LEARNING OBJECTIVES• review the anatomy and physiology of  the renal system• interpret the term renal calculi• describe th...
LEARNING OBJECTIVES• examine the clinical manifestations closely• differentiate the various diagnostic  measures• explain ...
THE RENAL SYSTEM
THE RENAL SYSTEM
DEFINITION• Nephrolithiasis refers to renal stone  disease; urolithiasis refers to the  presence of stones in the urinary ...
ETIOLOGY
ETIOLOGYMETABOLICLIFESTYLEGENETIC FACTORSDRUGSOTHERS
RISK FACTORS                                      HISTORY                                      OF                         ...
RISK FACTORSHIGH MINERALCONTENT IN DRINKINGWATER DIETARY INTAKE   UTI & H/O FEMALE   GENITAL MUTILATION     PROLONGED     ...
PATHOPHYSIOLOGY• Slow urine flow, resulting in  supersaturation of the urine  with the particular element  that first beco...
PATHOPHYSIOLOGY• Damage to the lining of the  urinary tract
PATHOPHYSIOLOGY• Decreased inhibitor  substances in the urine that  would otherwise prevent  supersaturation and  crystall...
TYPES OF STONES•   Calcium Phosphate•   Calcium oxalate•   Uric acid•   Cystine•   Struvite
CLINICAL MANIFESTSTIONS• Severe  abdominal or  flank pain• Frequency and  dysuria• Oliguria and  anuria in  obstruction
CLINICAL MANIFESTSTIONS•   Hematuria•   Renal colic•   Nausea•   hydronephrosis
DIAGNOSTIC STUDIES
DIAGNOSTIC STUDIES
CYSTOSCOPY   DIAGNOSTIC STUDIES
DIAGNOSTIC STUDIES
DIAGNOSTIC STUDIES
DIAGNOSTIC STUDIES    RETROGRADE    PYELOGRAM      CT SCAN   24 HOUR URINE     SPECIMEN LAB INVESTIGATIONS
MANAGEMENT
MEDICAL• DRUG THERAPY  Opioid agents  NSAIDS  Spasmolytic agents
COMPLIMENTARY THERAPY•Hypnosis, imagery, therapeutic or healing touch, acupuncture and breathing techniques•Positioning th...
OTHER TECHNIQUES• Avoiding over  hydration and  under hydration• Strain the urine• Send any strained  stone to laboratory ...
SPECIFIC APPROACHES URINARY   CHARACTERIS   PREDISPOSING      THERAPEUTIC MEASURESSTONE      TICS          FACTORS Calcium...
SPECIFIC APPROACHES URINARY    CHARACT    PREDISPOSING   THERAPEUTIC MEASURESSTONE       ERISTICS   FACTORS Calcium  Mixed...
SPECIFIC APPROACHES URINARY   CHARACTERIS    PREDISPOSING    THERAPEUTIC MEASURESSTONE      TICS           FACTORSStruvite...
SPECIFIC APPROACHES URINARY   CHARACTERI   PREDISPOSING   THERAPEUTIC MEASURESSTONE      STICS        FACTORS Uric      Pr...
SPECIFIC APPROACHES URINARY   CHARACTERISTICS    PREDISPOSING   THERAPEUTIC MEASURESSTONE                         FACTORSC...
SURGICAL MANAGEMENT
PROXIMAL URETER   SURGICAL MANAGEMENT                       ANTEGRADE                      NEPHROURETER   STENTING ALONE  ...
MIDURETER    SURGICAL MANAGEMENT              RETROGRADE                                 ESWL             URETEROSCOPY    ...
DISTAL URETER   SURGICAL MANAGEMENT                ESWL/ureteroscopy                Antegrade                nephrostouret...
SURGICAL MANAGEMENT            LASER         PERCUTANEOUS            ESWL
OPEN SURGICAL PROCEDURES   NEPHROLITHO   PYELOLITHOT      TOMY           OMY    URETHROLIT                 CYSTOTOMY     H...
NURSING MANAGEMENT
NURSING DIAGNOSIS• Acute pain related to irritation  and spasm from stone  movement in the urinary tract as  manifested by...
NURSING DIAGNOSIS• Anxiety related to uncertain  outcome and lack of  knowledge regarding possible  surgery as manifested ...
NURSING DIAGNOSIS• Ineffective therapeutic regimen  management related to lack of  knowledge as manifested by  repeated qu...
NURSING DIAGNOSIS• Impaired urinary elimination  related to trauma or blockage of  ureters or urethra as manifested  by de...
NURSING DIAGNOSIS• Risk for infection related to  introduction of bacteria  following manipulations of the  urinary tract ...
PREVENTION• Avoid protein intake; usually protein is  restricted to 60g/day to decrease urinary  excretion of calcium and ...
PREVENTION• Low-calcium diets are not generally  recommended,except for true absorptive  hypercalciuria. Evidence shows th...
PREVENTION• During the day, drink fluids (ideally water)  every1 to 2 hours.• Drink two glasses of water at bedtime  and a...
PREVENTION• Avoid activities leading to sudden  increases in environmental temperatures  that may cause excessive sweating...
JOURNAL PRESENTATIONS
QUESTIONS???
?Genetic              a)Cystic fibrosisfactor              b) sjogrens syndromeinvolved in   c) goutrenal         d) myast...
?Stone in thekidney is      a) nephrolithiasis               b) ureterolithiasiscalled as               c ) cystolithiasis...
?Uric acidstones can   a)Allopurinolbe reduced    b)thiazide diureticor           c)pencillamineprevented    d)potassium c...
?Preferredopioid agent    a)Morphineused in renal   b) ketorolaccalculi pain                c)propanthelenemanagement     ...
REFERENCES• Fauci AS, Braunwald  E, Kasper DL, Hauser  SL, Longo DL, Jameson  JL, et al., editors. Harrison’s  principles ...
REFERENCES• Johnson J.Y.Brunner anD  Suddharth`s:Textbook of  Medical Surgical Nursing.  11th edn.  Philadelphia:Lippincot...
REFERENCES• Black M.J, Hawks H.K.  Medical Surgical Nursing. 7th  edn. Missouri:  Saunders;2005
REFERENCES• Taal M.W,Cherton G,Marsden  P.A. Brenner and Rector`s:  The Kidney. 9th  edn.Philadelphia:  Elsevier;2012
REFERENCES• Walsh C.Urology. 10th edn.  Philadelphia:  Elsevier;2012
REFERENCES• Nettina S M, Mills E.J.Lippincott  Manual of Nursing Practice. 8th  edn.Philadelphia :Lippincott  Williams & W...
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Renal calculi ppt

  1. 1. LEARNING OBJECTIVES• review the anatomy and physiology of the renal system• interpret the term renal calculi• describe the etiology of renal calculi• discuss the pathogenesis involved in the disease process• list the types of renal calculi
  2. 2. LEARNING OBJECTIVES• examine the clinical manifestations closely• differentiate the various diagnostic measures• explain the medical management• Identify the surgical management of renal calculi• distinguish the nursing management for renal calculi including the nursing diagnosis
  3. 3. THE RENAL SYSTEM
  4. 4. THE RENAL SYSTEM
  5. 5. DEFINITION• Nephrolithiasis refers to renal stone disease; urolithiasis refers to the presence of stones in the urinary system. Stones, or calculi, are formed in the urinary tract from the kidney to bladder by the crystallization of substances excreted in the urine•
  6. 6. ETIOLOGY
  7. 7. ETIOLOGYMETABOLICLIFESTYLEGENETIC FACTORSDRUGSOTHERS
  8. 8. RISK FACTORS HISTORY OF METABOLIC RENAL DISTURBANCES CALCULI DEHYDRATION SEDENTARY LIFE STYLEIMMOBILITY
  9. 9. RISK FACTORSHIGH MINERALCONTENT IN DRINKINGWATER DIETARY INTAKE UTI & H/O FEMALE GENITAL MUTILATION PROLONGED INDWELLING CATHETERISATION NEUROGENIC BLADDER
  10. 10. PATHOPHYSIOLOGY• Slow urine flow, resulting in supersaturation of the urine with the particular element that first become crystallized and later become stone
  11. 11. PATHOPHYSIOLOGY• Damage to the lining of the urinary tract
  12. 12. PATHOPHYSIOLOGY• Decreased inhibitor substances in the urine that would otherwise prevent supersaturation and crystalline aggregation
  13. 13. TYPES OF STONES• Calcium Phosphate• Calcium oxalate• Uric acid• Cystine• Struvite
  14. 14. CLINICAL MANIFESTSTIONS• Severe abdominal or flank pain• Frequency and dysuria• Oliguria and anuria in obstruction
  15. 15. CLINICAL MANIFESTSTIONS• Hematuria• Renal colic• Nausea• hydronephrosis
  16. 16. DIAGNOSTIC STUDIES
  17. 17. DIAGNOSTIC STUDIES
  18. 18. CYSTOSCOPY DIAGNOSTIC STUDIES
  19. 19. DIAGNOSTIC STUDIES
  20. 20. DIAGNOSTIC STUDIES
  21. 21. DIAGNOSTIC STUDIES RETROGRADE PYELOGRAM CT SCAN 24 HOUR URINE SPECIMEN LAB INVESTIGATIONS
  22. 22. MANAGEMENT
  23. 23. MEDICAL• DRUG THERAPY Opioid agents NSAIDS Spasmolytic agents
  24. 24. COMPLIMENTARY THERAPY•Hypnosis, imagery, therapeutic or healing touch, acupuncture and breathing techniques•Positioning the client to comfortable position aids in pain reduction
  25. 25. OTHER TECHNIQUES• Avoiding over hydration and under hydration• Strain the urine• Send any strained stone to laboratory to aid in preventive treatment in the future
  26. 26. SPECIFIC APPROACHES URINARY CHARACTERIS PREDISPOSING THERAPEUTIC MEASURESSTONE TICS FACTORS Calcium Small Idiopathic Increase hydrationoxalate often hypercalciuria Reduce dietary oxalate 35-40 possible to hyperoxaluria Give thiazide diuretics get ,Independent cellulose phosphate,(chelate trapped in of urinary pH calcium and prevent GI ureter ,family history absorption), ,more potassium citrate(alkaline frequent in urine), men cholestyramine(bind oxalate), calcium lactate(precipitate oxalate in GI tract) Reduce daily sodium intake
  27. 27. SPECIFIC APPROACHES URINARY CHARACT PREDISPOSING THERAPEUTIC MEASURESSTONE ERISTICS FACTORS Calcium Mixed Alkaline urine, Treat underlyingphosphate stones primary cause and other 8-10% with hyperthyroidism stones struvite or oxalate stones
  28. 28. SPECIFIC APPROACHES URINARY CHARACTERIS PREDISPOSING THERAPEUTIC MEASURESSTONE TICS FACTORSStruvite 3 to 4 times urinary tract Antimicrobial agents10-15 % common in infections acetohydroxamic acid women ≥ Surgical interventions men,always Measures to acidify urine in association with urinary tract infection
  29. 29. SPECIFIC APPROACHES URINARY CHARACTERI PREDISPOSING THERAPEUTIC MEASURESSTONE STICS FACTORS Uric Predomi Gout, acid Reduce urinaryacid nant in urine concentration of uric acid men high ,inherited Alkanize urine with5-8 % incidence conditions potassium citrate in jewish Administer allopurinol men Reduce dietary purines
  30. 30. SPECIFIC APPROACHES URINARY CHARACTERISTICS PREDISPOSING THERAPEUTIC MEASURESSTONE FACTORSCystine Genetic Acid urine Increase hydration autosomal Give α pencillamine and1-2 % recessive tiopronin to prevent cystine defect,defective crystallization absorption of gi Potassium citrate to cystine from gi alkaline urine tract and kidney excess concentrations causing stone formation
  31. 31. SURGICAL MANAGEMENT
  32. 32. PROXIMAL URETER SURGICAL MANAGEMENT ANTEGRADE NEPHROURETER STENTING ALONE OLITHOTOMY PERCUTANEOUS RETROGRADE URETERO URETEROSCOPY LITHOTOMY ESWL NEPHROLITHOTOMY
  33. 33. MIDURETER SURGICAL MANAGEMENT RETROGRADE ESWL URETEROSCOPY ANTEGRADE OPEN URETERO- NEPHROSTOURETE LITHOTOMY ROLITHOTOMY
  34. 34. DISTAL URETER SURGICAL MANAGEMENT ESWL/ureteroscopy Antegrade nephrostoureterolithotomy Stenting alone Open ureterolithotomy
  35. 35. SURGICAL MANAGEMENT LASER PERCUTANEOUS ESWL
  36. 36. OPEN SURGICAL PROCEDURES NEPHROLITHO PYELOLITHOT TOMY OMY URETHROLIT CYSTOTOMY HOTOMY
  37. 37. NURSING MANAGEMENT
  38. 38. NURSING DIAGNOSIS• Acute pain related to irritation and spasm from stone movement in the urinary tract as manifested by complaints of pain, facial grimacing, restlessness
  39. 39. NURSING DIAGNOSIS• Anxiety related to uncertain outcome and lack of knowledge regarding possible surgery as manifested by expressions
  40. 40. NURSING DIAGNOSIS• Ineffective therapeutic regimen management related to lack of knowledge as manifested by repeated questions
  41. 41. NURSING DIAGNOSIS• Impaired urinary elimination related to trauma or blockage of ureters or urethra as manifested by decreased urinary output and bloody urine
  42. 42. NURSING DIAGNOSIS• Risk for infection related to introduction of bacteria following manipulations of the urinary tract and obstructed urinary blood flow
  43. 43. PREVENTION• Avoid protein intake; usually protein is restricted to 60g/day to decrease urinary excretion of calcium and uric acid.• A sodium intake of 3 to 4 g/day is recommended. Table salt and high-sodium foods should be reduced, because sodium competes with calcium for reabsorption in the kidneys.
  44. 44. PREVENTION• Low-calcium diets are not generally recommended,except for true absorptive hypercalciuria. Evidence shows that limiting calcium, especially in women, can lead to osteoporosis and does not prevent renal stones.• Avoid intake of oxalate-containing foods (eg, spinach,strawberries, rhubarb, tea, peanuts, wheat bran).
  45. 45. PREVENTION• During the day, drink fluids (ideally water) every1 to 2 hours.• Drink two glasses of water at bedtime and an additional glass at each nighttime awakening to prevent urine from becoming too concentrated during the night.
  46. 46. PREVENTION• Avoid activities leading to sudden increases in environmental temperatures that may cause excessive sweating and dehydration.• Contact your primary health care provider at the first sign of a urinary tract infection
  47. 47. JOURNAL PRESENTATIONS
  48. 48. QUESTIONS???
  49. 49. ?Genetic a)Cystic fibrosisfactor b) sjogrens syndromeinvolved in c) goutrenal d) myasthenia graviscalculiformation:
  50. 50. ?Stone in thekidney is a) nephrolithiasis b) ureterolithiasiscalled as c ) cystolithiasis d ) cholelithiasis
  51. 51. ?Uric acidstones can a)Allopurinolbe reduced b)thiazide diureticor c)pencillamineprevented d)potassium citrateby the useof:
  52. 52. ?Preferredopioid agent a)Morphineused in renal b) ketorolaccalculi pain c)propanthelenemanagement d)tramadol hydrochlorideinitially is:
  53. 53. REFERENCES• Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al., editors. Harrison’s principles of internal medicine. 17th ed. New York: McGraw Hill; 2008
  54. 54. REFERENCES• Johnson J.Y.Brunner anD Suddharth`s:Textbook of Medical Surgical Nursing. 11th edn. Philadelphia:Lippincott;20 08.
  55. 55. REFERENCES• Black M.J, Hawks H.K. Medical Surgical Nursing. 7th edn. Missouri: Saunders;2005
  56. 56. REFERENCES• Taal M.W,Cherton G,Marsden P.A. Brenner and Rector`s: The Kidney. 9th edn.Philadelphia: Elsevier;2012
  57. 57. REFERENCES• Walsh C.Urology. 10th edn. Philadelphia: Elsevier;2012
  58. 58. REFERENCES• Nettina S M, Mills E.J.Lippincott Manual of Nursing Practice. 8th edn.Philadelphia :Lippincott Williams & Wilkins; 2006
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