I.

Introduction

Renal stone are common problem affecting men more frequently than women.
Approximately millions are hospitalized each year with kidney stone and an equal
number are treated for stone without hospitalization. People in hotter climate are
commonly affected. Stone may from any where in the urinary track but most commonly
form in the kidney, they frequently move to other parts of the urinary tract, causing pain,
infection, and obstruction. Approximately 90% of the stone past spontaneously. Stone
may be treated medically, mechanically, or surgically are large stones that fill and
obstruct the renal pelvis. Recurrence of stones is a problem; patients face lifelong need
for preventative management. This care plan addresses management of the patient
hospitalized with kidney stones; it also addresses postoperative and postlithotripsy care.

II – A. OBJECTIVE OF THE STUDY

At the end of this study the group will be able to:

- To identify chief complaints of our client and give its specific

interventions.
- To identify the cause and effect of the main problem through a correct
analysis of the schematic presentation of the family health problems.
- To evaluate the effectiveness of the actual nursing care plan that was
established.
- To give referrals and follow up for the health promotion of the client.

In general, this study aims to develop the skills and learning of the
student, with which the student, exposed and learned the genuine community
setting in every case that student encountered. The student tends to pour out
and search more knowledge to attain the desired goal and intervention for the
wellness of the patient.

1
 1
B. SCOPE AND LIMITATIONS
This study encompasses on the condition of the Caudor family and the
environment where they live in. And It also has the following limitations:
1. Limited to two visits only.
2. Data is gathered only in the interview, observation and the family obtained
during the visits.

III . FAMILY HEALTH PROFILE

A.1 – Head of the Family

Name: Carlito Caudor

Age: 41 yrs. old
Birthday: December 8, 1967
Height: 7’7”
Weight: 57 kilos
Occupation: Farmer
Educational attainment: High School level
Allergy: None
Smoking: 1 pack per day
Beverages: None
Elimination pattern: Once a day
Chief complain: Kidney stone
Relationship with the head of the family: Son

2
 2
A.2: Family member Profile
Name: Vilma Caudor
Age: 33 years old
Birthday: February 15, 1975
Height: 5’2”
Weight: 58 kilos
Occupation: House wife
Educational attainment: High school graduate
Allergy: None
Smoking: None
Beverages: None
Elimination pattern: Once a day
Relationship with the head of the family: Daughter in-law

A.3:
Name: Carmila Caudor
Age: 10 years old
Birthday: January 10, 1998
Immunization: Complete
Weight: 20 kilos
Height: 4’
Relationship with the head of the family: Grand Daughter

A.4:
Name: Mabelle Caudor
Age: 8 years old
Birthday: May 19, 2000
Immunization: Complete

3
Weight: 15 kilos
Height: 48”
Relationship with the head of the family: Grand Daughter
3
A.5:
Name: Carlo Caudor
Age: 5 years old
Birthday: May 11, 2003
Immunization: Complete
Weight: 11 kilos
Height: 42”
Relationship with the head of the family: Grand Son

A.6
Name: Maeca Caudor
Age: 6 months old
Birthday: December 5, 2007
Weight: 10 kilos
Height: 70 cm
Relationship with the head of the family: Grand Daughter
Immunization: (Refer exhibit I)

1st 2nd 3rd 4th 5th 6th

NEWBORN SCREENING
BCG (at birth) 12/17/07
DPT (6 wks, 10 wks, 14 wks old) 2/18/08 3/17/08 4/21/08
OPV (6 wks, 10 wks, 14 wks old) 2/18/08 3/17/08 4/21/08
HEPATITIS B (6 wks, 10 wks, 14 wks old) 2/18/08 3/17/08 4/21/08
MEASLES (9 months)
VITAMIN A (start at 6 mos.)
DEWORMING
DENTAL CHECK-UP

4
 4

SPOT MAP
Baikingon is a part of Cagayan de Oro. It is approximately 30 to 45
minutes drive away from Liceo de Cayayan University. Located south west of
the city. From Liceo de Cagayan University he hired a jeepney to transport us to
Baikingon. The fare cost P50.00 back and fort from Liceo de Cagayan University
to Baikingon.

Our client is from zone – 6 Baikingon. Located north in zone 6 proper

going to the creek. .

IV. CHIEF COMPLAINT

At the time we did our assessment to our client Mr. Carlito Caudor , we
found out that he was suffering painful urination cause by kidney stone.

V. HISTORY OF PRESENT ILLNESS FOR THE FAMILY

MEMBER WITH A HEALTH PROBLEM

A. Family History

According to the client the kidney problem is from his family for his father
suffered the same illness.

B. Past Medical History

The patient has already experienced painful urination for the past four
years and has been prescribed with Co-trimoxazole 500 mg.

C. Social History

5
 The patients social life was affected since he is suffering from altered
urination, its hard for him to mingle with other people and cannot do his daily
task because of his problem and aside from that he feels pain when he walks .

5
VI. GROWTH AND DEVELOPMENT
(Family Members)

Carlo Caudor
5 years old

Sigmund Freud’s Psychosexual Theory

Preschooler (Phallic Stage)

At this point of age, he already knows that he is a boy. In this stage the
child detects his gender and the differences of a girl and boy. He keeps
comparing his self toward his younger sister. He likes to play with his father than
his mother. He sticks with his father. He doesn’t want to see his father hugging
his mother in front of him, he feels like ashamed of what they are doing. He finds
more attention to his father than to his mother.

Erik Eriksson’s Psychosocial Theory

Preschooler (Initiative versus Guilt)
He belongs to a stage where he starts to develop his motor skills. He likes to hold
the hammer and imitate his father in fixing there chair.

Maeca Caudor
6 months old
Psychosocial Development

Sensory Oral or Early Infancy ( Trust vs. Mistrust)

At this time Maeca must be given sufficient amount of feeding, love, care
and attention to develop the child’s ability to display affection, gain confidence,
gratification and ability to trust others. She’s a breast fed baby according to his
mother “ wala jud koy problima ani niya kay dili jud hilakon”..

6
 During Sensory oral stage Mouth is the center of pleasure. Lack of
gratification can cause individual to develop negative behaviors such as:
suspicion of others, fears affection, and projection. In the end developing
mistrust.

VII. FAMILY SERVICE and PROGRESS RECORDS

A. Head of the family

• Carlito Caudor
B. Family Member
• Vilma Caudor
• Carmila Caudor
• Mabelle Caudor
• Carlo Caudor
• Maeca Caudor

C. Address
• Zone 6 Baikingon, Cagayan de Oro

D. Family Member Number

•5
E. Name of Family Members
Names of Relationship Sex Birthday Highest Occupation Type of Place of
family with the head Educ. work work
member completed
1.Vilma wife F February 15, High housewife None Baikingon
Caudor 1975 school
graduate
2.Carmila Daughter F January 10, Grade 4 N/A N/A N/A
Caudor 1998

7
3.Mabelle Daughter F May 19, 2000 Grade 3 N/A N/A N/A
Caudor

4.Carlo Caudor son M May 11, 2003 None N/A N/A N/A

7
VIII. DESCRIPTION of HOME and ENVIRONMENT
(ENVIRONMENTAL PROFILE)

HOME AND ENVIRONMENT

The home and environment determines the health status of a family which
is based on the sanitary conditions classified as a safe, intermediate, danger
within the five categories: Home, Water Supply, Kitchen, Waste Disposal,
Domestic Animals and the community in general.
As part of the Family Care Study the group has assessed the Home and

Environment of the family.

• Housing

 The Caudor family has their own house.

 The house is a combination of concrete cement and wood. It is a
two story house that has 3 bedrooms and the living room is
adjacent to the kitchen.
 They have Television set, Cd player, Karaoke and a Cabinet.
 They have their own source of electric power.
 They use firewood in cooking their food.

8
 • Water Supply

 The family source of water is from NAWASA

• Kitchen

 They use firewood in cooking their food

 The cooking area is not well organize and clean
 The pots are separated from the utensils

• Toilet

 They used water seal

 It is separated from the house

• Sanitary Condition

 Both the front and the backyard is not cemented thus it becomes
muddy and slippery during rainy days.
 Limited stored water in the house
 Utensils not properly kept in their places

 Inadequate food storage

• waste Disposal

 The family doesn’t have proper garbage segregation

9
  They have no compost in their backyard.
 They sometimes burn their garbage also outside their house.

• Domestic animals
 The family has dog

• Community
 Most of the people living in the community are farmers, barbe- q
stick maker and some were construction workers. Health
awareness is one of the priority problems in zone 6 Baikingon .
9

Pathophysiology

10
 10
Pathophysiology
Kidney stone formation is the end result of a physicochemical process that
involves nucleation of crystals from a supersaturated solution. The common constituents
of kidney stones. The factors that influence crystal generation are urine volume,
concentration of stone constituents (a function of urine volume), the presence of a nidus
and the balance among various physicochemical factors that inhibit or promote stone
formation.

Most people's urine is supersaturated with the common components of renal

stones, including calcium phosphate, calcium oxalate and, frequently, uric acid.
Supersaturation of the urine constitutes a driving force within the solution favouring
crystal nucleation and growth.

A great deal of attention has been focused recently on the interactions between
crystals that are being formed and the cell surfaces in the renal tubules.3,4 The most
common constituent of kidney stones, calcium oxalate monohydrate, binds
electrostatically to anionic sites on cell surfaces. Thereafter, the crystals may be
internalized, or they may remain on the cell surface, which allows further binding and
propagation of the crystals. Soluble anions, such as citrate, may inhibit this process, as
may urinary glycoproteins; these compounds thus act as inhibitors of the early phase of
stone formation.

11
 There is a fine balance in urine among substances that readily form crystals, such
as calcium, oxalate and uric acid; promoters of crystallization, including pH, stasis and
low volume; and inhibitors of this process, such as high urine volume and flow, citrate
(which forms a complex with calcium to prevent its crystallization with oxalate) and
urinary glycoproteins. The following section outlines how various factors affect the
formation of stones.

Predisposing factor:
a. hypercalcemia and hypercalcuria caused by hyperparathyroidism, renal
tubular acidosis, multiple myeloma, and excessive intake of vitamin D,
milk, and alkali.
b. Chronic dehydration, poor fluid intake, and immobility.
c. Diet high in purines and abnormal purine metabolism (hyperuricemia and
gout)
d. Genetic predisposition for urolithiasis or genetic disorders (crystinuria)
e. Chronic infection with urea-splitting bacteria (Proteus Vulgaris)
f. Chronic obstruction with stasis of urine, foreign bodies within the urinary
tract.
g. Excessive oxalate absorption in inflammatory bowel disease and bowel
resection or ileostomy.
h. Living in mountainous, desert, or tropical areas.

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Precipitating factor

For people with a history of kidney stones, doctors usually recommend passing at least
2.5 quarts (2.3 liters) of urine a day. To do this, you'll need to drink about 14 cups (3.3
liters) of fluids every day — and even more if you live in a hot, dry climate.

What should you drink? Water is best. Include a glass of lemonade every day, too. Make
your own with real lemons, or use a liquid or frozen concentrate, but avoid powdered
lemonade mixes. Lemonade increases the levels of citrate in your urine, and citrate helps
prevent stone formation.

In addition, if you tend to form calcium oxalate stones, your doctor may recommend
restricting foods rich in oxalates. These include rhubarb, star fruit, beets, beet greens,
collards, okra, refried beans, spinach, Swiss chard, sweet potatoes, sesame seeds,
almonds and soy products. What's more, studies show that an overall diet low in salt and
very low in animal protein can greatly reduce your chance of developing kidney stones.

Target organ

• kidney
• urinary bladder

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 Signs and Symptoms

• Colicky pain: "loin to groin". Often described as "the worst pain experienced".
• Hematuria: blood in the urine, due to minor damage to inside wall of kidney,
ureter and/or urethra.

• Pyuria: pus in the urine.

• Dysuria: burning on urination when passing stones (rare). More typical of
infection.
• Oliguria: reduced urinary volume caused by obstruction of the bladder or urethra
by stone, or extremely rarely, simultaneous obstruction of both ureters by a stone.
• Abdominal distention.
• Nausea/vomiting: embryological link with intestine—stimulates the vomiting
center .
• Fever and chills.

Complications

If a stone stays inside one of your kidneys, it usually doesn't cause a problem
unless it becomes so large it blocks the flow of urine. This can cause pressure and pain,
along with the risk of kidney damage, bleeding and infection. Smaller stones may
partially block the thin tubes that connect each kidney to your bladder or the outlet from
the bladder itself. These stones may cause ongoing urinary tract infections or kidney
damage if left untreated.

12

NURSING SYSTEM REVIEW CHART

NAME: Carlito Caudor DATE: June 30, 2008

V/S
HR: 105 bpm RR: 36 cpm BP:130/80 mmHg Temp: 37.0 ºC Height:5’7” Weight: 167.2 lbs.

An [X] is placed in the area of abnormality. Comment at the space provided. Indicate the location of
the problem in the figure using [X].

13
EENT: ________________
[ ] impaired vision [ ] blind ________
[ ] pain redden [ ] drainage
[ ] gums [ ] hard of hearing [ ] deaf
________________
[ ] burning [ ] edema [ ] lesion teeth ____________
[ ] assess eyes ears nose __Pale__________
[ ] throat for abnormality [X] no problem DrySkin_________
RESP: ______________
[ ] asymmetric [ ] tachypnea [ ] barrel chest
[ ] apnea [ ] rales [ ] cough
________________
[ ] bradypnea [ ] shallow [ ] rhonchi __
[ ] sputum [ ] diminished [ ] dyspnea ________________
[ ] orthopnea [ ] labored [ ] wheezing ________________
[ ] pain [ ] cyanotic ________________
[ ] assess resp. rate, rhythm, pulse blood
[ ] breath sounds, comfort [X ] no problem
_______________P
CARDIOVASCULAR: ain_________
[ ] arrhythmia [ ] tachycardia [ ]numbness ________________
[ ] diminished pulses [ ] edema [ ] fatigue ________________
[ ] irregular [ ] bradycardia [ ] mur mur ________________
[ ] tingling [ ] absent pulses [ ] pain
Assess heart sounds, rate rhythm, pulse, blood
__
Pressure, circ., fluid retention, comfort
[X ] no problem ________________
GASTROINTESTINAL TRACT: ________________
[ ] obese [ ] distention [ ] mass ________________
[ ] dysphagea [ ] rigidity [ ] pain
[ ] assess abdomen, bowel habits, swallowing
________________
[ ] bowel sounds, comfort [X ] no problem ________________
GENITO – URINARY AND GYNE ________________
[X ] pain [X ] urine [ ] color [ ] vaginal bleeding FAMILY
________________
[ ] hematuria [ ] discharge [ ] nuctoria ________body
[ ] assess urine frequency, control, color, odor, comfort
[ ] gyne bleeding [ ] discharge [ ] no problem
weakness________
NEURO: ________________
[ ] paralysis [ ] stuporus [ ] unsteady [ ] seizure ___________
[ ] lethargic [ ] comatose [ ] vertigo [ ] treamors
[ ] confused [ ] vision [ ] grip
[ ] assess motor, function, sensation, LOC, strength
[ ] grip, gait, coordination, speech [ x ] no problem
MUSCULOSKELETAL and SKIN:
[ ] appliance [ ] stiffness [ ] itching [ ] petechie
[ ] hot [ ] drainage [ ] prosthesis [ ] swelling
[ ] lesion [ ] poor turgor [ ] cool [ ] flushed
[ ] atrophy [ ] pain [ ] ecchymosis [ ] diaphoretic moist
[ ] assess mobility, motion gait, alignment, joint function
[X ] skin color, texture, turgor, integrity [ ] no problem 13
X.HEALTH CARE PLAN
(Family Health Problem)

Cues Nursing Objectives Interventions Rationale Evaluation

14
 Diagnosis
Subjective: At the end of • Increased • Help to At the end of 1
“Mura kog permi Altered urinary 30 to 1 hour fluid intake clean and hour patient
kaihion, pero gamay elimination the patient will at least 8 – flushes was not able to
ra ako maihi” related to empty his 10 glasses the empty his
blockage of urinary bladder per day system bladder
urine flow by through completely
stone • Monitor urination
Objective: intake and • To
• Small output monitor
frequent the liquid
urination • Monitor intake of
• Incontinence daily the
• Retention weight patient

• Nocturia • To have
baseline

• Advised
data
about the
patient to
patient
avoid salty
• It may
foods
trigger
the
• Refer to
formation
visit health of the
center or stone
hospital for
• To have
further
proper
assessmen
monitorin
t
g about
his
illness

14
Cues Nursing Objectives Interventions Rationale Evaluation
Diagnosis
Subjective: At the end of 15 • Advice the • This is to At the end of 15
“Dili kayo ko Disturbed sleep min. I will be patient to avoid min patient
katulog kay sigi pattern related able to impart lessen fluid urinating at acquired
ko ihi ihi” to frequent knowledge on intake night . enough
urination how to manage before knowledge on
Objective: his sleep how to manage
going to
• So that the
• Pale pattern sleep. his sleep
patient can
• Fatigu problem. • Limit the pattern problem

15
 e intake of sleep at
• Dark cafainated night
circle drinks after
under eyes mid
• Frequent afternoon
yawning

Cues Nursing Objectives Interventions Rationale Evaluation

Diagnosis
Subjective: At the end of 1 hour • Encourage • To provide At the end of
“Sakit i-ihi” Acute pain the patient will be and assist comfort to 15 min
ma’am as related to able to: patient to the patient patient
verbalized by inflammation, 1. understand assume a acquired
the patient. obstruction, the ways position of enough
and abration of or methods comfort knowledge
Objective: the urinary in • Involve the • To provide on how to
• Facial tract allivating family comfort to manage his
grimace pain. members in the patient sleep
• Guard Dependent: assisting the pattern
ing signs 2. follow patient to problem
of pain doctors ambulate to
• fatigu prescriptio obtain some
e n on taking pain relief
pain • Scale • Help
reliever or patient’s evaluate
whenever level of pain site of
pain tolerance obstructio
occurs: from 0-10 (0 n and
Mefenamic as no pain progress
acid 500mg and 10 as of renal
PRN for very painful) stone
pain: movement
• Stress out
• vigorous
the
hydration
importance
promotes
of increasing
flashing of
patient’s
stone,
fluid intake
prevents
3-4 L/day
urinary
within
stasis, and
cardiac
aids in
prevention
of further
stone
• Administer formation

16
 narcotic • to relieve
analgesic as pain. Act
prescribed as pain
by the reliever
doctor:
mefenamic
acid 500mg
PRN for pain

XII. DRUG STUDY

Nam Generi Classificati Dose/ Mechanis Specific Contraindication Side/Toxic Nursing

e of c on frequen m of Indication Effects Precaution
Drug Name cy Action
Route
Acal Potassiu Antiurolithi 10 mEq The aim - Treatment - Renal insufficiency¨ - Slight - The tablets
ka m c of the of patients Persistent alkaline gastrointesti must not be
Citrate treatment with renal urinary infections nal masticated or
is to lithiasis and - Obstruction of the disorders diluted. The
restore the hypocitratur urinary tract may appear active
level of ia, chronic - which can component of
the formers of Hyperpotassemia¨Ad be palliated Acalka is
urinary calcium renal insufficiency by means of contained
citrate and oxalate, - Respiratory or the joint with a porous
to phospate metabolic alkalosis administrati wax matrix.
increase calculia. - Active peptic ulcer on of food. As this was
the pH of - Uric acid - Intestinal matrix is
urine to 6- lithiasis obstruction insoluble, it
7. alone or - Patients submitted can be
accompanie to anticholinergic eliminated in
d by therapy visible form
calcium - Patients with slow in the feces.
lithiasis gastric emptying The active
component,
however, has
been released
in the
gastrointestin
al tract.
- Must not be
administered
to patients
receiving
potassium-
sparing
diuretics
(traimterene,
spirolactone,
or
amyloride).
- It is
advisable to
carry out an
evaluation of
electrolytes
(Na-K-Cl)
and CO2,
creatinine and
hemogram

every 4 hrs.
- It is
recommended
that the
patients in

17
 treatment
with Acalka
follow a diet
w/o salt and
increase the
intake of
fluids.
- The
recommended
treatment in
case of
hyperpotasse
mia is: IV
administratioi
n f 10%
dextrose
solution,
containing
10-12 units of
insulin/1000
ml.
Correction of
the possible
acidosis with
IV sodium
bicarboate
and
hemodialysis
or peritoneal
dialysis.

Name of Gene Classifica Dose/ Mechanism Specifi Contraindic Side/Toxic Nursing

Drug ric tion freque of Action c ation Effects Precaution
Nam ncy Indicati
e Route on
cotrimoxa Bactri Anti- Sulfamethox Treatm Patient with GI upset, In case of
m; infective azole (SMZ) ent of marked nausea, severe allergy,
Septra inhibits renal liver vomiting, bronchial
800 formation of infectio parenchym glossitis, ashma,strepto
mg/16 dihydrofolic ns al damage, stomatitis,anore coccal
0 mg acid from hematolic xia,kin rashes, paryngitis,
(capsul PABA , disorder arthalgia and impaired renal
e) trimethoprim blood myalgia. and hepatic
e (TMP) dyscracia, function, folate
inhibits megaloblas of G6PD
dihydrofolate tic bone deficiency
reductase marrow,
thereby severe Avoid in
bloking the renal patient’s
synthesis of insufficienc receiving oral
tetrahydrofoli y. antiguagulant
c acid, the
combination
of this drugs
block two
consecutive
steps in
bacterial

18
 synthesis of
folic acid

RECOMMENDATIONS

For some patients who form stones, diet is the primary control mechanism for stone
formation, while for others proper dietary management enhances the role of medications.
In most cases, the diets of stone formers reveal excessive intake of foods and low intake
of fluids, both modifiable. Stones are associated with excess in the patient’s diet, namely
of salt and protein. The following are common dietary measures patient may take to
reduce stone formation:

IDEAL NURSING MANAGEMENT

• Assess understanding of factor s that predispose to formation

of renal stone
Family history of kidney stone
Dietary factor including low fluid intake, intake of food
high in purine, calcium and oxalate.
• Assess understanding of the possible courses of
therapy to treat kidney stone
• Assess history of renal stone formation. Recurrences
may indicate knowledge deficit regarding prevention

ACTUAL NURSING MANAGEMENT

• Health teaching

BIBLIOGRAPHY
Atkinson, Rita et al. Hilgard’s Introduction to Psychology.12th ed. Harcourt
Brace College Publisher:1996.
Doenges, M.E. And Moorehouse, M.F. Nurses Pocket Guide: Diagnosis,
interventions and rationale. 7th ed. F.A. Davis Company. Huamark, Bangkok,
Thailand,2000
Maglaya, Araceli S. 2004. Nursing Practice in the Community. 4th edition.
Argonauta Corporation, Marikina City. Pp 112-117.

Pearson, Durk, et al. Life Extension. A Practical Scientific Approach. USA:

Warner Communications Company, 1982.

19
Reyala, et al. 2000. Community Health Nursing services in the Philippines. 9 th
edition. Community Health nursing section, National League of
Philippine Government Nurses, Inc.

Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology, 4th ed.,
McGraw Hill, 876–9.

Valenti, et al. Lippincott’s Review Series: Critical Care Nursing Lippincott Raven
Publisher, 1998 pp 14-30

en.wikipedia.org/wiki/

en.emedicine.com
www.c

Evaluation

After the 2 weeks of the exposure, the student had established rapport to
the family, identifies problems and was able to discuss it with the family. The
family has appreciated the health teachings the student have imparted as well
the interventions done.
On the course of visits the family cooperates very well and was very
hospitable and shared pertinent information about their family. It’s overwhelming
to work with them because they were accommodating and interested with the
actions done. Community nursing is a two way process, we may give this and
that advises to the family but if they failed to see it and put them to action nothing
will happen. It was a seemingly fruitful community exposure for the student have
learned a lot on what is community nursing and that it is a unique field of nursing
where we could dig deeper into the lives of our patients/clients.

20
21