2. Renal calculi…
• Are hard, generally small stones that form
somewhere in the renal structures.
• The stones are masses of crystals and protein
that form when the urine becomes
supersaturated with a salt capable of forming
solid crystals
3. Pathophysiology
• Stones vary in size from minute granular deposits to the
size of an orange.
Factors that favor stone formation
• Family history
• Infection,
• Urinary stasis,
• Immobility
• Deficiency of substances that normally prevent
crystallization in the urine (e.g. nephrocalcin, and
uropontin)
• The fluid volume status of the patient
4. Calculi may be found anywhere from the kidney to the
urethra.
5. Stone Passage
• A stone can traverse the ureter without symptoms,
but passage usually produces pain and bleeding.
• The pain begins gradually, usually in the flank, but
increases over the next 20–60 min to become so
severe that narcotics may be needed for its control.
Stones less than 5 mm are readily passed in the
urine spontaneously.
6. Types of stones
Calcium stones (calcium oxalate and phosphate)
• Make up 75–85% of the total stone
• More common in men
• The average age of onset is the third to fourth
decade.
• Approximately 50% of people who form a single
calcium stone form another within the next 10
years
7. Uric acid stones
• 5–10% of all stones
• May be idiopathic, precipitated by gout,
heredity
• Also more common in men
Struvite stones (5%)
Cystine stones (1%)
8.
9. Clinical Manifestations
• Manifestations depend on the presence of
obstruction, infection, and edema
• Symptoms range from mild to excruciating pain
and discomfort.
10. Stones in Renal Pelvis
• Intense, deep ache in costovertebral region
• Hematuria and pyuria
Pain that radiates anteriorly and downward
toward bladder in female and toward testes in
male
• Acute pain, nausea, vomiting, costovertebral
area tenderness (renal colic)
• Abdominal discomfort, diarrhea
11. Ureteral Colic (Stones Lodged in Ureter)
• Acute, excruciating, colicky, wavelike pain,
radiating down the thigh to the genitalia
• Frequent desire to void, but little urine
passed; usually contains blood because of the
abrasive action of the stone (known as
ureteral colic)
12. Stones Lodged in Bladder
• Symptoms of irritation associated with urinary
tract infection (Dysuria, frequency, urgency)
• Hematuria
• Urinary retention
• Possible urosepsis if infection is present with
stone
13. Diagnostic Tests
• X-rays of the kidneys, ureters, and bladder
• Ultrasound
• A 24-hour urine test for measurement of
(calcium, uric acid, creatinine, sodium, pH,
and total volume)
14. Medical management
Goal: To eradicate the stone, control infection,
relive any obstruction that may be present
Pharmacologic and Nutritional Therapy
• Opioid analgesic agents and NSAIDs
• Increased fluid intake to assist in stone passage
For calcium stones: reduced dietary protein and
sodium intake; liberal fluid intake; medications to
acidify urine, such as ammonium chloride and
thiazide
For uric stones: low-purine and limited protein
diet
15. Medical mgt…
• For cystine stones: low-protein diet;
alkalinization of urine; increased fluids.
• For oxalate stones: dilute urine; limited oxalate
intake (spinach, strawberries, rhubarb,
chocolate, tea, peanuts, and wheat bran)
• Surgical removal may be required for large
stones, obstructions, or intractable pain
• LITHOTRIPSY: Lithotripsy therapy is the use of
sound, laser, or dry shock-wave energies to
break the stone into small fragments.
16. Nursing Process??
Assessment
• Assess for pain and discomfort, including severity,
location, and radiation of pain
• Observe for signs of urinary tract infection (chills,
fever, frequency, and hesitancy) and obstruction
(frequent urination of small amounts, oliguria, or
anuria).
• Observe urine for blood; strain for stones or
gravel
• Assess patient’s knowledge about renal stones
and measures to prevent recurrence.
17. Nursing Diagnosis
• Acute pain related to inflammation,
obstruction, and abrasion of the urinary tract
• Deficient knowledge regarding prevention of
recurrence of renal stones
18. Nursing Interventions
Relieving Pain
• Administer opioid analgesics (IV or
intramuscular) with IV NSAID as prescribed.
• Encourage and assist patient to assume a
position of comfort.
• Assist patient to ambulate to obtain some pain
relief.
• Monitor pain closely and report promptly
increases in severity.
19. Monitoring and Managing Complications
• Encourage to increase fluid intake 3,000 to
4,000 mL water every 24 hours
• Begin IV fluids if patient cannot take adequate
oral fluids.
• Monitor total urine output and patterns of
voiding.
• Encourage ambulation as a means of moving
the stone through the urinary tract
20. • Instruct patient to report decreased urine
volume, bloody or cloudy urine, fever, and pain.
• Instruct patient to report any increase in pain.
• Monitor vital signs for early indications of
infection;
Infections should be treated before efforts are
made to dissolve the stone.
