus is likely to destroy the kidney and/or cause life-threatening infections
(sepsis). Complete removal of the stone is important in order to eradicate infection, relieve obstruction,
prevent further stone growth, and preserve kidney function.

PATHOPHYSIOLOGY
 MODIFIABLE:
Diet: high in salty foods
(soy and fish sauce)
Low fluid intake NON-MODIFIABLE:
Fond of drinking soft Age: 59 years old
drinks Sex: female
Recurrent urinary tract Family history of kidney stones
infection
V. NURSING CARE PLAN
VI. DRUGS STUDY

DRUG DATA CLASSIFICATION MECHANISM OF INDICATI CONTRAINDICATI ADVERSE NURSING

ACTION ON ON REACTION RESPONSIBILITIES
Generic Name: Antibiotic, Sulbactam is Gynecolo Conditions: Most After reconstitution,
Ampicillin+Sulbacta Penicillin present in this gical >Clostridium Common: solutions should stand
m product because infections difficile infection hypersensi so that any foaming
it irreversibly caused by >Kidney disease tivity, will dessipitate; inspect
Brand Name: inhibits beta- E. Coli, with reduction in nausea & vial to ensure
Unasyn lactamases, thus Klebshiell kidney function vomiting, dissolution.
ensuring activity a spicies >Inflammation of gastritis, Give by slow injection
Patient Dose: 750 of ampicillin (including the liver with stomatitis over 10-15 minutes or,
mg IV Q12 against beta- B. fragilis) stoppage of bile if mixed with 50-100 ml
lactamase- flow of diluent, over 15-30
producing Allergies: minutes.
microorganisms. >Penicillins Monitor CBC, cultures,
Thus, Sulbactam >Betalactams renal function.
broadens the >Sulbactam During first 30 min of IV
antibiotic therapy monitor
spectrum of closely for S&S of
Ampicillin to hypersensitivity
those bacteria reactions.
normally
resistant to it.
Generic Name: Cephalosporin, Cefuroxime acts Urinary Hypersensitivity Glossitis, To reconstitute
Cefuroxime second by inhibiting Tract to cephalosporins nausea, suspension, loosen
Brand Name: generation bacterial cell Infections & Acute vomiting, powder by shaking the
Kefox wall synthesis. (acute & porphyria. diarrhea, bottle. Add
Patient Dose: Lack of bacterial chronic gastric, appropriate amount of
750mg IV Q8 cell wall resuts pyelonep pyrosis, water (depending on
in death due to hritis, abdominal bottle size). Invert
lysis of bacteria. cystitis & pain. Very bottle and shake
asympto seldom, vigorously. Shake
matic urticarial before each use. Store
bacteriuri or reconstituted
a). cutaneous suspension either at
Prophylax rash, room temperature or
is against pruritus & refrigerate.
infection arthralgia. Note reasons for
in therapy, characteristics
abdomina of S&S, culture results,
l, pelvic, baseline assessments.
orthopae Report lack of
dic, response, persistent
cardiac diarrhea or S&S of
pulmonar anemia.
y,
esophage
al &
vascular
surgery.
Generic Name: Benzodiazipine, Short-acting Preoperat Hypersensitivity Flactuatio Give IM doses in a large
Midazolam adjunt to benzodiazepine ive to ns in VS, muscle mass.
hydrochloride general with sedative- sedation, benzodiazipines. including When used for
Brand Name: anesthesia general anxiolysis Acute narrow- decreased induction of general
Dormicum anesthetic and angle glaucoma. respirator anesthesia, give the
Patient Dose: 5 mg properties. amnesia Use in obstetrics, rate and initial dose over 20-30
IM (Pre-OP med) Depresses the prior to or coma, shock, or tidal seconds.
response of the during acute alcohol volume, Carefully monitor all IV
respiratory short intoxication apnea. doses with the
system to diagnostic where VS are Headache, immediate availability
carbon dioxide , depressed. pain at of oxygen,
stimulation, therapeut injection resuscitative
which is more ic or site, equipment, and
pronounced in endoscopi muscle personnel who are
clients with c stiffness, skilled in maintaining a
COPD. Possible procedure enduratio patent airway and
mild to s (either n, redness. ventilation support;
moderate alone or continue monitoring
decreases in CO, with other during recovery period.
mean arterial CNS
BP, SV, systemic depressan
vascular ts).
resistance.
Generic Name: Cholinergic Blocks Preanesth Use with caution Dry Review indications for
Atropine sulfate blocking drug acetylcholine etic to in infants, small mouth, drug use, frequency of
Brand Name: effects on control children and urinary use and route of
Atropine postganglionic salivation geriatric patients, hesitancy, administration.
Patient Dose:0.5 mg cholinergic and diabetes hypo- or headache, Increase fluids and add
IM on call at OR receptors in bronchial hyperthyroidism, flushing, bulk to diet to ensure
(Pre-Op med) smooth muscle, secretions narrow anterior constipati hydration and diminish
cardiac muscle, . Relax chamber angle, on, constipating effects.
exocrine glands, biliary and individuals with heartburn, Use caution, may
urinary bladder, ureteral Down Syndrome. nausea experience dizziness,
and the AV and colic and confusion or visual
SA nodes in the spasm vomiting. problems. Report all
heart and adverse side effects.
bronchial
spasms.
Relieve
pylorospa
sm, small
intestine
hypertoni
city and
colon
hypermot
ility.
Generic Name: Cephalosporin Broad-spectrum Periopera Hypersensititvity Phlebitis, When use for
Cefoxitin second cephalosporin tive to inflammat prophylactic use in
Brand Name: generation that is prophylax cephalosporins, ion at the surgery, give 30-60
Monowel penicillinase- is, renal injection minutes before the
Patient Dose: 1 and including insufficiency. site, GI surgery. Stop
gram IVP on call to cephalosporinas hysterect Pregnancy and reactions- prophylactic
OR in AM (Pre-Op e-resistant and omy, GI lactation. nausea administration within
med) is stable in the surgery, Neonates (for and 24 hour since
presence of TURP, solution vomiting. continuing use
Beta- prosthetic containing increases the risk of
lactamases. arthroplas preservatives). side effects but, in the
ty and C- majority of cases, does
section. not reduce the
UTIs due incidence of
to E. coli, subsequent infection.
klebshiell
a species,
proteus
mirabilis,
morganell
a
morganii,
proteus
vulgaris
and
providenc
ia species.
Generic Name: Centrally-acting A centrally Immediat Hypersensitivity Dizziness, List reasons for
Tramadol Analgesic acting analgesic e release: to tramadol. In headache, therapy, location, onst,
Brand Name: not chemically managem acute intoxication CNS triggers, characteristics
Patient Dose: 100 related to ent of with alcohol, stimulatio of S&S. use a pain-
mg IVP Q8 x 5 doses opiates. It bind moderate hypnotics, n, ataxia, rating scale to rate
to mu-opioid to centrally acting sedation/s pain.
receptors and moderatel analgesics, omnolenc Assess for history of
inhibit reuptake y severe opiates, or e, drug addiction, allergy
of pain in psychotropic vertigo,itc to opiates or codein,
norepinephrine adults. drugs. Use in hing/pruri seizures; may increase
and serotonin. clients with past tus, the risk of convulsions.
The analgesic Extended or present constipati Monitor VS, I&O,
effect is only release: addiction or on & reduce dose with
partially Moderate opiate nausea. dysfunction and if over
antagonised by to dependence or in 75 years old.
the antagonist moderatel those with prior
naloxone. y severe history of allergy
Causes chronic to codeine or
significantly less pain in opiates.
respiratory adults
depressin than who
morphine. require
around-
the-clock
pain
therapy
for a
period of
time.
 N05BB01 Hydroxyzine is a Symptom Hypersensitivity Somnolen Start geriatric clients
Generic Name: - hydroxyzine ; 1st generation atic relief to hydroxyzine, ce; on low doses and
Brand Name: Iterax Belongs to the antihistamine of anxiety cetirizine & other headache, observe closely.
Patient Dose: 25 mg class of that crosses in adults; piperazine fatigue, Store PO dosage forms
tonight (po stat) diphenylmetha extensively the pruritus; derivatives, dry from 15-30 degree
ne derivatives blood-brain premed aminophylline or mouth. Celsius.
anxiolytics. barrier and has a before ethylenediamine. Dispense in tight, light
Used in the high affinity for surgery. Porphyria; resistant containers.
management of histaminic acquired or Wait and evaluate
anxiety, receptors into congenital QT sedative effects of drug
agitation or the brain, interval before performing
tension. thereby prolongation; tasks that require
producing patients w/ mental alertness; may
sedative- known risk factor cause drowsiness.
anxiolytic to QT interval
effects. prolongation
including known
CV disease,
significant
electrolyte
imbalance &
bradycardia,
history of sudden
cardiac death.
Drugs prolonging
QT interval &/or
induce torsade de
pointes.
Pregnancy &
lactation
Generic Name: Multivitamins, It is necessary The major  constipati Do not crush or chew
Brand Name: Iberet belongs to the for the indication Iron Metabolism on, this medication. Doing
Patient Dose: 500 class of iron production of of Disorder causing diarrhea; so can release all of the
mg 1 tab OD pc hemoglobin. suppleme Increased Iron drug at once, increasing
 nausea,
Iron deficiency ntal iron is Storage the risk of side effects.
vomiting,
can lead to in the heartburn;
decreased preventio Increased Bodily This medication is best
production of n and Iron from High  stomach
taken on an
Red Blood Cell pain,
hemoglobin and treatment empty stomach 1 hour
Destruction upset
a microcytic, of iron before or 2 hours after
Hemolytic Anemia stomach;
hypochromic deficiency meals. Take with a full
anemmia. anemia. It  black or glass of water.
has Ulcer from dark-
putative Stomach Acid colored Avoid taking antacids,
immune- stools or dairy products, tea, or
enhancing Ulcerated Colon urine; coffee within 2 hours
,  temporary before or after this
anticarcin Several Blood staining of medication because
ogenic Transfusions the teeth; they will decrease its
and  headache; effectiveness. Do not lie
cognition- Problems with or. down for at least 10
enhancing Food Passing minutes after taking this
 unusual or
activities. Through the medication.
unpleasan
Esophagus
t taste in
your
Diverticular
mouth.
Disease
 Adverse
Generic Name: Cough and cold This medicine Relief of If the patient is effects with This product contains
Dextrometh
Brand Name: preparation. contains cough, allergic to any orphan are Paracetamol. Severe
Tuseran Forte Dextromethorp Dextromethorp clogged ingredient in the rare and liver damage may occur
Patient Dose: 1 cap han HBr 15 mg, han HBr, nose, product. include if the patient takes:
TID phenylephrine Phenylephrine postnasal If the patient has nausea, More than 4 g of
stomach
HCl 10 mg, HCl and drip, high blood Paracetamol in 24
discomfort,
paracetamol Paracetamol. headache, pressure or dizziness, hours, which is the
325 mg Dextromethorp body severe heart drowsiness, maximum daily
han HBr, an aches & disease unless excitation, amount; With other
antitussive, fever recommended by and mental medicines containing
confusion.
suppresses the associate a doctor. Phenylephrin Paracetamol (or
area in the brain d w/ If the patient has e HCl may Acetaminophen); 3 or
that causes common anemia, kidney or cause tremor more alcoholic drinks
coughing. cold, liver disease (muscle everyday while using
shaking),
Phenylephrine sinusitis, unless restlessness,
this product.
HCl, a nasal flu & recommended by anxiety
decongestant, other a doctor. (feeling of
clears minor If the patient is uneasiness),
obstructed air resp tract pregnant or insomnia/sle
eplessness,
passages and infections breastfeeding. dizziness,
nasal sinuses . Helps increased
due to decongest blood
congestion sinus pressure,
palpitation,
making openings
arrhythmia
breathing & (irregular
easier. It also passages. heart beat),
reduces weakness,
postnasal drip. respiratory
distress
Paracetamol is (noisy,
an effective congested
fever reducer breathing),
and pain and pallor.
Paracetamol,
reliever. when taken
within the
recommende
d dose and
duration of
treatment,
has low
incidence of
side effects.
Skin rashes
and minor
stomach and
intestinal
disturbances
have been
reported.
Generic Name: Calcium Inhibits influx of Hypertens Use with palpitatio Monitor VS, ECG, CBC,
Amlodipine Channel Blocker calcium through ion alone grapefruit juice. ns, renal and LFTs. Reduce
Brand Name: the cell or in Severe dizziness/l dose in elderly clients
Patient Dose: 5 mg/ membrane, combinati hypotension, ight- with liver dysfunction.
tab OD resulting in a on with shock (including headedne Take as directed, once
depression of other cardiogenic ss, daily. May take with or
automaticity antihyper shock), headache, without food; food
and conduction tensives. obstruction of the fatigue/ helps decrease
velocity in Chronic outflow tract of lethargy, stomach upset. Avoid
cardiac muscle. stable the left ventricle flushing. grapefruit juice;
Decreases SA angina (e.g. aortic increases drug
and AV alone or in stenosis), concentrations.
conduction and combinati haemodynamicall
prolongs AV on with y unstable heart Report S&S of chest
node effective other failure after acute pain, SOB, dizziness,
and functional antiangin MI. swelling of exrimities,
refractory al drugs. irregular pulse, or
periods. Slight Vasospast altered vision
decrease in HR. ic immediately.
possible slight (Prinzmet
decrease in al’s or
myocardial variant)
contractility. CO angina
is increased; alone or in
moderate combinati
decrease in on with
peripheral other
vascular antiangin
resistance. al drugs.
Generic Name: Stimulant Bisacodyl Bowel Acute abdominal Abdomina This drug may cause
Bisacodyl laxative stimulates evacuatio conditions (e.g. l dizziness and/or
Brand Name: peristalsis by n appendicitis, discomfort syncope due to
Dulcolax directly Adult: Init intestinal (e.g. colic, vasovagal response
Patient Dose: 2 tabs irritating the ially, 10- inflammatory cramps), (e.g. abdominal
tonight (pre op smooth muscle 20 mg the bowel disease), diarrhoea, spasm), if affected, do
med) of the large night intestinal electrolyte not drive or operate
intestine. It before obstruction, ileus, disturbanc mach inery.
alters water and the severe e, nausea,
electrolyte procedure dehydration, vertigo,
secretion, followed severe abdominal vomiting,
producing net by 10 mg pain associated haematoc
interstitial fluid rectal w/ nausea and hezia;
accumulation supp the vomiting. irritation
and laxation. next Presence of anal and
morning. fissures or proctitis
Alternativ ulcerative colitis (rectal).
ely, 10 mg w/ mucosal Rarely,
on each of damage (rectal). hypersensi
the 2 tivity
nights reactions
before (e.g.
the angioede
procedure ma,
. anaphylac
toid
reactions).
Generic Name: Antianxiety Reduces anxiety Managem Use IV diazepam Drowsines Diazepam interacts
Diazepam drug, by increasing or ent of with extreme s with plastic containers
Brand Name: benzodiazepine facilitating the anxiety caution in the (transient) or administration sets
Patient Dose: po at inhibitory disorder elderly, in very ill ataxia, will decrease drug
9PM tonight neurotransmitte or for clients, and in confusion availability.
r activity of short- those with
GABA. The term limited Parenteral
skeletal muscle relief of pulmonary administration may
relaxant effect symptoms reserve as apnea cause bradycardia,
may be due to af anxiety or cardiac arrest respiratory, cardiac
enhancement of Relief of may occur. arrest; have emergency
GABA- mediated anxietyan Narrow-angle equipment/drugs
presynaptic d tension glaucoma, available.
inhibition at the in those children under 6
spinal level as undergoin months, lactation Review anxiety level;
well as in the g surgical and parenterally identify contributing
brain stem procedure in children less factors.
reticular s. than 12 years.
formation.
Generic name: Nonsteroidal Inhibits Relief of Use in severe Abdomina Determine any GI
Celecoxib anti- prostaglandin signs and hepatic l pain/ bleed/ulcer history,
Brand name: inflammatory synthesis, by symptoms impairment, in cramps, sulphonamide allergy,
Celebrex drug, COX-2 inhibiting cyclo- of those who have diarrhea, aspirin, other NSAID-
Patient’s dose: 200 inhibitor oxegenase-2 osteoarth shown an allergic nausea, induce asthma,
mg/ cap Q12 (COX-2) thus ritis and reaction to dyspepsia urticaria, allergic-type
decreasing rheumato sulphonamides, /indigestio reactions.
inflammation. id arthritis
or in those who n, URTI.
Does not inhibit in adults. experienced This class of drugs has
COX-1 asthma, been associated with
isoenzyme. Acute urticarial, or increased risk of heart
Does not affect pain in allergic-type attacks/stroke (those
platelet adults. reactions after with CV disease or risk
aggregation; taking aspirin or factors for CV disease
renal effects other NSAIDs. may be at higher risk);
similar to other Use in late monitor for S&S.
NSAIDs. Causes pregnancy (may
fewer GI cause
complications, prematureclosur
such as bleeding e of ductus
and perforation, arteriosus).
compared with Lactation.
other NSAIDs.
Generic name: Proton pump Thought to be a Short Lactation. Use as Headache, Record abdominal
Omeprazole inhibitor gastric pump term maintence abdominal assessments,
Brand name: inhibitor in that treatment therapy for pain, radiographic/endoscop
Patient’s dose: 40 it blocks the of active duodenal ulcer diarrhea, ic findings and H. Pylori
mg cap OD final step of acid duodenal disease. OTC use N&V, results.
production by ulcer. in those who URTI,
inhibiting the Long term have trouble or dizziness, Take capsule at least 1
H+/K+ ATP-ASE treatment pain swallowing rash. hour before eating and
system at of food, or vomiting swallow whole; do not
secretory hypersecr blood, or open, chew or crush.
surface of the etory excreting bloody Antacids can be
gastric parietal conditions or black stools. administered with
cell. Both basal . omeprazole.
and stimulated
acid secretions Treatmen
are inhibited. t of heart
Serum gastrin burn and
levels are other
increased during symptoms
the first 1 or 2 associate
weeks of d with
therapy and are GERD.
maintained at
such levels
during the
course of
therapy.
VII. NURSING RESPONSIBILITIES
VIII. CONCLUSIONS
IX. RECOMMENDATIONS
X. DISCHARGE PLAN
 Take Home Meds Instruction
 Celecoxib (Coxidia) 400mg. tab OD x 5days
 Algesia 1 tab. TID PRN for severe pain
 TCB after 2 weeks at JMC Clinic
 Pls. notify other MD’s