Pathophysiology
Comment 1:
Nurses play a pivotal role in managing patients with kidney stones and helping them adopt preventative strategies to reduce the likelihood of recurrence. Kidney stones, or renal calculi are crystalline mineral deposits that form within the kidneys. These stones can cause intense pain and urinary issues. There are a number of causes for kidney stone formation many of which are lifestyle factors such as dehydration, obesity and diets high in salt or protein. Other causes include genetic predisposition, hyperthyroidism, gout, patients with chronic urinary tract infections and patients who have a history of gastrointestinal surgery (Mayo Clinic, 2022). Because of the pain associated with passing these stones, these patients typically present with severe flank pain. Others manifestations are hematuria, nausea, vomiting and if infection is present a fever (Cleveland Clinic, 2024). As the stone moves through the urinary tract, the pain will likely shift and the intensity may increase.
Nursing interventions for patients with kidney stones are first and foremost, pain management. Pain management can range from NSAIDs to opioids depending on the severity of pain. Hydration, in this instance is the key! Hydration not only promotes the stones descend but also prevents stone formation. Because of the potential complications, nurses must closely monitor vital signs and urine output. These simple everyday tasks could indicate much more severe complications in these patients such as infection or obstruction that could require surgery. Throughout the patients stay, it is important to educate and promote lifestyle/ dietary modification to both prevent future stone formation and promote optimal health. Providing these patients with information on potential symptoms of complications like infection or severe obstruction that warrant immediate medical attention. Kidney stones require collaborative treatment methods. It’s important to address key aspects such as causes, clinical presentation, interventions, patient education and prevention. Follow-up care to monitor kidney function and identify any new stones that may form will include periodic imaging. Imaging is usually on necessary in instances of chronic kidney stone formation or poor kidney function.
Comment 2:
The kidneys have a number of important jobs and affect all organs in the body. Their first job is to filter the blood and prevent toxins from entering the bloodstream. They also regulate blood pressure, play a role in acid-base balance, excrete metabolic waste, and regulate bone mineral metabolism, as well as the production of red blood cells. If one’s kidneys shut down death will follow unless dialysis is performed (Whitney, 2022). The formation of Renal calculi (kidney stones) happens when solutes in the urine crystallize and create stones. This is also called urolithiasis. A major cause of kidney stones is low urine volume or dehydration. There are four different types of renal calculi: calcium stones, uric acid stones, struvite stones, and cystine stones. It would be advantageous to diagnose the type of stones that this 45 year old male is experiencing, so that they can be prevented in the future. Renal stones are a common cause of hematuria. They manifest themselves in intense pain abdominal, flank, or groin pain. Stones are often visible when they pass through the ureters and are excreted in the urine. One stone will not alter the kidney, but repeated episodes can cause permanent damage. Having one kidney stone increases your chances of having another one to almost 50%. About 80%-90% of all renal calculi will pass on their own (Leslie et al., 2023).
Our patient will need to collect a urine sample upon arrival. Crystals may be present, and urinary tract infection (UTI) can accompany stones. If the urine sample is positive for
nitrites, leukocytes, and bacteria it is sent for culture and the patient must be treated with antibiotics. All urine should be strained for stones. An x-ray or ultrasound of the abdomen can be done to identify stones. The best way to diagnose renal urolithiasis is with a non-contrast abdominal and pelvic CT scan. Treatment for our patient can include IV or oral hydration, IV and IV or oral analgesics for pain and emesis. Calcium channel blockers or alpha-blockers may provide pain relief due to the relaxation of the ureter and helps the passage of the stone. The urine should be strained for stones. Giving calcium channel blockers or alpha-blockers may relax the ureter and help the passage of the stone, thus relieving pain. If a large stone obstructs the ureter and causes obstructive pyelonephritis, extracorporeal shockwave lithotripsy (ESWL) will need to be done (Leslie et al., 2023).
Comment 3:
Kidney stones is medically termed nephrolithiasis. A kidney stone is a hard object that is made from chemicals in the urine. There are four types of kidney stones: calcium oxalate, uric acid, struvite, and cystine. National Kidney Foundation. (2023). In a working 45-year-old adult male, several factors such as diet, dehydration, genetic predisposition, and underlying medical conditions like hyperparathyroidism or gout may contribute to the development of kidney stones. The pathophysiological stages typically involve the formation of small crystals within the kidney’s tubules or renal pelvis, which gradually grow larger over time. As these stones move through the urinary tract, they can cause obstruction. Common symptoms of kidney stones include a sharp, cramping pain in the back and side. This feeling often moves to the lower abdomen or groin. The pain often starts suddenly and comes in waves. It can come and go as the body tries to get rid of the stone. Urology Care Foundation. (2021). Kidney stones often accompanies other symptoms such as hematuria (blood in the urine), dysuria (painful urination), frequent urination, and nausea/vomiting. Complications of kidney stones include urinary tract infections (UTIs), hydronephrosis (swelling of the kidney due to obstruction), kidney damage or failure, and sepsis if infection spreads systemically.
Prognosis varies depending on the size and location of the stones, as well as the patient’s overall health and response to treatment. Diagnostic tests commonly used to detect kidney stones include imaging studies such as ultrasound, CT scans, or intravenous pyelogram (IVP). Urinalysis helps in identifying the presence of blood or crystals in the urine, while blood tests may reveal abnormal levels of certain substances like calcium or uric acid, which contribute to stone formation. Medical treatments and procedures aim to alleviate symptoms, promote stone passage, and prevent recurrence. Conservative management often includes hydration, pain management with analgesics, and the use of alpha-blockers to facilitate stone passage. In cases of larger stones or those causing complications, interventions such as extracorporeal shock wave lithotripsy (ESWL), ureteroscopy with laser lithotripsy, or percutaneous nephrolithotomy (PCNL) may be necessary to fragment or remove the stones. Integrating concepts from the “Statement of Human Flourishing”, the nurse’s approach is to holistic care. Recognizing the patient not merely as a collection of symptoms but as a unique individual with physical, emotional, and spiritual dimensions, the nurse engages in meaningful interactions that promote his overall well-being. The nurse plays a crucial role in supporting the patient’s psychological, emotional, and spiritual needs throughout the diagnosis, treatment, and recovery process. This includes providing education about the condition and treatment options, offering emotional support to alleviate anxiety and distress associated with pain and uncertainty.
Comment 4:
pancreatitis occurs when the pancreas becomes inflamed; it can be classified as chronic or acute. Pancreatitis often presents after eating a large meal or over indulging in alcohol. It can present as epigastric pain near the umbilicus that worsens over time or severe abdominal pain if it is acute (Whitney, 2022). other symptoms include tenderness when the belly is touched, belly pain that radiates to the back, fever, rapid pulse, nausea, and vomiting. Excessive alcohol use, obesity, diabetes, and family history predispose one to pancreatitis. The pancreas has two main jobs. One is to produce insulin which helps the body manage sugars, and the other is to produce enzymes that aid in digestion. These enzymes are stored in the pancreas until they are needed for the break down of proteins in the small intestine. If these enzymes are released into the pancreas too soon, they can irritate, damage, and destroy cells. This can lead to an immune system response that causes inflammation (Mayo Clinic, n. d.). Diagnostic tests include complete blood count, serum amylase, and lipase levels. A liver panel may be drawn as well. White cells counts and pancreatic and liver enzymes are usually elevated in pancreatitis Whitney, 2022). A stool sample is usually collected and an ultrasound, CT, or MRI is done to evaluate where the problem originated. An endoscopic retrograde cholangiopancreatography can be done to visualize bile ducts and the pancreatic duct. Gallbladder surgery may be necessary if gallstones are blocking a duct.
Treatments include IV therapy, pain medications, and diet modification. Enzymes may be given to improve digestion. The nurse supports the patient by instructing them about tests and procedures to be done, allowing time for questions which can assist in lowering anxiety levels. Patient education includes alcohol and smoking cessation, increasing fluid intake, and adhering to a low fat diet. The patient must be made aware of the complications of pancreatitis which can include kidney failure, infections of the pancreas, pseudo-cyst, diabetes, malnutrition, breathing problems, and pancreatic cancer (Mayo Clinic, n. d.). Education for this patient goes beyond a paper given to her at dismissal. Discharge planning should address attainable goals for quitting smoking and alcohol as well as scheduling an appointment with the dietitian to assist her with a low fat dietary plan. By supporting the patient with education, and follow-up appointments as well as referrals to mental health and spiritual counselor, this patient can recover and live productive happy life.
Comment 5:
Pancreatitis is an inflammatory condition of the pancreas that can be either chronic or acute. “The pathophysiology of acute pancreatitis is based on the premature activation of the enzymes zymogen and trypsinogen, resulting in local pancreatic destruction and activation of the inflammatory cascade, which causes the systemic inflammatory response syndrome (SIRS) often associated with acute pancreatitis (Gapp, 2023).” Pancreatitis requires a combination of clinical assessment, laboratory testing and imaging studies. Clinical presentation of pancreatitis can vary depending on it being either chronic or acute. Acute pancreatitis presents as severe, persistent abdominal pain, nausea/ vomiting, fever, and tachycardia (Mohy-ud-din, 2023). Other indicators include abdominal tenderness, decreased bowel sounds, jaundice, hypotension, and in the most severe cases shock (clammy skin and confusion). Chronic pancreatitis presents as chronic abdominal pain, weight loss, steatorrhea, and diabetes mellitus (Mohy-ud-din, 2023). Other indicators include abdominal tenderness, malnutrition, jaundice, and fat- soluble vitamin deficiencies. There are a few similarities between chronic and acute pancreatitis.
Comment 6:
Pancreatitis is a condition characterized by inflammation of the pancreas, which can be acute or chronic. In this case, we will discuss acute pancreatitis in a 35-year-old adult female.
Pathophysiology:
The pancreas is a retroperitoneal gland with both exocrine and endocrine functions. The exocrine pancreas produces digestive enzymes, including amylase, lipase, and trypsin, which are secreted into the duodenum via the pancreatic duct. The endocrine pancreas produces hormones such as insulin and glucagon, which are released into the bloodstream. (Gapp, 2023).
Acute pancreatitis occurs when the pancreas becomes inflamed, leading to the release of activated pancreatic enzymes into the pancreas itself, causing tissue damage and activation of the inflammatory cascade. The most common causes of acute pancreatitis include gallstones and alcohol abuse. Other causes include medications, infections, trauma, and metabolic disorders. (Gapp, 2023).
Clinical Manifestations:
The clinical manifestations of acute pancreatitis include abdominal pain, nausea, vomiting, fever, and tachycardia. The abdominal pain is typically located in the epigastric region and may radiates to the back. The pain may be severe and is often exacerbated by eating or lying flat. Other symptoms may include abdominal distention, diminished bowel sounds, and jaundice.
Prognosis:
The prognosis of acute pancreatitis depends on the severity of the disease. Most cases of acute pancreatitis are mild and resolve within a few days with supportive care. However, severe cases may lead to complications such as pancreatic necrosis, abscess, pseudocyst, and respiratory and renal failure. The mortality rate of acute pancreatitis is approximately 5-10%.(Mohy-ud-din, 2023).
Diagnostic Tests:
The diagnosis of acute pancreatitis is based on clinical presentation, laboratory tests, and imaging studies. Laboratory tests include elevated serum amylase and lipase levels. Imaging studies may include abdominal ultrasound, CT scan, and MRI. The role of imaging is to identify the underlying cause of pancreatitis, such as gallstones or pancreatic duct obstruction. (Mohy-ud-din, 2023).
Medical Treatments and Procedures:
The treatment of acute pancreatitis is primarily supportive and includes fluid resuscitation, pain management, and nutritional support. In severe cases, intensive care unit (ICU) admission may be necessary. Endoscopic retrograde cholangiopancreatography (ERCP) may be performed to remove obstructions in the pancreatic duct. In rare cases, surgery may be required to remove necrotic tissue or drain pancreatic abscesses.
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