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
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
THE RENAL SYSTEM
THE RENAL SYSTEM
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•
MEDICAL• DRUG THERAPY Opioid agents NSAIDS Spasmolytic agents
COMPLIMENTARY THERAPY•Hypnosis, imagery, therapeutic or healing touch, acupuncture and breathing techniques•Positioning the client to comfortable position aids in pain reduction
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
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
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
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
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
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
OPEN SURGICAL PROCEDURES NEPHROLITHO PYELOLITHOT TOMY OMY URETHROLIT CYSTOTOMY HOTOMY
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
NURSING DIAGNOSIS• Anxiety related to uncertain outcome and lack of knowledge regarding possible surgery as manifested by expressions
NURSING DIAGNOSIS• Ineffective therapeutic regimen management related to lack of knowledge as manifested by repeated questions
NURSING DIAGNOSIS• Impaired urinary elimination related to trauma or blockage of ureters or urethra as manifested by decreased urinary output and bloody urine
NURSING DIAGNOSIS• Risk for infection related to introduction of bacteria following manipulations of the urinary tract and obstructed urinary blood flow
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.
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).
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.
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
?Genetic a)Cystic fibrosisfactor b) sjogrens syndromeinvolved in c) goutrenal d) myasthenia graviscalculiformation:
?Stone in thekidney is a) nephrolithiasis b) ureterolithiasiscalled as c ) cystolithiasis d ) cholelithiasis
?Uric acidstones can a)Allopurinolbe reduced b)thiazide diureticor c)pencillamineprevented d)potassium citrateby the useof:
?Preferredopioid agent a)Morphineused in renal b) ketorolaccalculi pain c)propanthelenemanagement d)tramadol hydrochlorideinitially is:
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
REFERENCES• Johnson J.Y.Brunner anD Suddharth`s:Textbook of Medical Surgical Nursing. 11th edn. Philadelphia:Lippincott;20 08.
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