Hesi Case Study: Adult Nephrolithiasis with Complications .
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Hesi Case Study
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Hesi Case Study
Hesi Case Study: Adult Nephrolithiasis with Complications . Mr. Bruce Skene is a 55-year-old computer programmer who is originally from an area of Canada that has a population comprised largely of Scottish heritage. He has been married for 32 years and has worked for the same company for 28 years....
Hesi Case Study: Adult Nephrolithiasis with Complication s 2022 -2023 Mr. Skene quietly paces in the ED waiting area with his hands on his hips and rubbing his mid -
lower left side. He has a flat facial expression. Which factor is most important fo r the nurse to consider when interpreting this client's pain behavior? - answer Client's cultural identity. The nurse takes Mr. Skene to the triage area and performs a focused assessment of his nontraumatic, mid -lower flank pain. If a client has symptoms of tenderness at the costovertebral angle (CVA), what should be the nurse's priority? - answer Assess for bladder distention. Urinary tract obstruction that contributes to pain is an emergency that can result from a stone blocking the bladder neck or uret hra and it must be treated immediately to preserve kidney function. The triage nurse continues to assess Mr. Skene's pain. Which elements should be included in the pain assessment? (Select all that apply.) - answer -severity -quality -timing S is for ass essing pain Severity using a valid pain rating scale, such as the 0 to 10 pain scale. Q is for Quality of the pain during assessment, such as sharp or dull. T is for assessing the Temporal or time -related aspects of pain, such as intermittent or constant. In 5 minutes, the triage nurse takes Mr. and Mrs. Skene to a treatment room, where the ED nurse interviews Mr. Skene about his health history. Which reported chronic condition in Mr. Skene's health history is most significant to his acute condition and th e reason for this visit? - answer Gouty arthritis. The cause of gouty arthritis is the formation of uric acid crystals within the joints. The same formation of uric acid crystals can also form renal calculi. In 20 minutes, the healthcare provider (HCP) visits Mr. Skene and prescribes one tablet of hydrocodone/acetaminophen 5 mg/300 mg by mouth to be given now as a preliminary pain medication. Which data in the client's medical record is important for the nurse to review before administering hydrocodone/acetaminophen ? (Select all that apply.) - answer -home medications -vital signs -allergies to medications -liver enzymes Mr. Skene's medical record has no allergies listed. Which action is the best intervention for the nurse to perform next? - answer Ask the client if he has any food or drug allergies. The most important intervention at this stage would be to ask the client about any known food or drug allergies. Mr. Skene reports to the nurse that he has a cod eine allergy. When he had a cold last winter, he was prescribed cough syrup with codeine and it gave him a rash all over his body. The HCP advised his wife to give him diphenhydramine 50 mg by mouth and it got better in a couple of days. He states that he stopped taking the cough syrup and he eventually got better. The nurse records the allergy report in Mr. Skene's medical record and prepares to speak with the HCP. Which information is important for the nurse to include in the conversation with the HCP? (Select all that apply.) - answer -The client reports that cough syrup with codeine gave him a rash. -The nurse requests a prescription for fentanyl 50 mcg intravenous now. -The client has no allergies listed in his medical record. -Hydrocodone/acetaminophen is prescribed for pain. The HCP cancels the hydrocodone/acetaminophen prescription and prescribes fentanyl 50 mcg intravenously one time now with a 500 mL normal saline bolus. Prescriptions for abdominal radiography and computed tomography (CT) scan with contrast are also added. The nurse obtains a vial of fentanyl for intravenous administration from the medication cabinet. - answer 1 ml The nurse inserts a peripheral intravenous catheter, gives the IV fentanyl and the saline bolus, and enters the radiol ogy prescriptions into the computerized order entry system. Which actions should the nurse take next? (Select all that apply.) - answer -Determine when the last dose of glucophage was taken. -Question the client about any shell fish allergies. -Have the cl ient rate his pain on a 10 -point scale. Glucophage should be stopped at least 24 hours before contrast dye is used and not be restarted until adequate kidney function has been established. The nurse should assess the client for an iodine allergy in prepar ation for the CT scan with contrast. A shellfish allergy would contraindicate contrast dye administration. The nurse should evaluate the client's response to the IV pain medication that was administered. Mr. Skene returns from the radiology department and the HCP tells him that several renal calculi were found on the CT scan. Which discharge instructions should the nurse anticipate giving Mr. Skene? (Select all that apply.) - answer -medication instructions -follow up with a nephrologist -increase fluid in take -how to use a urine strainer
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