N 510 Module 5: Discussion Question

N 510 Module 5: Discussion Question:

Choose one of the following case studies from the Bruyere textbook and complete. Please post your answers, and then reply to two classmates.

• #77 – gout
• #79 – osteoporosis
• #33 – renal cell carcinoma
• #34 – urinary stone disease

Your initial posting should be 200 to 300 words in length and utilize at least one scholarly source other than the textbook. Please reply to at least two classmates. Replies to classmates should be between 100 and 200 words in length. To properly “thread” your discussion posting, please click on REPLY.

 

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N 510 Module 5: Discussion Question

Urinary stone disease

Patient case question 1). Pathophysiologic mechanism for pallor and diaphoresis in pt.

This patient is acute pain, and acute pain activates the autonomic nervous system causing his pallor and diaphoresis. In addition, to his pallor and diaphoresis acute pain is also causing his nausea and vomiting, and restlessness (McCance, & Huether, 2014 p. 492).

Patient case question 2). Promethazine nausea mechanism.

Promethazine or Phenergan is used to treat and prevent nausea. It blocks the action of acetylcholine (anticholinergic) it is a H1- antagonist that has sedative effects as well as antiemetic properties. The relief of nausea appears to be related to central anticholinergic actions and may implicate activity on the medullary chemoreceptor trigger zone (Drugbank, 2018).

Patient case question 3).Four contributing factors for reoccurring kidney stones.

1. Not enough hydration
2. Diet
3. Inactivity
4. History of renal previous stones

Patient case question 4). Pharmacological and non-pharmacological recommendations.

Non-pharmacological recommendations would be to stay hydrated, increase activity, monitor diet more closely, stopping multi-vitamin and vitamin C are all non-pharmacological recommendations. Studies suggest that people who take calcium and or vitamin D as a dietary supplement have a higher risk of developing kidney stones. In contrast, high intakes of dietary calcium do not appear to cause kidney stones, and essentially protect against their formation (Johri, Cooper, Robertson et al., 2010). Increasing potassium in the diet also reduces the risk of stone formation because potassium promotes the urinary excretion of calcium crystal formation, and a diet low in magnesium also promotes the formation of kidney stones since magnesium inhibits the calcium crystal formation (Riley, J.M. , Kim, H., Averch, T.D., Kim, H.J. (2013).

Pharmacological recommendations are aimed at promoting the passage of the stone through the urethra. Alpha antagonists such as Tamsulosin and calcium channel blockers such as nifedipine are pharmacological interventions to assist with passing kidney stones (McCance, & Huether, 2014 p. 1344).

Patient case question 5). Not a uric stone?

Uric levels in blood test are normal. So, no not a uric stone.

Patient case question 6). Allopurinol appropriate?

No this is not appropriate, medication is used to decrease uric acid in blood, pts. was normal.

Patient case question 7). Penicillamine appropriate?

No cystine levels are  pts. is 128. No this would not be an appropriate treatment for this patient. Penicillamine is a degraded product of penicillin antibiotics penicillamine chelates with heavy metals and increases and escalates their excretion. Since the patients citrate levels are low this would not be a course of treatment for this patient.

Patient case question 8). Can kidney stones be dissolved with medication?

Yes they can, most notably uric kidney stones can be dissolved with alkali citrate or sodium carbonate and works to increase the pH levels of urine; coupled with increasing fluids this will potentiate the effects of alkali citrate, the more that is produced the better the dissolving capabilities of the medication (Institute for Quality and Efficiency in Health Care, (2016).

Patient case question 9). Oxalate foods

Cranberry juice, cooked broccoli and red raspberries would rate 3 very low in oxalate.

Pecans, baked potatoes, cooked carrots would rate 2 mild to moderate in oxalate

Cooked beet greens, stewed rhubarb, pickled beets would rate 1 extremely rich in oxalate.

N 510 Module 5: Discussion Question References

Drugbank (2018). retrieved from: https://www.drugbank.ca/drugs/DB01069.

Johri, N., Cooper, B., Robertson, & Choong, S. et al. (2010). An update and practice guide to

Renal stone management. Nephron ClinicalPractice.116(3):159-171. retrieved from:

https://en.wikipedia.org/wiki/Kideny_stone_disease.

Institute for Quality and Efficiency in Health care. Treating kidney stones (2016) retrieved from:

https://www.ncbi.nim.nih.gov/books/NBK348939/.

McCance, K.L., Heuther, S.E. (2014, 7^thed.) Pathophysiology the biologic basis for disease in

adults and children.St. Louis, MO: Elsevier Mobsy. 

Riley, J.M., Kim, H., Averch, & Kim, H.J. (2013). Effect of magnesium on calcium and oxalate ion

binding. J Endoural . 27(12):1487-1492. doi:10.1089/end.2013.0173.PMC 38830282.PMID

24127630.