Medical Surgical Kidney stones #3

Question

The client diagnosed with renal calculi calls the nurse into the hospital room to state that the pain has improved. Which action will the nurse perform next?

Answers

  1. Administer an opioid analgesic for discomfort.
    • Rationale:

      This answer is incorrect because the client states the pain has improved. Opioid analgesics should only be administered when needed for pain.

  2. Prepare discharge-planning instructions since the stone passed.
    • Rationale:

      This answer is not correct because there is no evidence that all stones have passed. As the stone moves further along the urinary tract, there will be less pain.

  3. Apply heat to the flank area to promote further passage of the stone.
    • Rationale:

      This answer is not correct because application of heat to the flank area does not assist with passage of the stone. Heat therapy may be used for pain management during the colicky stage of calculi.

  4. Carefully strain all urine and instruct on the importance of straining.
    • Rationale:

      This answer is correct because less pain may indicate that the stone has moved further down into the tract. When the client reports no pain, this usually means the stone has reached the bladder. Once in the bladder, the stone has to go through the ureter. This is when the pain may start again, unless the stone has broken into tiny fragments. The nurse should educate the client about this and continue to strain urine.

Overview

Renal calculi (i.e., kidney stone) is defined as hard, small deposits that form in the kidneys and is often painful when passed. Improvement in pain is evidence that the stone has descended down further into the urinary tract.

Explanation

Learning Outcomes

The nurse should continue straining urine, and should re-instruct the client on straining. This is important because the pain has improved (the pain was not stated to be absent) and less pain may indicate the calculi may be descending down the urinary tract. Fluids should be encouraged for increased output and flushing to help move the stone along. When the client reports no pain, this usually means the stone has reached the bladder. Once in the bladder, the stone has to go through the ureter. This is when the pain may start again, unless the stone has broken into tiny fragments. The nurse should educate the client about this and continue to strain urine.

Test Taking Tip

Next indicates that while all choice may be appropriate only one should be performed first before the others are initiated by the nurse.

Video Rationale