Urinary Elimination Unfolding Case Study 1. Highlight the below assessment findings that require immediate follow up by the nurse. A 22-year-old patient was admitted to a cardiac stepdown unit for right upper quadrant pain, nausea, and vomiting. The patient states the pain is a 9 out of 10 to RLQ and radiates to their right flank area. The patient stated, Im in so much pain, I took all the acetaminophen extra strength tablets I could find before I came to the Emergency Department. The patient has a medical history of kidney stones, bipolar depression, and primary hypertension. Their surgical history reveals a tonsillectomy two years ago. VS are BP 160/100, P 90, R 20, T 99.2 F, and O2 sat is 98%. ECG monitor shows a normal sinus rhythm with slight ST elevation and a rate of 92. Current home medications are acetaminophen 500 mg 1 to 2 tablets PRN pain, sertraline 100 mg one PO daily, quetiapine 200 mg one PO q HS and lisinopril 20 mg one PO daily. HCP orders home medications, a CT scan of the abdomen and hydrocodone 5 mg/acetaminophen 325 mg one or two tablets PO every 6 hours PRN for moderate pain and morphine 2-4 mg IVP q 2 hours PRN for severe pain..

1. Urinary Elimination Unfolding Case Study
A 22-year-old patient was admitted to a cardiac stepdown unit for right upper quadrant pain, nausea, and
vomiting. The patient states the pain is a 9 out of 10 to RLQ and radiates to their right flank area. The
patient stated, "I'm in so much pain, I took all the acetaminophen extra strength tablets I could find before I
came to the Emergency Department. The patient has a medical history of kidney stones, bipolar
depression, and primary hypertension. Their surgical history reveals a tonsillectomy two years ago. VS are
BP 160/100, P 90, R 20, T 99.2 F, and 02 sat is 98%. ECG monitor shows a normal sinus rhythm with slight
ST elevation and a rate of 92. Current home medications are acetaminophen 500 mg 1 to 2 tablets PRN
pain, sertraline 100 mg one PO daily, quetiapine 200 mg one PO q HS and lisinopril 20 mg one PO daily.
HCP orders home medications, a CT scan of the abdomen and hydrocodone 5 mg/acetaminophen 325 mg
one or two tablets PO every 6 hours PRN for moderate pain and morphine 2-4 mg IVP q 2 hours PRN for
severe pain.
1. Highlight the above assessment findings that require immediate follow up by the nurse. (10-points)
2. Use an X to indicate which assessment finding is associated with each of the listed patient's health
problems. All assessment findings should be used and can be used only once. (7-points)
Assessment Finding Elimination (urinary)
Perfusion
Pain of 9 out of 10 to RLQ
History of kidney stones
BP 160/100
ECG shows NSR with ST elevation
Lisinopril 325 mg PO daily
Morphine 2-4 mg IVP q 2 hours
Nausea and vomiting
The patient stated that "all that acetaminophen I took at home is not working anymore." Upon further
questioning, the patient states they took over 30 acetaminophen tablets.
The patient requests something for pain and said their pain is now above a 10/10 to their RUQ and RLQ.
The patient states they are also very nauseated and feels lightheaded when standing. The patient states
they have not been able to void for the past 6 hours. Bladder is felt during palpation of abdomen. The CT
scan reveals a large kidney stone in the left ureter.
3. Based on the patient's condition, the patient's priority need will be to prevent_(1)_.
In addition, he will need interventions to prevent potentially life-threatening complications of urinary
elimination especially_ (2)_ and_(2)_. (3-points)
Options for 1 Options for 2
Acetaminophen toxicity Ureteral reflux
vomiting urinary retention
kidney stone acetaminophen toxicity
an accidental suicide acute kidney failure
a bipolar episode urinary incontinence
fever urinary tract infection
The patient stated that "all that acetaminophen I took at home is not working anymore."
Upon further questioning, the patient states they took over 30 acetaminophen. The patient requests
something for pain and said their pain is now above a 10/10 to their RUQ and RLQ. The patient states they
are also very nauseated and feels lightheaded when standing. The patient states they have not been able
to void for the past 6 hours.
Bladder is felt during palpation of abdomen. The CT scan reveals a large kidney stone in the left ureter.
4. Use an X for the nursing actions listed below that are Indicated (appropriate or necessary),
Contraindicated (could be harmful), or Non-essential (makes no difference or not necessary) for the
patient's care at this time. Only one selection can be made for each nursing action. (10-points)
Nursing Action Indicated Contraindicated Non-essential
Draw an acetaminophen level
Give Zofran 4 mg IVP for nausea
Obtain a 12-lead ECG
Administer hydrocodone 5 mg/acetaminophen 325 mg PO
Administer morphine IV
Teach urinary self-catheterization
Serve a regular food diet
The patient's lab work is back and exhibits these abnormals: WBC is 14, K is 2.8, BUN is 17, creatinine is
1.9, AST is 145 and ALT is 219, acetaminophen level is 438 mcg/mL, albumin is 2.8, and BNP is 120. The
nurse assessed that the patient's last acetaminophen ingestion at home was more than 5 hours ago. The
patient has vomited clear, greenish liquid twice. Current VS reveal BP 170/108, P 100, R 24, T 100.8 F, 02
sat 96%. IV NS with 20 KCL was started, and patient received morphine 2 mg IVP for pain 40 minutes ago.
The 12-lead ECG shows normal sinus rhythm. Bladder scan exhibits 620 mL of urine.
5. Use an X to indicate which actions listed in the left column would be implemented by the nurse. (10-
points)
Actions Implemented by the nurse
Perform a 24-hour diet recall
Teach on acetaminophen use
Bolus NS with 20 KCL at 500 mL/hr
Give acetylcysteine 140 mg/kg now
Reassess pain in 20 minutes
Give acetaminophen for T 100.8 F
Call HCP regarding lab work
Start IV heparin 18 units/kg/hr
The patient's lab work is back and exhibits these abnormals: WBC is 14, K is 2.8, BUN is 17, creatinine is
1.9, AST is 145 and ALT is 219, acetaminophen level is 438 mcg/mL, albumin is 2.8 and BP is 120. The
nurse assessed that the patient's last acetaminophen ingestion at home was more than 5 hours ago. The
patient has vomited clear, greenish liquid twice. Current VS reveal BP 170/108, P 100, R 24, T 100.8 F, 02
sat 96%. IV
NS with 20 KCL was started, and patient received morpine 2 mg IVP for pain 40
minutes ago. The 12-lead ECG shows normal sinus rhythm. Bladder scan exhibits 620 mL of urine. The
HCP prescribes an antidote for acetaminophen toxicity, NO status and has surgical lithotripsy and ureteral
stent placed. An IV of NS is at 75 mL/hr and furosemide 20 mg IV push given
6. The nurse evaluates the effectiveness of actions. Which of the following findings indicate effectiveness?
Select all that apply. (10-points)
A. Pain is reported 6/10
B. UA is obtained
C. Vomit x 2
D. Fever of 101.4 F
E. Urinary strainer shows crystals
F. Acetaminophen level is 180
G. Normal sinus rhythm noted on the monitor
H. BP 160/100