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A patient is admitted with renal calculi.

1. What symptoms will the patient manifest if he is experiencing renal colic?

• A patient experiencing renal colic will mainly have pain. The type of pain felt with renal colic is “colicky” as the stone blocks the outflow and stretches the ureter. This pain is reflected in the flank of the side being affected (Grossman & Porth, 2014). This pain may also radiate to the lower abdomen/bladder region and nausea and vomiting may also accompany renal colic.

1. How will the nurse best manage the renal colic?

• The best way to manage renal colic is to first alleviate the pain and any other accompanying symptom as this can cause extreme anxiety in the patient. Antibiotic treatment may also be implemented. Once pain is relieved and the stone has passed, all efforts should be made to ensure it does not happen again. Also ensuring an adequate fluid intake can help prevent the recurrence (Grossman & Porth, 2014).

1. The nurse is straining the urine for presence of stones that the patient may have passed. What is the importance of this nursing action?

•  It is of extreme importance to strain the urine to identify the chemical components of the stone. This dictates the course to follow, what dietary changes need to be made, what medication needs to be prescribed, long-term measures to avoid new stone formation, and it helps also to identify any underlying cause (Grossman & Porth, 2014).

Reference

Grossman, S. C., & Porth, C. (2014). Porth’s pathophysiology: concepts of altered health states. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

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Descending Spinal Tract

• Corticospinal, reticulospinal, and vestibulospinal
• Sends impulses from the brain to muscle groups
• Control muscle tone, posture, and motor movements
• Efferent

1. Ascending Spinal Tract
2. Spinothalamic and spinocerebellar
3. Sends sensory signals to accomplish complex tasks
4. Ascending tracts recognize exact stimulus and location
5. Contains fibers that discriminate rough from light touch, temperature and pain
6. Afferent

• If the spinal cord is completely severed, then complete loss of function below the point if injury is expected (Ball, Dains, Flynn, Solomon & Stewart, 2015).
• The nervous system is a group of nerves and neurons that transmit messages to different parts of the body. It is in charge of coordinating and controlling the body (Ball et al., 2015). The nervous system is divided into the central and the peripheral nervous system, further subdivided into autonomic, sympathetic and parasympathetic. The central nervous system is comprised of the brain. The peripheral nervous systems is comprised of the cranial and spinal nerves and the ascending and descending pathways (Ball et al., 2015). With all parts functioning properly the nervous system is able to receive and identify stimuli, control voluntary and involuntary body functions (Ball et al., 2015).
• The three major units of the brain are the cerebrum, the cerebellum and the brainstem (Ball et al., 2015).
• The difference between the ascending and descending tracts is that the ascending is sensory (afferent) because it delivers information to the brain and the descending tract delivers motor (efferent) information to the periphery (Ball et al., 2015)
• The pituitary gland regulates metabolic processes and controls growth, lactation, and vasoconstriction through hormonal regulation (Ball et al., 2015).
• The fourth cranial nerve is called trochlear and it is in charge of the downward and inward movement of the eye (Ball et al., 2015).
• Risk factors for cerebrovascular accidents include hypertension, obesity, sedentary lifestyle, smoking, stress, high cholesterol/triglycerides/lipoproteins, congenital conditions and family history of cerebrovascular accidents (Ball et al., 2015).
• The 5.07 monofilament test is used to test sensation in different parts of the foot in patients suffering from diabetes mellitus or peripheral neuropathy (Ball et al., 2015).  
• The 0 to 4+ scale is used to grade the response when testing the reflex. 0 indicates no response and 4+ indicates hyperactive reflex (Ball et al., 2015).
• Older adults may be taking medication for other conditions that can affect their balance, mental status and coordination and it is important know this in order to rule out whether a symptom is due to a side effect or a cause for concern (Ball et al., 2015).
• Meningitis that occurs during the first year may cause epilepsy later on in life, also any infection in the first year of life can impair brain functioning and development (Ball et al., 2015).
• Peripheral neuropathy is a loss of motor and sensory function due to diabetes mellitus, vitamin B12 deficiency, Lyme disease, HIV infection, poor blood circulation and altered lipid metabolism. In this case the cause of EI’s neuropathy is Diabetes Mellitus due to the elevated A1c (Ball et al., 2015).
• Objective data in peripheral neuropathy include reduced sensation in the foot, inability to feel sharp touch, diminished distal pulses, unable to stand on toes or heels, skin ulcers in extremities that are often not felt by the patient and decreased sensation below the knees (Ball et al., 2015).
• The best technique to assess for peripheral neuropathy is the 5.07 monofilament test because it assesses sensation in different areas of the foot (Ball et al., 2015).

Reference  

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidels guide to physical examination. St. Louis, MI: Elsevier Mosby.