S.R. was discharged with instructions to strain all urine and return if she experienced pain unrelieved by

Question

the pain medication or increased nausea and vomiting.

What specific instructions will you give S.R. about straining her urine, fluid intake,
medications, and activity?

Answer 1

Straining: Instruct S.R. to strain all urine (provide strainer) and keep all stones. Inform her that the
urologist can examine the stones to determine the type; this information is helpful to determine
the plan for preventing stones in the future.
Fluids: S.R. should increase her intake to 3000 to 4000 mL/day with urinary output of at least
2000 mL/day. She should understand that this is the primary method of flushing the stone from
the urinary tract. A written record might help her keep track of her actual intake; constant sipping
of water is usually more tolerable than drinking large amounts less frequently. Here is a useful
method to ensure she is drinking sufficient fluids: Fill the appropriate number of bottles (depends
on the size of the bottles) with water, and place them in the refrigerator as the main source of
fluids. If any other liquids are drunk, remove the equivalent amount from the containers. Mark on
the container how many bottles must be gone by 12 noon, 4 pm, and 8 pm.
Activity: Ambulation might facilitate movement of the stone through the urinary tract.
Medications: S.R. should take the pain medication regularly. She should also understand not to operate
machinery while taking the medication. It is better to avoid nonsteroidal anti-inflammatory
drugs (NSAIDs) or products such as aspirin that cause bleeding in case surgery is needed. Opioids
might slow bowel activity and result in constipation. Fortunately, her increase in fluid intake and
ambulation might offset the effects of opioids on bowel activity. You can counsel her to increase
fiber intake to prevent constipation.