Discussion Questions

Discussion 5 Question 1
Overview
Louis Johnson, a 48-year-old partnered, Caucasian male presents to the emergency department with unremitting right flank pain. He denies dysuria or fever. He does report significant nausea without vomiting. He has never experienced anything like this before. On examination he is afebrile, and his blood pressure is 160/80 mm Hg with a pulse rate of 110/min. He is writhing on the gurney, unable to find a comfortable position. His right flank is mildly tender to palpation, and abdominal examination is benign. Urinalysis is significant for 1+ blood, and microscopy reveals 10–20 red blood cells per high-power field. Nephrolithiasis is suspected, and the patient is intravenously hydrated and given pain medication with temporary relief.
In this discussion as a registered nurse:
1. Discuss with your colleagues the pathophysiological development of nephrolithiasis.
2. Describe the exact mechanism causing the pain that sent Mr. Johnson to the emergency department.
3. Provide a rationale for whether this patient should be further evaluated for renal surgery at this time.
4. Describe any adverse effects arising if a renal calculus blocks a ureter completely.
5. Describe and discuss your plan of care for this patient until he leaves the hospital and for the first two weeks following discharge.
6. Include citations from the text or the external literature in your discussions.

Discussion 5 Question 2
Overview
Holly, a 4-year-old female patient, has started wetting the bed again after being dry at night for the last 5 months. Her mother reports she is crabby & tired all the time and when she urinates, she cries. This has happened before when Holly has a urinary tract infection. A urine sample is obtained revealing cystitis for which the APRN-NP prescribes an antibiotic. A referral is made to a urologist, as the NP is concerned that Holly may have vesicoureteral reflux since she has had previous urinary tract infections within the past year or so.
In this discussion as a registered nurse:
1. Describe the findings of the urine sample that would indicate cystitis. If the urine sample did not indicate a urinary tract infection, what might be other causes for nocturnal enuresis?
2. Describe the pathophysiological reasons leading patients with urinary tract infections to develop nocturnal enuresis.
3. Describe vesicoureteral reflux and its relationship with a urinary tract infection.
4. Discuss any patient teaching and health promotion activities you would provide for this family.
Include citations from the text or the external literature in your discussions.