Help with prioritizing & outcome

[mlauren]

Hey guys. It has been a while since I've needed some help, but I'm having a little bit of a problem deciding what i should be focusing on with my patient. He has a UTI and kidney stones (staghorn) and also has COPD. So on my care plan I know for sure his main problems are acute pain, impaired urinary elimination, and ineffective airway clearance. There are others as well, but those are my top 3 that I think I need to focus on. I think that impaired urinary elimination should come before pain because if his UTI and kidney stones are taken care of then he won't be in pain. But when ti comes to deciding where to put ineffective airway clearance I'm just not sure. He quit smoking in 2008. He is very compliant with treatment for COPD. He has a wheeze in the early morning, but it clears with cough. His respiratory rate and O2sats are fine. I know that airway comes before anything so that's why I'm having a hard time deciding if this should come first even though he's not currently having any respiratory problems. What do you guys think? Should this come before the other two? In my opinion pain and urinary elimination are the focus because that's what he is in the hospital for, but like i said airway is so important. I'm confused.

Also, I'm really struggling with an outcome for impaired urinary elimination. This patient had bladder cancer in 2008 and had a radical cystectomy with urinary diversion and ileal conduit. He has had problems with staghorn kidney stones ever since the urostomy. So now he has a bilateral nephrostomy. Urostomy drained about 175 in 4 hrs, Rt nephrostomy drained 750 and left drained 400. The urine was pale, clear, yellow with brown sediment. So I think the UTI is resolving, but still he has to have a lithotripsy in a few days for the kidney stones. Anyway, I'm not sure what my outcome should be or how to make it measurable. If you guys have any hints I would greatly appreciate it. THe only thing I've thought of is > patient will have no sediment in urine one week after lithotripsy procedure and will have negative urine cultures. I don't know how realistic that is. I'm researching the procedure now to find out what's expected afterwards and how long antibiotics take to eradicate bacteria with UTIs. I guess after the full course of antibiotics. He was getting meropenen IVPB for that. ANyways, hopefully someone can help me to reach a conclusion here. Thanks for any help!