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Kidney Stones Natalie Bennett Christina Karanasos Jessica Reetz
Stone Formation <ul><li>Highly concentrated urine constituents  crystallize and harden to form calculi. </li></ul><ul><li>...
Types of Stones <ul><li>Calcium oxalate </li></ul><ul><li>Calcium phosphate </li></ul><ul><li>Struvite </li></ul><ul><li>U...
Diagnostic Tests <ul><li>Urinalysis </li></ul><ul><li>IVP </li></ul><ul><li>Abdominal ultrasound </li></ul><ul><li>CT </li...
Treatment <ul><li>TREAT THE PAIN!!! </li></ul><ul><li>Lithotripsy </li></ul><ul><li>Ureteroscopy </li></ul><ul><li>Surgica...
Trivia <ul><li>What are common signs and symptoms of kidney stones? </li></ul>
Answer <ul><li>Severe flank or lower abdominal pain </li></ul><ul><li>Dysuria </li></ul><ul><li>Hematuria </li></ul><ul><l...
Trivia <ul><li>Case Study #2: The MD orders an IVP (intravenous pyelogram). What question do you need to ask S.R. before t...
Answer <ul><li>Ask if patient is allergic to shellfish or iodine. </li></ul><ul><li>* Note: If patient is severely dehydra...
Trivia <ul><li>This is the famous logo of which band? </li></ul>
Answer <ul><li>The Rolling  Stones !!!!! </li></ul>
Trivia <ul><li>List nursing interventions for the following diagnosis: </li></ul><ul><ul><li>Acute pain r/t effects of ren...
Answer <ul><li>PQRST pain assessment </li></ul><ul><li>Pain control measures to prevent break through pain  </li></ul><ul>...
Trivia <ul><li>Case Study #4: What are the two most common types of stones? </li></ul>
Answer <ul><li>Calcium and struvite stones </li></ul><ul><li>(Lewis, et al., 2007) </li></ul>
Trivia <ul><li>What is the name of this famous landmark? </li></ul>
Answer <ul><li>Stone henge!!! </li></ul>
Trivia <ul><li>Case Study #10: Because S.R.’s stone has been reported as calcium oxalate, what type of diet would be recom...
Answer <ul><li>Increase fluid intake </li></ul><ul><li>Consume adequate amounts of calcium </li></ul><ul><li>Limit dietary...
Trivia <ul><li>What is the name of the first book in the Harry Potter series? </li></ul>
Answer <ul><li>Harry Potter and the Sorcerer’s  Stone !!! </li></ul>
Trivia <ul><li>What commonly prescribed drug increases the risk of developing kidney stones due to increased renal excreti...
Answer <ul><li>Lasix </li></ul><ul><li>*Note: Topamax and Indinavir also increase the risk for kidney stones. </li></ul><u...
Trivia <ul><li>True/False: It is important to force fluids on a patient with a kidney stone.  </li></ul><ul><li>Why or why...
Answer <ul><li>False. It is not effective in assisting the patient to pass the stone and may exacerbate the pain. </li></u...
Trivia <ul><li>Name two nursing diagnosis besides pain and list two interventions for each. </li></ul>
Answer <ul><li>Impaired urinary elimination </li></ul><ul><ul><li>Monitor I&O’s and urine characteristics </li></ul></ul><...
Trivia <ul><li>Fill in the Blank: </li></ul><ul><li>The term __________ refers to the stone, and _________ refers to stone...
Answer <ul><li>The term  calculus  refers to the stone, and  lithiasis  refers to stone formation. </li></ul><ul><li>(Lewi...
Trivia <ul><li>What’s the name of the  </li></ul><ul><li>“ modern stone-age family, from the town of Bedrock (They’re a pa...
Answer <ul><li>The Flint stones !!! </li></ul>
Trivia <ul><li>Case Study #7: S.R. was discharged with instructions to strain all urine and return if she experienced pain...
Answer <ul><li>Urine: check for cloudy, malodorous urine, presence of blood (may be tea colored) </li></ul><ul><li>Fluid i...
References <ul><li>Deglin, J. & Vallerand, A. (2005). Davis’s drug guide for nurses (10 th  ed.). Philedelphia: F. A. Davi...
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GU Calculi

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Transcript of "GU Calculi"

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