I. Introduction

Renal stone are common problem affecting men more frequently than women.

Approximately millions are hospitalized each year with kidney stone and an equal

number are treated for stone without hospitalization. People in hotter climate are

commonly affected. Stone may from any where in the urinary track but most commonly

form in the kidney, they frequently move to other parts of the urinary tract, causing pain,

infection, and obstruction. Approximately 90% of the stone past spontaneously. Stone

may be treated medically, mechanically, or surgically are large stones that fill and

obstruct the renal pelvis. Recurrence of stones is a problem; patients face lifelong need

for preventative management. This care plan addresses management of the patient

hospitalized with kidney stones; it also addresses postoperative and postlithotripsy care.

II – A. OBJECTIVE OF THE STUDY

At the end of this study the group will be able to:

- To identify chief complaints of our client and give its specific

interventions.

- To identify the cause and effect of the main problem through a correct

analysis of the schematic presentation of the family health problems.

- To evaluate the effectiveness of the actual nursing care plan that was

established.

- To give referrals and follow up for the health promotion of the client.

In general, this study aims to develop the skills and learning of the

student, with which the student, exposed and learned the genuine community

setting in every case that student encountered. The student tends to pour out

and search more knowledge to attain the desired goal and intervention for the

wellness of the patient.

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B. SCOPE AND LIMITATIONS

This study encompasses on the condition of the Caudor family and the

environment where they live in. And It also has the following limitations:

1. Limited to two visits only.

2. Data is gathered only in the interview, observation and the family obtained

during the visits.

III . FAMILY HEALTH PROFILE

A.1 – Head of the Family

Name: Carlito Caudor

Age: 41 yrs. old

Birthday: December 8, 1967

Height: 7’7”

Weight: 57 kilos

Occupation: Farmer

Educational attainment: High School level

Allergy: None

Smoking: 1 pack per day

Beverages: None

Elimination pattern: Once a day

Chief complain: Kidney stone

Relationship with the head of the family: Son

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A.2: Family member Profile

Name: Vilma Caudor

Age: 33 years old

Birthday: February 15, 1975

Height: 5’2”

Weight: 58 kilos

Occupation: House wife

Educational attainment: High school graduate

Allergy: None

Smoking: None

Beverages: None

Elimination pattern: Once a day

Relationship with the head of the family: Daughter in-law

A.3:

Name: Carmila Caudor

Age: 10 years old

Birthday: January 10, 1998

Immunization: Complete

Weight: 20 kilos

Height: 4’

Relationship with the head of the family: Grand Daughter

A.4:

Name: Mabelle Caudor

Age: 8 years old

Birthday: May 19, 2000

Immunization: Complete

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Weight: 15 kilos

Height: 48”

Relationship with the head of the family: Grand Daughter

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A.5:

Name: Carlo Caudor

Age: 5 years old

Birthday: May 11, 2003

Immunization: Complete

Weight: 11 kilos

Height: 42”

Relationship with the head of the family: Grand Son

A.6

Name: Maeca Caudor

Age: 6 months old

Birthday: December 5, 2007

Weight: 10 kilos

Height: 70 cm

Relationship with the head of the family: Grand Daughter

Immunization: (Refer exhibit I)

1st 2nd 3rd 4th 5th 6th

NEWBORN SCREENING

BCG (at birth) 12/17/07

DPT (6 wks, 10 wks, 14 wks old) 2/18/08 3/17/08 4/21/08

OPV (6 wks, 10 wks, 14 wks old) 2/18/08 3/17/08 4/21/08

HEPATITIS B (6 wks, 10 wks, 14 wks old) 2/18/08 3/17/08 4/21/08

MEASLES (9 months)

VITAMIN A (start at 6 mos.)

DEWORMING

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DENTAL CHECK-UP

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SPOT MAPSPOT MAP

Baikingon is a part of Cagayan de Oro. It is approximately 30 to 45Baikingon is a part of Cagayan de Oro. It is approximately 30 to 45

minutes drive away from Liceo de Cayayan University. Located south west ofminutes drive away from Liceo de Cayayan University. Located south west of

the city. From Liceo de Cagayan University he hired a jeepney to transport us tothe city. From Liceo de Cagayan University he hired a jeepney to transport us to

Baikingon. The fare cost P50.00 back and fort from Liceo de Cagayan UniversityBaikingon. The fare cost P50.00 back and fort from Liceo de Cagayan University

to Baikingon. to Baikingon.

Our client is from zone – 6 Baikingon. Located north in zone 6 properOur client is from zone – 6 Baikingon. Located north in zone 6 proper

going to the creek. .going to the creek. .

IV. CHIEF COMPLAINT

At the time we did our assessment to our client Mr. Carlito Caudor , we found out that he was suffering painful urination cause by kidney stone.

V. HISTORY OF PRESENT ILLNESS FOR THE FAMILYMEMBER WITH A HEALTH PROBLEM

A. Family History

According to the client the kidney problem is from his family for his father suffered the same illness.

B. Past Medical History

The patient has already experienced painful urination for the past four years and has been prescribed with Co-trimoxazole 500 mg.

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C. Social History

The patients social life was affected since he is suffering from altered urination, its hard for him to mingle with other people and cannot do his daily task because of his problem and aside from that he feels pain when he walks .

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VI. GROWTH AND DEVELOPMENT (Family Members)

Carlo Caudor5 years old

Sigmund Freud’s Psychosexual TheoryPreschooler (Phallic Stage)

At this point of age, he already knows that he is a boy. In this stage the child detects his gender and the differences of a girl and boy. He keeps comparing his self toward his younger sister. He likes to play with his father than his mother. He sticks with his father. He doesn’t want to see his father hugging his mother in front of him, he feels like ashamed of what they are doing. He finds more attention to his father than to his mother.

Erik Eriksson’s Psychosocial TheoryPreschooler (Initiative versus Guilt)

He belongs to a stage where he starts to develop his motor skills. He likes to hold the hammer and imitate his father in fixing there chair.

Maeca Caudor

6 months old

Psychosocial Development

Sensory Oral or Early Infancy ( Trust vs. Mistrust)

At this time Maeca must be given sufficient amount of feeding, love, care

and attention to develop the child’s ability to display affection, gain confidence,

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gratification and ability to trust others. She’s a breast fed baby according to his

mother “ wala jud koy problima ani niya kay dili jud hilakon”..

During Sensory oral stage Mouth is the center of pleasure. Lack of

gratification can cause individual to develop negative behaviors such as:

suspicion of others, fears affection, and projection. In the end developing

mistrust.

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VII. FAMILY SERVICE and PROGRESS RECORDS

A. Head of the family

Carlito Caudor

B. Family Member

Vilma Caudor

Carmila Caudor

Mabelle Caudor

Carlo Caudor

Maeca Caudor

C. Address

Zone 6 Baikingon, Cagayan de Oro

D. Family Member Number

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E. Name of Family Members

Names of

family

member

Relationship

with the head

Sex Birthday Highest

Educ.

completed

Occupation Type of

work

Place of

work

1.Vilma

Caudor

wife F February 15,

1975

High

school

housewife None Baikingon

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graduate

2.Carmila

Caudor

Daughter F January 10,

1998

Grade 4 N/A N/A N/A

3.Mabelle

Caudor

Daughter F May 19, 2000 Grade 3 N/A N/A N/A

4.Carlo Caudor son M May 11, 2003 None N/A N/A N/A

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VIII. DESCRIPTION of HOME and ENVIRONMENT

(ENVIRONMENTAL PROFILE)

HOME AND ENVIRONMENT

The home and environment determines the health status of a family which

is based on the sanitary conditions classified as a safe, intermediate, danger

within the five categories: Home, Water Supply, Kitchen, Waste Disposal,

Domestic Animals and the community in general.

          As part of the Family Care Study the group has assessed the Home and

Environment of the family.

Housing

The Caudor family has their own house.

The house is a combination of concrete cement and wood. It is a

two story house that has 3 bedrooms and the living room is

adjacent to the kitchen.

They have Television set, Cd player, Karaoke and a Cabinet.

They have their own source of electric power.

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They use firewood in cooking their food.

Water Supply

The family source of water is from NAWASA

Kitchen

They use firewood in cooking their food

The cooking area is not well organize and clean

The pots are separated from the utensils

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Toilet

They used water seal

It is separated from the house

Sanitary Condition

Both the front and the backyard is not cemented thus it becomes

muddy and slippery during rainy days.

Limited stored water in the house

Utensils not properly kept in their places

Inadequate food storage

waste Disposal

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The family doesn’t have proper garbage segregation

They have no compost in their backyard.

They sometimes burn their garbage also outside their house.

Domestic animals The family has dog

Community

Most of the people living in the community are farmers, barbe- q

stick maker and some were construction workers. Health

awareness is one of the priority problems in zone 6 Baikingon .

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Pathophysiology

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Pathophysiology

Kidney stone formation is the end result of a physicochemical process that involves nucleation of crystals from a supersaturated solution. The common constituents of kidney stones. The factors that influence crystal generation are urine volume, concentration of stone constituents (a function of urine volume), the presence of a nidus and the balance among various physicochemical factors that inhibit or promote stone

formation.  

Most people's urine is supersaturated with the common components of renal stones, including calcium phosphate, calcium oxalate and, frequently, uric acid. Supersaturation of the urine constitutes a driving force within the solution favouring crystal nucleation and growth.

A great deal of attention has been focused recently on the interactions between crystals that are being formed and the cell surfaces in the renal tubules.3,4 The most common constituent of kidney stones, calcium oxalate monohydrate, binds electrostatically to anionic sites on cell surfaces. Thereafter, the crystals may be internalized, or they may remain on the cell surface, which allows further binding and propagation of the crystals. Soluble anions, such as citrate, may inhibit this process, as

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may urinary glycoproteins; these compounds thus act as inhibitors of the early phase of stone formation.

There is a fine balance in urine among substances that readily form crystals, such as calcium, oxalate and uric acid; promoters of crystallization, including pH, stasis and low volume; and inhibitors of this process, such as high urine volume and flow, citrate (which forms a complex with calcium to prevent its crystallization with oxalate) and urinary glycoproteins. The following section outlines how various factors affect the formation of stones.

Predisposing factor:a. hypercalcemia and hypercalcuria caused by hyperparathyroidism, renal

tubular acidosis, multiple myeloma, and excessive intake of vitamin D, milk, and alkali.

b. Chronic dehydration, poor fluid intake, and immobility.c. Diet high in purines and abnormal purine metabolism (hyperuricemia and

gout)d. Genetic predisposition for urolithiasis or genetic disorders (crystinuria)e. Chronic infection with urea-splitting bacteria (Proteus Vulgaris)f. Chronic obstruction with stasis of urine, foreign bodies within the urinary

tract.g. Excessive oxalate absorption in inflammatory bowel disease and bowel

resection or ileostomy.h. Living in mountainous, desert, or tropical areas.

11Precipitating factor

For people with a history of kidney stones, doctors usually recommend passing at least 2.5 quarts (2.3 liters) of urine a day. To do this, you'll need to drink about 14 cups (3.3 liters) of fluids every day — and even more if you live in a hot, dry climate.

What should you drink? Water is best. Include a glass of lemonade every day, too. Make your own with real lemons, or use a liquid or frozen concentrate, but avoid powdered lemonade mixes. Lemonade increases the levels of citrate in your urine, and citrate helps prevent stone formation.

In addition, if you tend to form calcium oxalate stones, your doctor may recommend restricting foods rich in oxalates. These include rhubarb, star fruit, beets, beet greens, collards, okra, refried beans, spinach, Swiss chard, sweet potatoes, sesame seeds, almonds and soy products. What's more, studies show that an overall diet low in salt and very low in animal protein can greatly reduce your chance of developing kidney stones.

Target organ

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kidney urinary bladder

Signs and Symptoms

Colicky pain: "loin to groin". Often described as "the worst pain experienced". Hematuria: blood in the urine, due to minor damage to inside wall of kidney,

ureter and/or urethra.

Pyuria: pus in the urine. Dysuria: burning on urination when passing stones (rare). More typical of

infection. Oliguria: reduced urinary volume caused by obstruction of the bladder or urethra

by stone, or extremely rarely, simultaneous obstruction of both ureters by a stone. Abdominal distention. Nausea/vomiting: embryological link with intestine—stimulates the vomiting

center . Fever and chills.

Complications

If a stone stays inside one of your kidneys, it usually doesn't cause a problem unless it becomes so large it blocks the flow of urine. This can cause pressure and pain, along with the risk of kidney damage, bleeding and infection. Smaller stones may partially block the thin tubes that connect each kidney to your bladder or the outlet from the bladder itself. These stones may cause ongoing urinary tract infections or kidney damage if left untreated.

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NURSING SYSTEM REVIEW CHART

NAME: Carlito Caudor DATE: June 30, 2008V/SHR: 105 bpm RR: 36 cpm BP:130/80 mmHg Temp: 37.0 ºC Height:5’7” Weight: 167.2 lbs.

An [X] is placed in the area of abnormality. Comment at the space provided. Indicate the location of the problem in the figure using [X].

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EENT:[ ] impaired vision [ ] blind[ ] pain redden [ ] drainage[ ] gums [ ] hard of hearing [ ] deaf[ ] burning [ ] edema [ ] lesion teeth[ ] assess eyes ears nose[ ] throat for abnormality [X] no problemRESP:[ ] asymmetric [ ] tachypnea [ ] barrel chest[ ] apnea [ ] rales [ ] cough[ ] bradypnea [ ] shallow [ ] rhonchi[ ] sputum [ ] diminished [ ] dyspnea[ ] orthopnea [ ] labored [ ] wheezing[ ] pain [ ] cyanotic[ ] assess resp. rate, rhythm, pulse blood[ ] breath sounds, comfort [X ] no problemCARDIOVASCULAR:[ ] arrhythmia [ ] tachycardia [ ]numbness[ ] diminished pulses [ ] edema [ ] fatigue[ ] irregular [ ] bradycardia [ ] mur mur[ ] tingling [ ] absent pulses [ ] painAssess heart sounds, rate rhythm, pulse, bloodPressure, circ., fluid retention, comfort [X ] no problemGASTROINTESTINAL TRACT:[ ] obese [ ] distention [ ] mass[ ] dysphagea [ ] rigidity [ ] pain[ ] assess abdomen, bowel habits, swallowing[ ] bowel sounds, comfort [X ] no problemGENITO – URINARY AND GYNE[X ] pain [X ] urine [ ] color [ ] vaginal bleeding[ ] hematuria [ ] discharge [ ] nuctoria[ ] assess urine frequency, control, color, odor, comfort[ ] gyne bleeding [ ] discharge [ ] no problemNEURO:[ ] paralysis [ ] stuporus [ ] unsteady [ ] seizure[ ] lethargic [ ] comatose [ ] vertigo [ ] treamors[ ] confused [ ] vision [ ] grip[ ] assess motor, function, sensation, LOC, strength[ ] grip, gait, coordination, speech [ x ] no problemMUSCULOSKELETAL and SKIN:[ ] appliance [ ] stiffness [ ] itching [ ] petechie[ ] hot [ ] drainage [ ] prosthesis [ ] swelling[ ] lesion [ ] poor turgor [ ] cool [ ] flushed[ ] atrophy [ ] pain [ ] ecchymosis [ ] diaphoretic moist[ ] assess mobility, motion gait, alignment, joint function[X ] skin color, texture, turgor, integrity [ ] no problem

FAMILY

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X.HEALTH CARE PLAN

(Family Health Problem)

Cues Nursing Objectives Interventions Rationale Evaluation

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________________________ ______________________________Pale__________DrySkin_______________________ __________________ _______________________________________________________________Pain_________ __________________________________________________

________________________________________________________________________________________________________________________body weakness___________________________________

Diagnosis

Subjective:

“Mura kog permi

kaihion, pero gamay

ra ako maihi”

Objective:

Small

frequent

urination

Incontinence

Retention

Nocturia

Altered urinary

elimination

related to

blockage of

urine flow by

stone

At the end of

30 to 1 hour

the patient will

empty his

urinary bladder

Increased

fluid intake

at least 8 –

10 glasses

per day

Monitor

intake and

output

Monitor

daily

weight

Advised

patient to

avoid salty

foods

Refer to

visit health

center or

hospital for

further

assessmen

t

Help to

clean and

flushes

the

system

through

urination

To

monitor

the liquid

intake of

the

patient

To have

baseline

data

about the

patient

It may

trigger

the

formation

of the

stone

To have

proper

monitorin

g about

his

illness

At the end of 1

hour patient

was not able to

empty his

bladder

completely

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Cues Nursing

Diagnosis

Objectives Interventions Rationale Evaluation

Subjective:

“Dili kayo ko

katulog kay sigi

ko ihi ihi”

Objective:

Pale

Disturbed sleep

pattern related

to frequent

urination

At the end of 15

min. I will be

able to impart

knowledge on

how to manage

his sleep

pattern

Advice the

patient to

lessen fluid

intake

before

going to

sleep.

This is to

avoid

urinating at

night .

So that the

patient can

At the end of 15

min patient

acquired

enough

knowledge on

how to manage

his sleep

15

Fatigu

e

Dark

circle

under eyes

Frequent

yawning

problem. Limit the

intake of

cafainated

drinks after

mid

afternoon

sleep at

night

pattern problem

Cues Nursing

Diagnosis

Objectives Interventions Rationale Evaluation

Subjective:

“Sakit i-ihi”

ma’am as

verbalized by

the patient.

Objective:

Facial

grimace

Guard

ing signs

of pain

fatigu

e

Acute pain

related to

inflammation,

obstruction,

and abration of

the urinary

tract

At the end of 1 hour

the patient will be

able to:

1. understand

the ways

or methods

in

allivating

pain.

Dependent:

2. follow

doctors

prescriptio

n on taking

pain

reliever or

whenever

pain

occurs:

Mefenamic

acid 500mg

PRN for

pain:

Encourage

and assist

patient to

assume a

position of

comfort

Involve the

family

members in

assisting the

patient to

ambulate to

obtain some

pain relief

Scale

patient’s

level of pain

tolerance

from 0-10 (0

as no pain

and 10 as

very painful)

Stress out

the

importance

of increasing

patient’s

fluid intake

3-4 L/day

within

cardiac

To provide

comfort to

the patient

To provide

comfort to

the patient

Help

evaluate

site of

obstructio

n and

progress

of renal

stone

movement

vigorous

hydration

promotes

flashing of

stone,

prevents

urinary

stasis, and

aids in

prevention

of further

stone

At the end

of 15 min

patient

acquired

enough

knowledge

on how to

manage his

sleep

pattern

problem

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Administer

narcotic

analgesic as

prescribed

by the

doctor:

mefenamic

acid 500mg

PRN for pain

formation

to relieve

pain. Act

as pain

reliever

XII. DRUG STUDY

Name of Drug

Generic

Name

Classification

Dose/ frequen

cy Route

Mechanism of

Action

Specific Indication

Contraindication Side/Toxic Effects

Nursing Precaution

Acalka

Potassium Citrate

Antiurolithic

10 mEq The aim of the

treatment is to

restore the level of

the urinary

citrate and to

increase the pH of urine to 6-

7.

- Treatment of patients with renal lithiasis and hypocitraturia, chronic formers of calcium oxalate, phospate calculia.- Uric acid lithiasis alone or accompanied by calcium lithiasis

- Renal insufficiency¨ Persistent alkaline urinary infections- Obstruction of the urinary tract- Hyperpotassemia¨Adrenal insufficiency- Respiratory or metabolic alkalosis- Active peptic ulcer- Intestinal obstruction- Patients submitted to anticholinergic therapy- Patients with slow gastric emptying

- Slight gastrointestinal disorders may appear which can be palliated by means of the joint administration of food.

- The tablets must not be masticated or diluted. The active component of Acalka is contained with a porous wax matrix. As this was matrix is insoluble, it can be eliminated in visible form in the feces. The active component, however, has been released in the gastrointestinal tract.- Must not be administered to patients receiving potassium-sparing diuretics (traimterene, spirolactone, or amyloride).- It is advisable to carry out an evaluation of electrolytes (Na-K-Cl) and CO2, creatinine and hemogram

every 4 hrs.- It is recommende

17

d that the patients in treatment with Acalka follow a diet w/o salt and increase the intake of fluids.- The recommended treatment in case of hyperpotassemia is: IV administratioin f 10% dextrose solution, containing 10-12 units of insulin/1000ml. Correction of the possible acidosis with IV sodium bicarboate and hemodialysis or peritoneal dialysis.

Name of Drug

Generic

Name

Classification

Dose/ freque

ncy Route

Mechanism of Action

Specific

Indication

Contraindication

Side/Toxic Effects

Nursing Precaution

cotrimoxazole

Bactrim; Septra

Anti-infective

800 mg/160 mg (capsule)

Sulfamethoxazole (SMZ) inhibits formation of dihydrofolic acid from PABA , trimethoprime (TMP) inhibits dihydrofolate reductase thereby bloking the synthesis of tetrahydrofolic acid, the combination of this drugs block two consecutive

Treatment of renal infections

Patient with marked liver parenchymal damage, hematolic disorder blood dyscracia, megaloblastic bone marrow, severe renal insufficiency.

GI upset, nausea, vomiting, glossitis, stomatitis,anorexia,kin rashes, arthalgia and myalgia.

In case of severe allergy, bronchial ashma,streptococcal paryngitis, impaired renal and hepatic function, folate of G6PD deficiency

Avoid in patient’s receiving oral antiguagulant

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steps in bacterial synthesis of folic acid

RECOMMENDATIONS

For some patients who form stones, diet is the primary control mechanism for stone formation, while for others proper dietary management enhances the role of medications.  In most cases, the diets of stone formers reveal excessive intake of foods and low intake of fluids, both modifiable.  Stones are associated with excess in the patient’s diet, namely of salt and protein.  The following are common dietary measures patient may take to reduce stone formation:

IDEAL NURSING MANAGEMENT

Assess understanding of factor s that predispose to formation of renal stone

Family history of kidney stoneDietary factor including low fluid intake, intake of food high in purine, calcium and oxalate.

Assess understanding of the possible courses of therapy to treat kidney stone

Assess history of renal stone formation. Recurrences may indicate knowledge deficit regarding prevention

ACTUAL NURSING MANAGEMENT

Health teaching

BIBLIOGRAPHY

Atkinson, Rita et al. Hilgard’s Introduction to Psychology.12 th ed. Harcourt

Brace College Publisher:1996.

Doenges, M.E. And Moorehouse, M.F. Nurses Pocket Guide: Diagnosis,

interventions and rationale. 7 th ed. F.A. Davis Company. Huamark, Bangkok,

Thailand,2000

Maglaya, Araceli S. 2004. Nursing Practice in the Community. 4th edition. Argonauta Corporation, Marikina City. Pp 112-117.

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Pearson, Durk, et al. Life Extension. A Practical Scientific Approach. USA: Warner Communications Company, 1982.

Reyala, et al. 2000. Community Health Nursing services in the Philippines. 9 th

edition. Community Health nursing section, National League of Philippine Government Nurses, Inc.

Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology, 4th ed., McGraw Hill, 876–9.

Valenti, et al. Lippincott’s Review Series: Critical Care Nursing Lippincott Raven Publisher, 1998 pp 14-30

en.wikipedia.org/wiki/

en.emedicine.comwww.c

Evaluation

After the 2 weeks of the exposure, the student had established rapport to

the family, identifies problems and was able to discuss it with the family. The

family has appreciated the health teachings the student have imparted as well

the interventions done.

On the course of visits the family cooperates very well and was very

hospitable and shared pertinent information about their family. It’s overwhelming

to work with them because they were accommodating and interested with the

actions done. Community nursing is a two way process, we may give this and

that advises to the family but if they failed to see it and put them to action nothing

will happen. It was a seemingly fruitful community exposure for the student have

learned a lot on what is community nursing and that it is a unique field of nursing

where we could dig deeper into the lives of our patients/clients.

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