A patient with a suspected diagnosis of urolithiasis is on bed rest. What would be the priority nursing inter… - PGIMER Sangrur NO - 2023

PGIMER Sangrur NO - 2023

Medical Surgical Nursing

Medium

Appeared in: PGIMER Sangrur NO - 2023

Explanation

Bed rest causes urinary stasis, a condition where urine pools in the renal pelvis, which significantly increases the risk of renal calculi (kidney stone) formation.
Increasing fluid intake is essential for an immobile patient to counteract stasis by flushing the urinary tract.
A high fluid intake (e.g., 2-3 L/day) increases hydrostatic pressure behind the stone, aiding its passage, and dilutes the urine to prevent crystals from forming or growing.
Given the limitation of bed rest, promoting fluid intake is the most effective and safest priority nursing action.

Option B: Catheterization is an invasive procedure with a high risk of introducing infection (Catheter-Associated UTI) and is not a primary or routine intervention for managing urolithiasis.
Option C: No single body position is therapeutic for passing kidney stones. In fact, prolonged immobility in any position, including supine, can worsen urinary stasis. The goal is to encourage a position of comfort.
Option D: The patient is explicitly on a medical order for 'bed rest.' Assisting the patient out of bed violates this order and compromises patient safety. Nursing interventions must align with prescribed activity levels.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Nursing management of urolithiasis and complications of immobility in the correct sequence, documenting the action clearly, and monitoring for the expected response.
A core nursing responsibility is to prevent complications of immobility, such as renal calculi, by implementing proactive measures like ensuring adequate hydration.
Always prioritize interventions that can be performed within the patient's prescribed activity level. Violating an order for bed rest can compromise patient safety and is outside the nursing scope of practice.
What if? If the patient on bed rest suddenly developed anuria (no urine output) and worsening flank pain, the priority would shift from increasing fluids to immediately notifying the healthcare provider. This suggests a complete obstruction, which is a medical emergency requiring urgent intervention.

How to Approach the Question

First, identify the patient's primary diagnosis, which is suspected urolithiasis (kidney stones).
Second, identify the most critical constraint mentioned in the stem: the patient is on 'bed rest'.
Third, evaluate each option based on its ability to address the urolithiasis while respecting the bed rest order.
Eliminate the option that directly contradicts the medical order ('Assist him out of the bed'), as this is a safety violation.
Analyze the remaining options. Catheterization is invasive and reserved for obstruction. A specific position is not therapeutic for stone passage.
Conclude that increasing fluid intake is the most effective, non-invasive, and appropriate priority action to help flush the stone, especially since the patient cannot use gravity to their advantage by walking.

Concept Tested & Keywords

Concept Tested: Nursing management of urolithiasis and complications of immobility.
Stem keywords: urolithiasis, bed rest, priority nursing intervention
Lead-in keywords: priority
Clinical cues: The patient being on 'bed rest' is a critical constraint that limits ambulation as an intervention.

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E6 Nursing Fundamentals Potter Perry 12e Part 4 p. 133-135

E6 Nursing Fundamentals Taylor pp. 593-595, 602-604