Nurse Harry is providing post-procedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra-high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to:
A. Limit oral fluid intake for 1 to 2 weeks.
B. Report the presence of fine, sand-like particles through the nephrostomy tube.
C. Notify the physician about cloudy or foul-smelling urine.
D. Report bright pink urine within 24 hours after the procedure.
Correct Answer: C. Notify the physician about cloudy or foul-smelling urine.
The client should report the presence of foul-smelling or cloudy urine. Like all other procedures, this procedure is also not without complications. Complications of extracorporeal shock wave lithotripsy (ESWL) include bacteremia. Preoperative evaluation and preparation will allow the provider to maximize the success rate of ESWL with minimal chances of unforeseen complications.
Option A: Unless contraindicated, the client should be instructed to drink large quantities of fluid each day to flush the kidneys. Through the different mechanisms, this energy can overcome the tensile strength of the stone resulting in fragmentation. Repetition of this process leads to the pulverization of the stone into small fragments that the body then can pass painlessly and spontaneously.
Option B: Sand-like debris is normal due to residual stone products. Extracorporeal shockwave lithotripsy (ESWL) is a truly non-invasive procedure as opposed to other surgical treatments used, such as retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL). The efficacy of ESWL lies in its ability to pulverize calculi in vivo into smaller segments, which are then expelled spontaneously by the boy. Shockwaves are generated and are then focused on a point within the body.
Option D: Hematuria is common after lithotripsy. Stone passage after the procedure is facilitated by using nonsteroidal anti-inflammatory drugs, alpha-blockers, calcium channel blockers, and corticosteroids. The total number of shocks delivered per session depends on patient habitus and stone characteristics, including stone location, stone density, stone composition, etc., and ranges between 2000 and 4500 shocks per session.
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