This is a case of Mr. R.K.

, a
42 year old, married male
and is residing at Muntinlupa
City. He was admitted to
Medical Center of
Muntinlupa on August 9,
2009 at 3:15 am. Upon
admission, patient chief
complaint was low back
a Blood Pressure of
130/100mmHg, Pulse Rate
of 74, Respiratory Rate of
24 and a Temperature of
36.7 C. 3 days prior to
admission the patient
experienced pain in his
back.
He take buscopan to
relief the pain but
unfortunately the pain
does not relief so the
patient and his wife
decided to consult the
doctor in MCP. The final
diagnosis is urolythiasis.
Afterthe case
discussion, the
student’s will be able
to obtain knowledge
regarding the case:
UROLYTHIASIS
Obtaining a good nursing
history and how the disease of
the patient progressed.
To be able to perform Physical
Examination
To be able to understand the
underlying
process/Pathophysiology basis
of the patient
To be able to explain the
laboratory values
 
To be able to understand the
medications taken

To be able to formulate a

good and reliable nursing
interventions
Tobe able to implement
those nursing interventions
and learn to evaluate its
effects on the patients
condition
According to the care giver
the patient’s activity before
hospitalization was going to
gym for 1-1 1/2 hours.
Financing health care wouldn’t
be a problem for his children’s
are capable of providing
everything.
He is taking buscopan with
doctor’s prescription. Patient
has no allergies. His father
has hypertension. He was
hospitalized on August 09,
2009 due to low back pain.
Patient’s present diet is low
salt low fat diet. There are
no religious restrictions in
terms of food. His usual
meal is composed of
carbohydrates, protein,
fats, and water.
He doesn’t take any food
supplements. He has a
good appetite. His highest
weight 140 lbs and his
lowest weight is 130 lbs.
Patient usually urinates 5-
6 times per day during his
stay in the hospital as a
measurement for his
voiding pattern. His urine
has a characteristic of
yellow in color and
aromatic.
His bowel pattern is ones a
day with a characteristic of
soft and brown stool. He
perspires heavily in certain
instances like when walking,
and when the weather is
humid or hot. Patient drinks
a lot of water. He has no
disease on digestive and
The patient exercises 1 to
1 1/2 hour 3 times a week
before he was hospitalized
by means of going to gym.
He doesn’t feel any
serious discomfort after
patient exercised.
The patient has no
problem with his eyes and
other senses. He is able to
express himself clearly and
logically.
The patient normally
sleeps 7 hours at night
and 1 hour nap within the
day. And patient feels
restless when the pain
occurs.
Patient was able to
express his perception
because. Patient is a jolly
type of person. And has
an attitude of being
happy go lucky.
According to patient care
giver the patient cares
about his family and
community. He was then a
good provider and very
supportive to his children.
But now due to his job, he
has limited time for his
his children take good care
of him sometimes. He
considers God to be the
most important in his life
and next is his family. His
love ones helped him
solve all the problems and
worries in life.
Thepatient has no
problems in his genitals
and other area of it.
Aswhat the care giver
noticed when there are
family problems he copes
up by expressing emotions.
The patient has not
undergone treatment for
emotional distress.
Patient is Roman Catholic.
And has no other
significant beliefs that
affect his health status. He
is not active to any
organizational group in his
community.
Weight: 70 kgs
Height: 5’4
Vital Signs:
Temperature: 36.1 0C
PR: 86 bpm RR: 19 cpm
BP: 90/60 mmHg
TheClient is conscious,
coherent and oriented to
place and person. Looks
according to his age.
Inspection: General color of
the skin is brown, uniform in
color except on part not
exposed to the sun.

Palpation:
Skin has a good skin turgor;
with flush skin and warm to
Inspection:
Normocepahalic, appears
round, evenly distributed
hair with no dandruff,
lesions and infestations.

Palpation: No mass
noted.
Inspection: Eyes are
symmetrical, the
conjunctiva is pink and with
anicteric sclera. Cornea and
lens are smooth and clear.
Pupil is equally round and
reactive to light.
Inspection: Symmetrical
and proportional to the
head. The external canal has
no purulent discharge.

Palpation: Upon
palpation, both ears are
non-tender with no
presence of mass or
nodules.
Inspection: Nasal folds are
symmetrical. Nasal septum is
located at the midline.
Mucosa is pink and moist, and
intact without presence of
discharge.
 Palpation: Airways are
patent on both nasal nares.
No tenderness on frontal and
Inspection: Upon
inspection of the mouth,
the lips are pinkish and dry
with tongue located at the
midline. Gums and mucosa
are pinkish and with
missing teeth.
Inspection: Uvula is
midline. Right tonsils and
posterior pharyngeal wall
are not inflamed.
Inspection: Neck is
symmetrical with full range of
motion. No visible deformities
seen

Palpation: Trachea is midline.

No swelling and tenderness of
lymph nodes noted. Thyroid
gland is non-palpable, no mass
Inspection: Shape of the
chest is symmetrical. No
lesions noted. I&E ratio is 1:2 .

Palpation: Anterior-Posterior-
Lateral ratio is 1:2 with
symmetrical lung expansion
and symmetrical vocal/tactile
fremitus.
Percussion: The sound of
resonance was found at the 1st
to 4th ICS and dullness at left 5th
ICS midclavicular line.

Auscultation: Bronchial sound

is heard over trachea,
bronchovesicular sound at 2nd
and 3rd ICS and vesicular sound
at the base of the lung. With
crackles heard on the lower
Inspection: Precordium is
normo-dynamic
 Palpation: No presence of
abnormal pulsations at
precordium
Auscultation: The point
of maximum impulse is
located at the 5 ICS MCL
th

with regular heart rhythm.

Heart sounds S1 is louder
at the apex; S2 is louder
at the base. No extra
heart sound noted.
Inspection: The client’s
abdomen is flat with
symmetrical configuration. No
scars, lesions, striae noted. The
color of the skin is slightly
lighter than those areas exposed
to sun.

Auscultation: Bowel sound was

Percussion: Tympanic
sounds are heard over
areas of RLQ and LLQ.
Dullness was heard over
RUQ (liver), dullness over
LUQ (spleen)

Palpation:There was no
tenderness when
Fourorgans:
•kidneys
•ureters
•bladder
•urethra
retroperitoneal,
paravertebral/paralumb
ar
right kidney is lower
than the left
dimension: 11 cm x 5-
7.5 x 2.5 cm
covered by renal
capsule, Gerota’s fascia
and adipose
areas: cortex
(glomeruli), medulla
(collecting ducts
terminating in papilla),
renal pelvis.
25-35 cm long, along
the psoas muscle, then
into the pelvis
points of obstruction:
ureteropelvic junction,
pelvic brim,
ureterovesical junction
retropubic,stretch
cranially when filled
4 cm in length in
female
20 cm in male: three
sections: prostatic
(3cm), membranous (1-
2), penile (15)
1. 1. Regulation of plasma
ionic composition.
2. Regulation of plasma
osmolarity
3. Regulation of plasma
volume
4. Regulation of plasma
hydrogen ion concentration
4. Removal of metabolic
waste products and
foreign substances from
the plasma.

5. Removal of metabolic
waste products and
foreign substances from
Name of drug
Generic Name: Ciprofloxacin

Brand Name: Ciproxin

Classification

Anti infectives
Dosage / Frequency
500 mg 1 tab
Route
Oral
Action

Inhibits bacterial DNA

synthesis, mainly by blocking
DNA gyrase; bacterial
Indication
- Mild to moderate UTI
- Severe or complicated UTI
- Chronic bacterial prostatsis
caused by E. coli, P. mirabilis.
- Complicated intra abdominal
infections
- uncomplicated UTI
 Nursing Responsibilities
- Monitor patient intake and out
put and observe patients for signs of
crystalluria
- Tell patient to take drug as
prescribed, even after he feels
better.
- Advise patient to drink plenty of
fluids to reduce risk of urine crystals
- Advise patient that
hypersensitivity reactions may occur
even after first dose.
Name of drug
Rowtinex

Cineol

Classification
Antiurolithic
Dosage / Frequency
1 capsule
Route

Oral
Action

promotes a diuresis and

relaxes urinary tract spasm,
thus assisting the passage of
stones..
The therapeutic effect of the
balanced combination of
terpenes reduces urinary tract
inflammation, stimulating renal
blood flow through the kidneys
and increasing the output of less
concentrated urine.
Indication

For the treatment of urinary

tract spasm and inflammation
associated with urolithiasis.
Assists in the dissolution and
expulsion of stones in the renal
system.
Nursing Responsibilities
Liquid intake should be
increased during therapy.
Store at temperatures not
exceeding 30 degrees Celcius.
Assessment:
Subjective:
“masakit and likuran ko”,
as
verbalized by the
patient.
Objectives:
● Facial grimace
(Pain Scale Score 9/10)
● Restlessness.
● V/S taken as
follows:
T: 38°C
PR: 92
RR 26
BP: 130/90mmHg
Acute pain related to
biological factors such as
trauma or activity of
disease process.
After8 hours of nursing
interventions, the patient’s
pain will be relieved or
controlled, with a pain
scale score of 3/10.
Independent:
1. Assess pain, noting
location, intensity (scale of
0 – 10), duration.
R:1. Provides information
to aid in determining
choice or effectiveness of
interventions.
2.Explain Cause of pain
and importance of
caregivers changes in pain
occurrence /
characteristics
R:Provides oopurtunity
for timely administration
of analgesia.
3.ENCOURAGE/ASSIST
WITH FREQUENT
AMBULATION AS
INDICATED AND
INCREASED FLUID INTAKE
OF AT LEAST 3–4 L/DAY
WITHIN CARDIAC
TOLERANCE.
R:
RENAL COLIC CAN BE
WORSE IN THE SUPINE
POSITION.
4.Observe for changes in
mental status, behaviour
or level of consciousness.