Cystitis and Urolithiasis Case Presentation

Cystitis and Urolithiasis

Christina, a 15-year-old highschool student visited her health practitioner with complaints of burning sensation upon urination, urinary frequency and urgency and urinating in small amounts. She has a low grade fever of 100.6 F. In addition, upon palpation, a lower abdominal tenderness was noted. History revealed that Christina had been treated for two occasions already of UTI last 2008 and 2010. Urinary tract anomalies had been seen during her last KUB. Her right ureter had stricture. 
Diagnostic and Laboratory tests:
Urine culture revealed presence of E. coli. Urinalysis shown many bacteria. There is Hematuria and pyuria also. 
Management
Increase fluid intake and encourage intake of acid containing foods. 
Ciprofloxacin and analgesics were ordered
Few months later, Christina suddenly develops severe back pain, nausea and diaphoresis. She was rushed to the emergency department, where urinalysis is positive for hematuria. Ultrasound indicates the presence of a renal calculus in the lower right ureter. The pain acute, excruciating and colicky as described by the patient. “ It’s terrible,” while patient is crying. 
An IV is started to administer narcotics for pain relief. Force fluid was ordered. 
24 hour urine test for measurement of calcium, uric acid, creatinine, sodium pH are part of diagnostic workup. 
She is being prepared for Lithotripsy.

Pertinent Data	Nursing Diagnosis	Rank	Justification
·         15 year old female ·         Complaints of burning sensation upon urination (Pyuria) ·         Urinary frequency ·         Urinary urgency ·         Fever (100.6 F) ·         Abdominal tenderness ·         Hx of UTI (2008 & 2010) ·         Urinary tract anomalies (Right ureter stricture) ·         (+) E. Coli ·         Hematuria ·         Severe back pain ·         Nausea ·         Diaphoresis	Acute pain related to nociceptor release from C fibers secondary to urethral inflammation	1	This is the prioritized problem because colicky pain in cystitis can be very excruciating and can alter the vitals of the patient which can be very crucial. Narcotics may be given for pain relief.
	Impaired urinary elimination related to calcium oxalate stone formation	2	This is the second prioritized problem because there may be anuria (no urine output) or polyuria (increased urination) because of the stone formation on the ureters. If this is not resolved, there will be increased accumulation of nitrogenous waste products which may subsequently damage renal function and lead to chronic renal failure. This may be solved with surgery or lithotripsy. It is also highly prioritized because it partially causes problem #1.
	Decreased cardiac output related vasoconstriction secondary to aldosterone release	3	This is the third prioritized problem because we have to induce increased blood flow for proper perfusion to the organs.
	Hyperthermia related to foreign body detection	4	This is the fourth problem because uncontrolled hyperthermia may induce fatal results. The client had hyperthermia as the body is trying to restore homeostasis which is done by the release of pyrogens.
	Risk for infection related to calcium oxalate stone formation	5	Though we have an ongoing infection, the client still has to be protected from further infection because the calcium oxalate stone formation places the patient at risk for further infection.