3. INTRODUCTION
A kidney stone is a hard solid mass of material that forms in the
kidney from the substances in the urine.
Kidney stones or calculi develop as a result of various metabolic
disorders which affect the fate of calcium and other mineral
elements in the body.
Stones may be formed in the kidney, urinary bladder, ureter
and urethra
4. DEFINITION
A kidney stone, also
known as a renal
calculus or
nephrolith, is a
solid piece of
material which Is
formed in the
kidneys from
minerals in urine
5. ETIOLOGY
Unknown
Risk factor:-
Imbalance of pH in urine Alkalic: - Calcium
stone Acidic:- Uric & cristine stone
Gout
Hyperparathyroidism
6. CONT…
RISK FACTORS :-
Immobility
Sedentary life style
Dehydration
Metabolic disturbances
History of renal calculi
7. CONT…
High mineral content in drinking water
Dietary intake
UTI
Prolonged Indwelling Catheterization
8. TYPES
There are mainly 5 types:-
1.Calcium oxalate stone (Is the most common
80% )
2. Calcium phosphate stone
3. Struvite stone (Triple stone)
4. Uric acid stone
5. Cystic stone
9.
10. TYPES
1.Calcium oxalate stone :-
(Is the most common 80% )-
Caused by super -
saturation of urine with
calcium & oxalate
Calcium oxalate stone tend to
form in alkaline chemistry
( Avoid food high in
oxalate(beer, wheat germ,
spinach).
11. CONT..
2. Calcium phosphate stone:-
(5-10%):- Caused by
super -saturation of urine with calcium
phosphate.
Calcium phosphate stone tend to form in
alkaline chemistry
(Avoid food high in calcium (Milk & dairy
product)
12. 3. Struvite stone (Triple phosphate stone):-
Caused by urea splitting bacteria (Proteus, Pseudomonas,
Klebsiella, Staphylococcus). more common in women then the man
because of UTI
Struvite stone tend to form in alkaline chemistry
13. 4. Cystic stone (10-15%):-
Caused by cystine crystal
formation.
Cystic stone tend to form
in Acidic urine ( cystine
source Avoid meat milk
,cheese, Egg)
14. 5. Uric acid stone (5-10%):-
Caused by excessive dietary
purine or gout
Uric acid stone tend to form in
Acidic urine (Avoid purine
sources eg. Meats, gravies, red
wine)
19. CLINICAL MANIFESTATION
Severe pain in the side and back, below the ribs
Pain that spreads to the lower abdomen and groin
Pain that comes in waves and fluctuates in
intensity
Pain on urination
Cloudy or foul-smelling urine
Nausea and vomiting
Fever and chills if an infection is present
Urinating small amounts of urine
31. 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.
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.
32. CONT..
Avoid intake of oxalate-containing foods (e.g.
spinach, strawberries, tea, peanuts, wheat bran).
During the day, drink fluids (ideally
water)everyday1 to 2 hours.
Drink two glasses of water at bedtime and an
additional glass at each night time awakening to
prevent urine from becoming too concentrated
during the night
33. CONT..
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.
34. NUTRITIONAL THERAPY
Foods high in purine, calcium, or oxalate:
Purine:
High: Sardines, herring, mussels, liver, kidney,
goose, venison, meat soups sweetbreads
Moderate: Chicken, salmon, crab, veal, mutton,
bacon, pork, beef, ham
Calcium: milk, cheese, ice cream, yogurt, sauces
containing milk, all beans (except green beans),
lentils, fish with fine bones (sardines, kippers
herring, salmon); dried fruits, nuts, chocolate, cocoa.
Oxalate: spinach, rhubarb, asparagus, cabbage,
tomatoes, beets, nuts, celery, parsley, runner beans,
chocolate, cocoa, instant coffee, Ovaltine, tea;
Worcestershire sauce
35.
36. NURSING DIAGNOSIS
1. Acute pain related to irritation and spasm from
stone movement in the urinary tract as
manifested by complaints of pain, facial
grimacing, restlessness.
Goal :-
To reduce pain.
Intervention:-
37. CONT…
2. Anxiety related to uncertain outcome and lack of
knowledge regarding possible surgery as
manifested by expressions.
Goal:-
To reduce anxiety.
Intervention:-
38. CONT…
3. Impaired urinary elimination related to trauma or
blockage of ureters or urethra as manifested by
decreased urinary output and bloody urine.
Goal:-
To increase the urine out put.
Intervention
39. CONT…
4. Risk for infection related to introduction of
bacteria following manipulations of the urinary
tract and obstructed urinary blood flow.
Goal:-
To reduce the risk of infection.
Intervention
40. NURSING DIAGNOSIS
5. Acute pain r/t obstructing urinary Calculus.
6. Altered urinary elimination related To presence
of urinary calculi
7. Risk for infection r/t obstructing Urinary
calculus.
8.Altered renal peripheral tissue Perfusion r/t
post renal Obstruction
41. BIBLIOGRAPHY
Brunner and Suddarth's text book of medical –surgical
nursing twelfth edition . Page no. 1295.
Lewis’s medical –surgical nursing , assessment and
management of clinical problems , second edition .
Page no. 1131.
