Question

The nurse is caring for a client who has recently undergone an emergency nephrostomy for treatment of hydronephrosis. When caring for the client with a nephrostomy tube, the nurse should: A. Irrigate the tube every 4 hours with sterile water B. Measure hourly output from the tube for 24 hours C. Clamp the tube for 15 minutes every 2 hours D. Report any red-tinged urine coming from the tube

Short answer

Short answer: Option B (Measure hourly output from the tube for 24 hours) is the most appropriate answer for providing proper nursing care to a patient who has undergone an emergency nephrostomy. This ensures that the nephrostomy tube is functioning properly and allows for early detection of potential issues, promoting the patient's safety and recovery.

Step-by-step solution

Understand the medical terms and the situation

First, familiarize yourself with the medical terms mentioned in the problem: nephrostomy, hydronephrosis, and nephrostomy tube. A nephrostomy is a procedure that creates an opening between the kidney and the skin to allow urine to drain. Hydronephrosis is the swelling of a kidney due to a build-up of urine, often caused by an obstruction. A nephrostomy tube is a catheter (tube) that is inserted through the skin and into the kidney to drain urine.

Evaluate each answer choice

Next, assess each answer choice and consider whether it is appropriate for the care of a client with a nephrostomy tube: A. Irrigate the tube every 4 hours with sterile water - Irrigation is generally recommended for clearing blockages in the nephrostomy tube. However, the frequency of irrigation should be based on the patient's individual needs and doctor's orders. B. Measure hourly output from the tube for 24 hours - Monitoring the output of urine from the nephrostomy tube is important for ensuring that it is functioning properly, and assessing kidney function. Measuring the output hourly for 24 hours allows for a thorough evaluation of the tube's performance and ensures the timely detection of any issues. C. Clamp the tube for 15 minutes every 2 hours - Clamping the tube can lead to a build-up of pressure in the kidney, potentially causing damage and worsening the patient's condition. This option is not appropriate. D. Report any red-tinged urine coming from the tube - Red-tinged urine might indicate blood in the urine, which could be a sign of complications, such as infection or injury. Reporting this to the healthcare provider is necessary for timely intervention and treatment if there is an issue.

Choose the best answer

Considering the information above, option B is the most appropriate answer. Measuring hourly output from the tube for 24 hours helps to ensure that the nephrostomy tube is functioning properly and allows for early detection of any problems. This is crucial for the patient's safety after undergoing an emergency nephrostomy.

Key concepts

Hydronephrosis

Hydronephrosis is a condition characterized by the swelling of one or both kidneys due to a backup of urine. This can occur because of an obstruction in the urinary tract, such as kidney stones, tumors, or an enlarged prostate, or due to a congenital issue such as vesicoureteral reflux.

When urine flow is hindered, it can lead to pressure building up in the kidney, which in turn causes the renal pelvis to dilate and the kidney to swell. This situation can be acutely painful and, if left untreated, can result in kidney damage. Symptom severity can vary and might include pain in the side and back, nausea, urinary urgency, and fever if accompanied by an infection.

Management of hydronephrosis typically involves addressing the underlying cause, relieving pressure on the kidney, and preventing infection. In severe cases, procedures like nephrostomy, which involves inserting a tube to bypass the obstruction and drain urine, could be necessary.

Nursing Management

Nursing management for a patient with a nephrostomy tube encompasses several vital responsibilities to prevent complications and promote healing.

Patient Education

Patients should be informed about the purpose of the tube, how to care for it, and signs of potential complications, such as infection or displacement.

Daily Care

The area around the nephrostomy tube must be kept clean and dry to prevent infection. The nurse should perform routine assessments of the insertion site for signs of redness, swelling, or discharge.

Monitoring Output

It is essential to measure hourly output from the nephrostomy tube, especially in the first 24 hours after surgery, to ensure the tube is draining adequately and to monitor for changes in urine volume or appearance which may indicate complications.

Beyond these, the nurse should also be vigilant for pain reports, as this might signify tube blockage or other complications requiring immediate medical attention.

Kidney Function Monitoring

Monitoring kidney function is crucial for patients with a nephrostomy tube. This not only involves assessing the amount of urine output but also its characteristics — clarity, color, and the presence of blood or other substances.

Urine Output

Tracking the quantity of urine helps in determining whether there is a possible blockage or leakage. Fluctuations in urine output can signal changes in kidney function.

Laboratory Tests

Blood tests, such as serum creatinine and blood urea nitrogen (BUN), can also provide valuable information about kidney function.

Imaging Studies

Occasional imaging studies like ultrasounds or CT scans may be required to evaluate the position of the nephrostomy tube and to check for ongoing issues such as persistent hydronephrosis or complications related to the nephrostomy tube.

These monitoring practices are integral to nursing management, to ensure the patient's recovery, and to prevent long-term kidney damage.