Question

A client with renal calculi has just returned from having extracorporeal shockwave lithotripsy to the right kidney. Following the procedure the nurse should give priority to: A. Straining the urine for the presence of stone fragments B. Applying anesthetic cream over the client's right flank C. Monitoring the vital signs and color of urine output D. Administering medication for pain

Short answer

Answer: Monitoring the vital signs and color of urine output.

Step-by-step solution

Understand the procedure and possible complications

Extracorporeal shockwave lithotripsy (ESWL) is a non-invasive procedure that uses shock waves to break kidney stones into smaller fragments, which can then be excreted through the urinary system. Potential complications of ESWL include infection, bleeding, acute kidney injury, stone fragments blocking the urinary tract, and pain due to inflammation or passing of stone fragments.

Evaluate each option

A. Straining the urine for the presence of stone fragments is an important aspect of care, as it allows for monitoring the progress of stone elimination post-ESWL. However, this may not be the highest priority compared to other interventions. B. Applying anesthetic cream over the client's right flank may provide some pain relief and comfort due to potential inflammation or pain from passing stone fragments. However, this intervention is not directly associated with monitoring for complications, so it may not be the top priority. C. Monitoring vital signs and color of urine output is essential, as it allows the nurse to detect any signs of infection, bleeding, or acute kidney injury – all of which are potential complications of ESWL and require immediate attention. Routine monitoring may also help detect problems more quickly if stone fragments block the urinary tract. Therefore, this option is a strong contender for the highest priority intervention. D. Administering medication for pain is important, as the patient may experience discomfort and pain from the procedure itself or the passage of stone fragments. However, as with option B, pain management is not directly associated with monitoring for complications and may not be the priority compared to other options.

Choose the priority action

Based on the analysis of each option, C. Monitoring the vital signs and color of urine output is the highest priority action for the nurse following an ESWL procedure. This is because it allows the nurse to closely monitor for potential complications and intervene promptly if any are detected. So, the correct answer is C. Monitoring the vital signs and color of urine output.

Key concepts

Renal Calculi Management

Managing renal calculi, commonly known as kidney stones, focuses on both the treatment of existing stones and the prevention of future stone formation. Diet and hydration are key preventive measures; increasing fluid intake can dilute the substances in the urine that lead to stones.

Medical treatments include medications to ease passage of stones or alter urine chemistry to prevent stones. Surgical interventions, such as ESWL, are reserved for larger or problematic stones.

Post-procedure care is critical in renal calculi management. It includes monitoring urinary output and straining urine to catch passed stone fragments, which may be analyzed to identify their composition—a crucial step in preventing recurrence. Patients are also advised to adhere to follow-up appointments for imaging, to ensure that no stone fragments remain that could lead to further complications.

Extracorporeal Shockwave Lithotripsy

Extracorporeal Shockwave Lithotripsy (ESWL) is a non-invasive procedure used to break down renal calculi into smaller, passable pieces using focused shock waves. During the procedure, patients are positioned in such a way that the shock waves can be accurately targeted at the stones.

The success of ESWL depends on factors such as the size, density, and composition of the stones as well as their location within the urinary tract.

Understanding the Procedure

ESWL requires careful patient preparation and positioning. The process might cause discomfort, thus analgesics and sedatives are often used. While ESWL is generally safe, risks such as bleeding, infection, and blockage by stone fragments need to be considered and monitored post-procedure.

Nursing Priorities Post-Procedure

After a patient undergoes ESWL, the focus of nursing care is on monitoring and supporting the patient's recovery.

Nurses should prioritize the following:

• Vital Sign Assessment: Early detection of any deviation from the patient's baseline can indicate complications such as bleeding or infection.
• Urine Output Monitoring: Checking the color of urine helps to identify hematuria, a common occurrence post-ESWL, which might also indicate bleeding or infection. Persistent or heavy bleeding should be addressed urgently.
• Pain Management: Patients may experience varying levels of pain following ESWL, necessitating prompt administration of pain relief to ensure comfort.

Further Considerations

Patient education is also a part of post-procedure care. This includes advising on fluid intake, activity level, signs of complications to watch for, and the importance of urine straining. Coordination with the healthcare team for follow-up and ongoing stone prevention strategies is vital to reduce recurrence.