Question

The nurse is caring for a client who had extracorporeal shock wave lithotripsy for renal calculi. The nurse should give attention to: A. Straining the urine to detect any stone fragments B. Applying anesthetic cream over the client's right flank C. Limiting the client's fluid intake for the next eight hours D. Applying a heating pad to the flank

Short answer

Answer: Straining the urine to detect any stone fragments.

Step-by-step solution

Understanding extracorporeal shock wave lithotripsy (ESWL)

ESWL is a non-invasive procedure that uses shock waves to break kidney stones into small fragments so that they can be easily passed through the urinary system. After the procedure, the primary focus is to ensure that the stone fragments are eliminated without causing any complications.

Evaluating Option A

Option A suggests that the nurse should give attention to "straining the urine to detect any stone fragments." This is a crucial part of post-ESWL care as it helps to monitor the elimination of stone fragments and confirm that the procedure has been successful. So, this option could be considered correct.

Evaluating Option B

Option B suggests "applying anesthetic cream over the client's right flank." It is not typically necessary or standard practice to apply anesthetic cream after ESWL, as the procedure itself is non-invasive and doesn't cause significant pain. Therefore, this option is not correct.

Evaluating Option C

Option C states, "limiting the client's fluid intake for the next eight hours." This is not a recommended practice after ESWL. In fact, it is essential to encourage the client to drink plenty of fluids following the procedure to help flush out the stone fragments. Thus, this option is incorrect.

Evaluating Option D

Option D suggests "applying a heating pad to the flank." While applying heat may help alleviate some discomfort, it is not a priority when caring for a client who has undergone ESWL. Other aspects of care, such as monitoring for stone fragments, are more important. Therefore, this option is not correct.

Conclusion

Based on the analysis provided, the correct answer is Option A: Straining the urine to detect any stone fragments. This practice is essential in monitoring and ensuring the successful elimination of stone fragments after extracorporeal shock wave lithotripsy for renal calculi.

Key concepts

Renal Calculi Treatment

The presence of kidney stones, or renal calculi, can lead to significant pain and potential complications. Treatment varies depending on the size and location of the stones, as well as the severity of the symptoms. One effective and commonly used non-invasive treatment is extracorporeal shock wave lithotripsy (ESWL). This procedure employs high-energy sound waves to break the stones into smaller fragments that can be naturally passed through the urinary tract.

The process is preferred for its minimal invasiveness, reducing the risks and discomfort associated with more invasive procedures like ureteroscopy or percutaneous nephrolithotomy. However, not all stones are suitable for ESWL; for example, stones that are very large, or those made of certain materials, might require alternative treatment measures.

Post-ESWL Care

After undergoing ESWL, patients are generally able to return to their normal activities relatively quickly. However, there are important guidelines to follow to ensure a smooth recovery and to aid in the passage of stone fragments. Among these, staying well-hydrated is paramount. Increased fluid intake facilitates the flushing out of stone pieces. Additionally, it's common for patients to experience mild to moderate pain as the fragments pass, making pain management an important aspect of post-ESWL care.

Patients are also advised to avoid strenuous activities for one to two weeks following the procedure to prevent any complications. The appearance of blood in the urine is not uncommon after ESWL, but should this symptom persist or be accompanied by severe pain or fever, medical attention is necessary.

Nursing Responsibilities After ESWL

Nurses play a critical role in the postoperative phase of ESWL. Their responsibilities include monitoring the patient's vital signs, assessing for complications, managing pain, and providing clear instructions for home care. One of the key tasks includes instructing the patient to strain their urine post-procedure to check for stone fragments, ensuring the process of lithotripsy was effective. Education on the importance of fluid intake, signs of infection, and when to seek further medical assistance are vital components of post-ESWL care. Nurses should also reassure patients about the normalcy of certain symptoms, like blood-tinged urine or flank pain, while remaining vigilant for signs that may indicate the need for further intervention.

Straining Urine Post-Lithotripsy

Straining urine after ESWL is a critical step to monitor for the passage of stone fragments. Patients should use a urine strainer every time they urinate to catch any pieces of the stone. These fragments should be saved and brought to follow-up appointments, where they can be analyzed to determine the composition of the stones, which can inform future prevention strategies. This process also serves as an indicator of the procedure's success.

While straining urine may be inconvenient, it provides valuable information and reassurance about the progress of recovery. Patients are generally instructed to continue straining their urine until no more stone fragments are seen, or as directed by their healthcare provider.