A client had a percutaneous nephrolithotripsy 3 hours ago to remove left renal calculi. Since then, the indwelling urethral catheter has drained 125 mL of urine and the nephrostomy tube has drained 0 mL. The client now reports left flank pain radiating to the left groin along with severe nausea. What is the appropriate nursing intervention?
Percutaneous nephrolithotripsy involves the insertion of a needle and sheath through the skin into the pelvis of the kidney. A nephroscope is inserted through the sheath to break and remove kidney stones too large to remove with other methods. Post procedure, a temporary percutaneous nephrostomy tube may be placed to prevent obstruction by stone fragments and to promote healing of injured tissue; maintaining tube patency is critical.
This client is experiencing left flank pain and has no drainage from the nephrostomy tube, which may indicate obstruction to urine flow in the left kidney that can lead to kidney injury (pressure atrophy). Gentle irrigation of the nephrostomy tube with a small volume of sterile normal saline (as prescribed or per protocol) using aseptic technique is the appropriate intervention. If tube patency cannot be established after irrigation, the health care provider is notified (Option 2).
(Options 1 and 3) The indwelling urethral catheter is appropriately draining 42 mL/hr, so it is not likely kinked or obstructed. The urine flow is likely coming from a normal-functioning right kidney.
(Option 4) The client is placed in the prone position for the procedure, but this does not facilitate drainage.
Educational objective:
A percutaneous nephrolithotripsy is a procedure to remove large kidney stones from the renal pelvis. Post procedure, a nephrostomy tube may be placed to prevent obstruction by stone fragments and to promote healing of injured tissue. Gentle irrigation of the nephrostomy tube with sterile normal saline may be necessary to maintain tube patency.
Percutaneous nephrolithotripsy involves the insertion of a needle and sheath through the skin into the pelvis of the kidney. A nephroscope is inserted through the sheath to break and remove kidney stones too large to remove with other methods. Post procedure, a temporary percutaneous nephrostomy tube may be placed to prevent obstruction by stone fragments and to promote healing of injured tissue; maintaining tube patency is critical.
This client is experiencing left flank pain and has no drainage from the nephrostomy tube, which may indicate obstruction to urine flow in the left kidney that can lead to kidney injury (pressure atrophy). Gentle irrigation of the nephrostomy tube with a small volume of sterile normal saline (as prescribed or per protocol) using aseptic technique is the appropriate intervention. If tube patency cannot be established after irrigation, the health care provider is notified (Option 2).
(Options 1 and 3) The indwelling urethral catheter is appropriately draining 42 mL/hr, so it is not likely kinked or obstructed. The urine flow is likely coming from a normal-functioning right kidney.
(Option 4) The client is placed in the prone position for the procedure, but this does not facilitate drainage.
Educational objective:
A percutaneous nephrolithotripsy is a procedure to remove large kidney stones from the renal pelvis. Post procedure, a nephrostomy tube may be placed to prevent obstruction by stone fragments and to promote healing of injured tissue. Gentle irrigation of the nephrostomy tube with sterile normal saline may be necessary to maintain tube patency.
