Health Medical Homework Help

The Response Posts will be to two peers (min 250 words) who are not in your alphabetical group, and from two different alphabetical categories.  The response posts should focus on any aspect of the nursing process (Assessment, Planning, Intervention, and Evaluation) that relates to the initial post. For example, if the initial post addressed a nursing intervention, then the response could address how the effectiveness of the intervention would be evaluated. The response posts may also use the textbook, but must include a peer-reviewed, current (within the last 5 years) NURSING journal article for each response post.  The NURSING journal articles should support the cited nursing interventions. (Two different articles are required.)

reply post 1

Emily BergholtzThursdayJul 22 at 10:50pm

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In a healthy individual, the kidney controls its water output to help regulate urine osmolality. The osmolality and concentration of urine is important because it helps keep electrolytes balanced in the body. Diabetes Insipidus is a rare disorder that involves the kidneys resistance to arginine vasopressin (AVP). Vasopressin is an antidiuretic hormone that the kidney uses to manage the water balance within the body. Without this hormone working properly within the kidneys, they are unable to reabsorb water and therefore unable to hold onto it. Diabetes Insipidus can be hereditary or acquired throughout life. Some of the conditions that may cause acquired diabetes insipidus include kidney disease, obstruction of the ureters, electrolyte imbalances such as hypokalemia and hypercalcemia, or pregnancy. Another reason one may develop this disorder is due to the use of the medication Lithium. Lithium is used to treat mania in patients with bi-polar disorder, therefore patients who have bi-polar disorder and are being treated with Lithium need to be monitored closely for signs of DI. The psychiatric nurse’s role is simply to be aware of this risk and regularly monitor intake and output, as well as instruct the patient to watch for changes. Other medications have also been linked to DI and include antifungals and antibiotics. The biggest clinical manifestations of DI are excessive thirst (polydipsia) and excessive urine production (polyuria). Due to the excessive urine output, dehydration is common. Dehydration comes with its own risks and needs to be managed carefully. Repeated episodes of extreme dehydration in these clients puts them at risk for developing serious complications. Diagnosis will depend on signs and symptoms being present. Additional testing can be done to rule out other problems and confirm a true diagnosis. One way of testing is to inject an antidiuretic hormone into the patient to see if they have a response. A water deprivation test may also be used, which includes the patient not ingesting anything for a certain amount of time, then having blood and urine samples drawn and studied. Treatment for DI is aimed at ensuring adequate fluid intake while reducing the output of urine. Treatment is individualized from case to case and include dietary changes, avoiding dehydration and timed water offerings for small children or infants. In extreme situations, a feeding tube may be utilized to ensure proper fluid intake.

References:

Nephrogenic Diabetes Insipidus. (2019, August 29). Retrieved from https://rarediseases.org/rare-diseases/nephrogenic… 

some information about reply post 1

A-D: Why is it necessary for urine to become concentrated before it is excreted? Visit the National Organization for Rare Disorders and learn about a disorder where the urine is not concentrated prior to excretion: https://rarediseases.org/rare-diseases/nephrogenic-diabetes-insipidus/ (Links to an external site.). Discuss the pathophysiology of this disorder; the clinical manifestations; diagnosis; and, treatment options. What treatment for a mental health disorder puts those patients at a 55% risk of developing this otherwise rare disease? What is the psychiatric nurse’s role in educating the patient about this risk? 

reply post 2

Elexa MolinaryYesterdayJul 27 at 10:09pm

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Kidney stones are developed when a process called supersaturation occurs, which is when there is a presence of a higher concentration of salt within a fluid than the volume is able to dissolve to maintain equilibrium (McCance & Huether, 2019). When supersaturation occurs, the solution starts to precipitate turning it into salts which then crystallize and can turn into stones. The pH of the urine also plays a role in stone formation because if the pH is more alkaline (> 7.0) then it can increase calcium phosphate stone formation and if it is more acidic (< 5.0) then it can increase the formation of uric acid stones. Some preventative measures discussed for at-risk patients to minimize recurrence of stones are increasing fluid intake to maintain 2.5 L of urine output, avoid drinking coke and other soft drinks, avoid dietary oxalate (chocolate, beets, nuts, spinach, teas, strawberries), eating less animal protein, limiting sodium intake, and maintaining an intake of 1000-1200 mg/day of dietary calcium to prevent calcium stone prevention.
Lieske (2017) conducted a review regarding probiotics for the prevention of urinary stones. The intestinal microbiome plays a role in modifying urinary stone risk, but probiotic use has not shown long-term evidence that O. formigenes can prevent stones. The studies showed that probiotics can decrease urinary oxalate excretion while actively taking the probiotic but that when the medication was stopped the fecal recovery dropped. There are also other factors that contribute to the success of O. formigenes like stone risk and urinary oxalate excretion. There have been no follow-up trials to support the use of the probiotic and issues noted with the use of O. formigenes include formulation of pharmacologic amounts, as well as the long-term viability of it in a paste or freeze-dried preparation. So overall, the intestinal microbiome plays a role in modifying urinary stone risk to an extent, but diet change is a better prevention than probiotics. I would not discourage the use of the probiotic, but I would encourage a diet change be the utmost importance in the prevention of stones since the reduction of oxalate only occurs when you are taking the probiotic.

References:

Lieske J. C. (2017). Probiotics for prevention of urinary stones. Annals of translational medicine, 5(2), 29. https://doi.org/10.21037/atm.2016.11.86

McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier.

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M-R: Consider the following case study and then answer the 3 questions that follow it: A 52 year old male presented to the emergency department with severe right flank pain radiating to the right lower quadrant. The pain was insidious in onset and had an intensity of 10/10 on verbal analog scale which decreased to 8/10 after administration of Toradol and Morphine medications provided in the emergency department. A computerized tomography (CT) scan was obtained and revealed a 7mm calcific density in the right proximal ureter and multiple 1–2mm non-obstructing calculi noted in the left renal parenchyma. ed with a right ureteric calculus and further managed with pain and antiemetic medications, and the patient was scheduled for stent and calculus removal and was able to naturally pass the stone a few days after the stent placement.

1. Explain the pathophysiology of the development of kidney stones.

2. What are some of the preventive measures at-risk patients can do to minimize the risk of developing kidney stones?

3. A patient with urolithiasis tells you about a preventive measure not discussed in the textbook: the use of ingesting probiotics (O. formigenes) that degrade oxalate in the body, thus decreasing it’s availability to bind with calcium in the kidney and form kidney stones. Do some research about this self-care measure online. Based on the evidence that you find, would you support or discourage the patient from using probiotics to decrease the amount of oxalate in the body? Justify your answer.