please reply discussion post below
Urinary Stone Disease
Patient Case Question 1. Describe the pathophysiologic mechanism that caused pallor and diaphoresis in this patient.
- The pallor and diaphoresis of the patient are caused by the anxiety he is in due to his contact pain and discomfort.
Patient Case Question 2. How does promethazine relieve nausea and vomiting?
- He was given promethazine hydrochloride IV to relieve him of his nausea, it works by blocking the acetylcholine receptors, the neurotransmitter that stimulates nausea.
Patient Case Question 3. In addition to the male gender and Caucasian race, identify four more risk factors that have likely contributed to this patients current urinary stone.
- The other identifiable risk factors that may have contributed to the urinary stone of the patient are dehydration, overweight, calcium vitamins, and a history of kidney stones.
Patient Case Question 4. Based on this patients medical history and all of the laboratory tests, what non-pharmacologic and pharmacologic recommendations might be appropriate?
- For non-pharmacologic recommendation patient must increase fluids, avoid salty food, high in oxalate content or anything high in sodium, stop taking calcium supplements or multivitamins. Recommended medicines would be pain relievers, calcium channel blockers, alpha-blockers to relax ureters to help move the stone, and diuretics to promote urination.
Patient Case Question 5. Which of the clinical findings above are consistent with the fact that the passed stone was not a uric acid stone?
- The elevated level of calcium, protein, specific gravity, and uric acid indicates that it was not a uric acid stone otherwise the levels should have lowered.
Patient Case Question 6. Is allopurinol an appropriate treatment for this patients recurring nephrolithiasis?
- Allopurinol statistically reduced stone recurrence. Oversaturation of urine with calcium oxalate or uric acid is linked to the mechanism of hyperuricosuria and the formation of uric acid calculi. Allopurinol reduces the saturation of urine with the urates thus preventing the pathogenic mechanism related to this disorder
Patient Case Question 7. Is penicillamine an appropriate treatment for this patients recurring renal stones?
- Yes, penicillamine will be an appropriate treatment since works by binding the substances that form the stones, therefore, preventing build-up and recurrence.
Patient Case Question 8. Are there any types of kidney stones that can be dissolved with medication?
- Alkaline citrate salts or sodium bicarbonate, and sometimes allopurinol are treatments recommended in dissolving uric acid stones, it is the only type of kidney stones that can be dissolved.
Patient Case Question 9. Rank the following sets of food items as such: 1 = extremely rich in oxalates; 2 = mild to moderately rich in oxalates; 3 = very low oxalate content.
__1___ cranberry juice, cooked broccoli, and red, raw raspberries
__3___ pecans, baked potatoes, cooked carrots
___1__ cooked beet greens, stewed rhubarb, pickled beets
Harold Joseph Bruyere. (2009). 100 Case Studies In Pathophysiology. Lippincott Williams & Wilkins.
Favus, M. J., & Coe, F. L. (1980). The effects of allopurinol treatment on stone formation on hyperuricosuria calcium oxalate stone formers. Scandinavian Journal of Urology and Nephrology. Supplementum, 53, 265271. https://pubmed.ncbi.nlm.nih.gov/6938003/
Scales, C. D., Tasian, G. E., Schwaderer, A. L., Goldfarb, D. S., Star, R. A., & Kirkali, Z. (2016). Urinary Stone Disease: Advancing Knowledge, Patient Care, and Population Health. Clinical Journal of the American Society of Nephrology: CJASN, 11(7), 13051312. https://doi.org/10.2215/CJN.13251215
Bruyere, Harold J.. 100 Case Studies in Pathophysiology (Kindle Locations 3209-3210). Wolters Kluwer Health. Kindle Edition.
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