What discharge teaching is appropriate for the nurse to provide to a patient who has had a lithotripsy.

Choice A rationale Extracorporeal shock wave lithotripsy (ESWL) uses sound waves to break large kidney stones into smaller fragments called gravel or sand. These fragments must then pass through the urinary tract. It is common and expected for patients to observe stone debris in their urine as it clears the system over several days to weeks. Educating the patient to strain their urine allows for the collection of fragments for chemical analysis to prevent future stone formation. Choice B rationale Decreasing fluid intake to 1000 milliliters per day is contraindicated after lithotripsy. Standard medical advice involves increasing fluid intake to at least 2000 to 3000 milliliters per day, unless otherwise restricted by heart or kidney failure. High fluid volume helps flush the remaining stone fragments through the ureters and prevents the formation of new calculi. Restricting fluids would increase the risk of urinary stasis, pain, and potential obstruction from the stone debris. Choice C rationale Remaining on restricted activity for an entire week is generally unnecessary after an uncomplicated lithotripsy procedure. Most patients are encouraged to ambulate shortly after the procedure to facilitate the movement of stone fragments down the urinary tract via gravity and increased peristalsis. While heavy lifting might be limited for a day or two, prolonged inactivity is discouraged as it can lead to complications like pneumonia or deep vein thrombosis without aiding stone passage. Choice D rationale Checking for edema of the legs and ankles is more relevant for patients with heart failure or advanced chronic kidney disease rather than post-lithotripsy care. While monitoring fluid balance is important, the specific focus after lithotripsy is on stone passage and preventing infection. Unless the patient has a pre-existing condition causing fluid retention, leg edema is not a standard expected complication of stone fragmentation. The primary focus remains on urinary output and hematuria.