Small calculi are passed naturally with no specific interventions.
If the stone is 5 mm or less in diameter, moving, the pain is tolerable, and no obstruction is present, the client is managed medically with vigorous hydration, analgesics, antimicrobial therapy, and drugs that dissolve calculi or eventually alter conditions that promote their formation (Table 64-1 pg 1132)
ESWL is administered with the client in a water bath or surrounded by a soft cushion while under light anesthesia or sedation.
Stones can also be pulverized with laser lithotripsy.--- to do so, a fine wire, through which the laser beam passes, is inserted into the ureter by means of a cystoscope. Repeated bursts of the laser reduces the stone to a fine powder, which is then passed in the urine.
Other stone removal procedures are performed with ureteroscopic approaches in which the endoscope is inserted from the urethra into the upper urinary tract under anesthesia to grasp, crush, and remove stones from the kidney pelvis or ureter.
Afterward, a catheter or ureteral stent , a slender supportive device, is left in place for 3 days to splint the ureter or divert the urine past any possible tear in the ureteral wall (fig 64-7) pg 1134
If the stone cannot be removed, a ureteral catheter is left in place for 24 hours to dilate the ureter in the hope that the stone will pass through it or that it will be pulled into the bladder when the catheter is removed.
A stricture is a narrowing of a lumen; in this case the ureter is narrowed
The recurrent inflammation and infection cause scar tissue to accumulate within the ureter.
Other conditions that can interfere with urine passing through the ureter are congenital anomalies or conditions that mechanically compress the ureter such as pregnancy and tumors within the abdomen or upper urinary tract.
The main complication associated with ureteral surgery is failure of the ureter to transport urine from the kidney to the bladder.
Contact the MD if signs of shock appear, urinary output from the ureteral catheter is decreased or absent, or if the client complains of significant abdominal pain, which may indicate leakage of urine into the peritoneal cavity.
The inability of the nephrons within the kidneys to maintain fluid, electrolyte, and acid-base balance, excrete nitrogen waste products, and perform regulatory functions such as maintaining calcification of bones and producing erythropoietin.
Azotemia, marked accumulation of urea and other nitrogenous wastes such as creatinine and uric acid in the blood, creates a potential for neurologic changes such as seizures, coma, and death.
Some clients excrete urinary volumes greater than 500 mL/day. However, the urine has a very low specific gravity because it lacks normal amounts of excreted substances such as excess potassium and hydrogen ions, to maintain homeostasis.
During dialysis the client’s blood is filtered by diffusion and osmosis.
Substances such as urea, creatinine,and dangerously high levels of potassium, and water move FROM the blood through the semipermeable membrane TO the dialysate, the solution used during dialysis that has a composition similar to normal human plasma.