Nursing Clinical Practice Guide
Clinical Scenario: You are the nurse on a medical-surgical unit. Mr. Johnson, 68, was admitted yesterday with a new diagnosis of bladder cancer. He has a history of painless hematuria. During your morning assessment, he is diaphoretic, clutching his left side, and says, "This pain just hit me out of nowhere, and I feel like I'm going to be sick."
Nursing Intervention Strategy
1. Immediate Assessment (ABCs first): Assess airway, breathing, circulation. Quickly obtain vital signs (hypertension or tachycardia may occur due to pain). Perform a focused assessment: Location (flank vs. suprapubic), character, and intensity of pain. Ask about nausea/vomiting and last void.
2. Immediate Action: Stay with the patient, call for help, and immediately notify the healthcare provider or rapid response team based on facility protocol. This is not a finding to document and wait.
3. Collaborative Care: Anticipate orders for:
- STAT renal ultrasound or CT scan.
- IV access for fluids and medications.
- Pain management (IV opioids, NSAIDs).
- Antiemetics.
- Blood work (BUN, Creatinine, electrolytes) to assess renal function.
- Straight catheterization or bladder scan to check for retention if no void.
4. Monitoring: Closely monitor urine output (goal >30 mL/hr), pain level, and vital signs. Assess for signs of infection (fever).
Patient Safety and Precautions
- Do not administer analgesics that could mask symptoms without a diagnosis, unless ordered for severe pain management during workup.
- Ensure patient safety if nausea/vomiting are present; have an emesis basin and assist as needed to prevent aspiration.
- After relief of obstruction (e.g., stent placement), monitor for signs of urosepsis (fever, chills, hypotension).
Nursing Procedure & Medication Flow- 1Pain Management:For severe renal colic, IV morphine 2-4 mg may be given slowly, monitoring for respiratory depression. Ketorolac 15-30 mg IV is effective for reducing inflammation and pain at the ureteral level.
- 2Monitoring Output:If the patient is unable to void, a straight catheterization may be performed to rule out concurrent bladder outlet obstruction and to obtain a urine specimen. Strict aseptic technique is mandatory.
- 3Post-Intervention:After stent placement, educate the patient that hematuria and urinary frequency/urgency are common. Instruct to report fever, chills, worsening pain, or a significant decrease in urine output.
A Word from Your Senior Nurse
"Nursing is not just about carrying out physician orders — it's about being the frontline guardian for your patients! In clinical practice, recognizing the shift from 'chronic cancer symptoms' to 'acute obstructive emergency' is a critical skill. That sudden, severe flank pain is your patient's kidney crying out for help. When studying for your boards, don't just memorize 'flank pain' — connect it to the pathophysiology of obstruction and the urgency of preserving kidney function. That clinical reasoning will not only earn you a great score on the NCLEX but will make you a nurse who can truly advocate for your patient's safety in a moment of crisis."