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GU Calculi
 

GU Calculi

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    GU Calculi GU Calculi Presentation Transcript

    • Kidney Stones Natalie Bennett Christina Karanasos Jessica Reetz
    • Stone Formation
      • Highly concentrated urine constituents crystallize and harden to form calculi.
      • Contributing factors:
        • Altered pH
        • Age/gender
        • Urine stasis and/or retention
        • UTI
        • Dehydration
        • Genetics
        • Climate
        • Underlying disorders
        • Diet
        • (Hanson, 2005) and (Lewis, et al., 2007)
    • Types of Stones
      • Calcium oxalate
      • Calcium phosphate
      • Struvite
      • Uric acid
      • Cystine
      • (Morton, Iliescu, and Wilson, 2002)
    • Diagnostic Tests
      • Urinalysis
      • IVP
      • Abdominal ultrasound
      • CT
      • KUB
      • Cystoscopy
      • (MayoClinic, 2008)
    • Treatment
      • TREAT THE PAIN!!!
      • Lithotripsy
      • Ureteroscopy
      • Surgical removal
      • Percutaneous nephrolithotomy
      • Nutritional therapy
      • (Hanson, 2005)
    • Trivia
      • What are common signs and symptoms of kidney stones?
    • Answer
      • Severe flank or lower abdominal pain
      • Dysuria
      • Hematuria
      • N/V
      • Chills and fever (if infection is present)
      • Blocked urinary flow
      • Anxiety
      • Pallor and/or cool, clammy skin
      • (Moe, 2006) and (National Kidney Foundation, 2009)
    • Trivia
      • Case Study #2: The MD orders an IVP (intravenous pyelogram). What question do you need to ask S.R. before the test is conducted?
    • Answer
      • Ask if patient is allergic to shellfish or iodine.
      • * Note: If patient is severely dehydrated, IVP may cause renal shutdown.
    • Trivia
      • This is the famous logo of which band?
    • Answer
      • The Rolling Stones !!!!!
    • Trivia
      • List nursing interventions for the following diagnosis:
        • Acute pain r/t effects of renal stone and inadequate pain control or comfort measures
    • Answer
      • PQRST pain assessment
      • Pain control measures to prevent break through pain
      • Administer pain meds as ordered
      • Teach use of nonpharmacologic techniques
      • (Lewis, et al., 2007)
    • Trivia
      • Case Study #4: What are the two most common types of stones?
    • Answer
      • Calcium and struvite stones
      • (Lewis, et al., 2007)
    • Trivia
      • What is the name of this famous landmark?
    • Answer
      • Stone henge!!!
    • Trivia
      • Case Study #10: Because S.R.’s stone has been reported as calcium oxalate, what type of diet would be recommended?
    • Answer
      • Increase fluid intake
      • Consume adequate amounts of calcium
      • Limit dietary oxalates
      • Limit sodium intake
      • (Krieg, 2005)
    • Trivia
      • What is the name of the first book in the Harry Potter series?
    • Answer
      • Harry Potter and the Sorcerer’s Stone !!!
    • Trivia
      • What commonly prescribed drug increases the risk of developing kidney stones due to increased renal excretion of calcium?
    • Answer
      • Lasix
      • *Note: Topamax and Indinavir also increase the risk for kidney stones.
      • (Deglin and Vallerand, 2007) and (WebMD, 2006)
    • Trivia
      • True/False: It is important to force fluids on a patient with a kidney stone.
      • Why or why not?
    • Answer
      • False. It is not effective in assisting the patient to pass the stone and may exacerbate the pain.
      • (Lewis, et al., 2007)
    • Trivia
      • Name two nursing diagnosis besides pain and list two interventions for each.
    • Answer
      • Impaired urinary elimination
        • Monitor I&O’s and urine characteristics
        • Teach patient to drink adequate amounts of liquids
        • Teach s/s of UTI
      • Anxiety
        • Remain with and calm patient
        • Provide education on condition
        • Teach relaxation techniques
    • Trivia
      • Fill in the Blank:
      • The term __________ refers to the stone, and _________ refers to stone formation.
    • Answer
      • The term calculus refers to the stone, and lithiasis refers to stone formation.
      • (Lewis, et al., 2007)
    • Trivia
      • What’s the name of the
      • “ modern stone-age family, from the town of Bedrock (They’re a page right out of history…)”
    • Answer
      • The Flint stones !!!
    • Trivia
      • Case Study #7: S.R. was discharged with instructions to strain all urine and return if she experienced pain unrelieved by pain meds or increased N/V.
      • What specific instructions will you give S.R. about her urine, fluid intake, meds, and activity?
    • Answer
      • Urine: check for cloudy, malodorous urine, presence of blood (may be tea colored)
      • Fluid intake: ensure adequate hydration (6-8 glasses/day), avoid overhydration
      • Meds: teach about side effects, don’t take more than directed
      • Activity: teach pt. that ambulation will help with passage of stone
    • References
      • Deglin, J. & Vallerand, A. (2005). Davis’s drug guide for nurses (10 th ed.). Philedelphia: F. A. Davis Company.
      • Flagg, L. (2007). Dietary and holistic treatment of recurrent calcium oxalate kidney stones: Review of literature to guide patient education. Urologic Nursing, 27, 113-121.
      • Guan, N. (2009). Melamine-contaminated powdered formula and urolithiasis in young children. The New England Journal of Medicine, 360, 1067-1074.
      • Hanson, K. (2005). Minimally invasive and surgical management of urinary stones. Urologic Nursing, 25, 458-464.
      • Krieg, C. (2005). The role of diet in the prevention of common kidney stones. Urologic Nursing, 25, 451-456.
      • Lewis, S., Heitkemper, M., Dirksen, S., O’Brien, P., & Bucher, L. (2007). Medical surgical nursing: Assessment and management of clinical problems (7 th ed.). St. Louis: Mosby Elsevier.
      • Mayo Clinic. (2008). Kidney stones. Retrieved April 20, 2009 from http://www.mayoclinic.com/health/kidney-stones/ds00282 .
      • Moe, O. (2006). Kidney stones: Pathophysiology and medical management. The Lancet, 367, 333-344.
      • Morton, A., Iliescu, E., & Wilson, J. (2002). Nephrology: Investigation and treatment of recurrent kidney stones. Canadian Medical Association Journal, 166 , 213-218.
      • Moyer, M., O’Gara, J., & Burrus, L. (1988). General anesthesia for extracorporeal shock wave lithotripsy. Journal of the American Association of Nurse Anesthetists, 56, 121-125.
      • Schardt, D. (2009). Skipping stones: How to avoid kidney stones. Nutrition Action Healthletter, 9-11.
      • Stegall, M. (2001). Urinary tract stones: Causes, complications and treatment. British Journal of Nursing, 10.
      • Taylor, E. & Curhad, G. (2008). Fructose consumption and the risk of kidney stones. Kidney International, 73, 207-212.
      • U.S. Department of Health and Human Services. (2007). Kidney stones in adults. Retrieved April 20, 2009 from http://kidney.niddk.nih.gov/kudiseases/pubs/pdf/KidneyStonesAdults.pdf .