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1. PRESENTED BY
NEHA VERMA
M.SC NURSING

2. TERMINOLOGY
 Urolithiasis - Stone in urinary tract
 Nephrolithiasis – Stone in kidney
 Ureterolithiasis- Stone in ureters ( most painful)

3. INTRODUCTION
 A kidney stoneor renal calculi are hard deposits of
minerals or salts , that are forms in kindney and
present in different sizes.
 It may occurs due to diet, overweight, some
medical conditions, medication and often occurs
when urine becomes concentrated, allowing
minerals to crystallize and stick together.
 Stones may be formed in the kidney, urinary
bladder, ureter and urethra.

5. DEFINITION
1. A kidney stone, also known as a renal calculus or
nephrolithiasis , it is define as calculi formation in
kidney and kidney part .
Acc. To P.K. Panwar
2. Kidney stone / renal calculi is solid mass made up
of crystals present in kidney or ureter.
Acc. To M.P. Sharma

7. ETIOLOGY
 Diet pattern –
80% causes of stone.
high in calcium , magnesium , phosphate
Family history
Dehydration
UTI & prolonged catheterization
Other disease of kidney –
 Renal failure
 Nephritis
 Dehydration
 Obstruction

8. TYPES
There are mainly five types
1. Calcium oxalate stone (is the most
common 80%)
2. Cystine stone
3. Struvite stone (triple stone)
4. Uric acid stone
5. Others stone

9. 1. CALCIUM OXALATE STONE:-
 It is the most common type of renal stones, about
80%.
 Calcium stones are the most Common stones
present in urinary tract.
 Calcium based stone are most commonly seen
in young men between the age of 20 and 30
years.
 It is present in foods such as spinach and vitamin
C supplements and citrus fruits .

10. 2.CYSTINE STONE
 Cystine stone is rare can form in people who have
cystinuria . It is cystine is a protein, about 2% of
chance
 It can affect both women and men .
(cystine source avoid meat milk, cheese, egg)

11. 3. STRUVITE STONE
 These stones are formed of struvite ( Mg amonium
phasphate)
 This type of stone is mostly found in women who
have a urinary tract infection.
 These stone can grow very large and can block
the kidney, ureter or bladder.

12. 4. URIC ACID STONE
 It is second most common type of renal stones
about10%.
 This type of stone is more Common in men than
women. They Can occur in individual with gout or
those taking chemotherapy .

13. OTHERS
 Other substances like medication like acylovir,
triamterene also can cause stones.

14. PATHOPHYSIOLOGY
due to any etiology factor
urine supersaturation
crystal nucleation
crystal growth
crystal aggregation
stone formation
Renal calculi

15. CLINICAL MANIFESTATION
 Usually symptoms of kidney stones may not occurs
until the stones reach to the ureters.
 Renal colic or severe sharp pain occurs in flank
area , that also radiate to lower abdomen and groin
.

16.  Pain or burning sensation while urinating.
 Other symptoms –
 Pink , red or brown urine.
 Cloudy or foul smelling urine.
 Uregency of urination ( sudden uncontrollabe, need
to urinate )
 Urinating small amounts of urine.
 Note _ kidney stones sometimes considered “the
great mimicker” but common their symptoms very
similar to appendicitis , gastritis, UTI, ovarian or
testicular conditions.

17. DIAGNOSTIC TEST
 History collection
 Physical examination
 Blood test ( to check calcium, phosphorus, uric acid and
electrolyte level)
 Urinalysis ( to see crystals and look for RBC in urine )
 Examine of stone to determine the type of stone or
blockage can be seen on :
 Abdominal CT scan
 Abdominal / kidney MRI
 Abdominal x-ray( less commonly )
 USG
 Intravenous pyelogram

19. MANAGEMENT- MANAGEMENT OF KIDNEY
STONES DEPENDING ON TYPE OF STONE AND
CAUSE OF STONE .
(A) Small stones with minimal symptoms _
Most small stones not require surgery, these may pass
by-
- drinking enough water ( 2.5- 3.5 lit/day )
Medical therapy – (<5mm treat medicine _ 10mm(50%
chance ), if >10 mm required surgery)
 Pain relievers_ ibuprofen, naproxen
 Uric acid stones_ allopurinol (zyloprim)
 Struvite stones_ antibiotics ( amoxicilline,
cotrimaxazole)
 Ca stones_ thiazide diuretics to prevent forming of
Calcium stones.
 To relax smooth muscles_ Jolyn (tamsulosin
+dutasteride)

20. (B) LARGE STONES
 Extracorporeal shockwave lithiotripsy-
It uses sound waves to create strong vibrations
(shock waves) that break stones into tiny pieces
that can be passed in to urine .
This procedure last about 45- 60 mins

21. (B) NEPHROLITHIOTOMY
 In this procedure a incision is made in flank area,
from which a small tube with scope inserted in to
the kidney and removes the stones.
 This procedure performed when extracorporeal
shockwave lithiotripsy is unsucessful.

22. (C) URETEROSCOPY
 In this procedure, first of all surgeon placed a tube
with camera into ureter by making incision into
bladder.
 A small cage is used to snag the stone and remove
it.

23. PREVENTION
 Avoid protein intake:-usually protein is restricted to
60 kg/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
hypercalcuria evidence shows that limiting calcium,
especially in women can lead to osteoporosis and
does not prevent renal stone.

24. CONT..
 Avoid intake of oxalate-containing foods (e.g.
spinach, strawberries, tea, peanuts, wheat bran)
 During the day, drink fluids (ideally water) every day
1-2 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.
 Avoid activities leading to sudden increase in
environmental temperature that may cause
excessive sweating and dehydration.
 Contact your primary health care provide at the first
sign of a urinary tract infection.

25. NURSING DIAGNOSIS
1-Acute pain related to obstruction in urine flow.
2-Deficient knowledge related to disease condition.
3-Impaired urinary elimination related to mechanical
obstruction.
4- Risk for infection related to introduction of bacteria
following manipulation of the urinary tract and
obstructed urinary blood flow.
5-Altered daily living pattern related to restlessness
and sudden attack of pain.

26. NURSING MANAGEMENT
 Advise the patient at least 6-8 glasses of water per
day to produce a large amount of urine. This will
help to pass the stone.
 Instrut to take a low sodium diet.
 Advise the patient to avoid the diet high in calcium,
purine and vitamin C.
 Monitor urine output, frequency, consistency odour,
volume and colour to evaluate the petency of
urinary system.
 Assess the quality, intensity, severity location and
frequency of pain.

27.  Advise the patient to change life style pattern.
 Advise the patient to avoid prolonged sitting and
standing.
 Administer the medications as the prescription.
 Check and maintain input and output chart.
 Teach the patient that this condition may lead to
urinary tract infection so explain about sign and
symptoms of UTI.
 Educate about the proper care of wound if surgical
opening to remove stone.
 Use the pain control measure before it become
severe.

28. COMPLICATION
 Urinary tract infection.
 Kidney damage or scarring (if treatment is delay
for too long)
 Obstruction of ureter (acute unilateral obstructive
uropathy).

29. CONCLUSION
 Kidney stones can develop as a result of several
factors, including dehydration , the urine become
concentrated and minerals can from crystals that
can ultimately develop into stones.

30. SUMMARY-
 Introduction
 definition
 Etiology
 Risk factor
 Types
 Pathophysiology
 Clinical manifestation
 Management
 Prevention
 Complication

32. BIOLIOGRAPHY
 Brunner and Suddarth’s , “Text book of Medical Surgical
Nursing” ,3rd volume , 9 th edition, Wolters Kluwer : Wolters
publication, (2001), page no.1389-1402.
 Lippincott, “ Text book of manual of Medical Surgical
Nursing,”6th volume, Edition- 10th,Wolters Kluwer:Wolters Kluwer
Pvt.Ltd. ; 2009,page no.1098-1123
 M.P. Sharma , “Text book of medical surgical nursing”, 1st
edition, Virendra kumar: AITBS Publishers;2016,page no. 234-
238.
 P.K. Panwar, “ Textbook of Medical Surgical Nursing”,6th edition,
Virendra Kumar Arya:AITBS Publishers; 2022,page no.345-349
 https://www.ncbi.nih.gov

33. THANK YOU