1. The lesson plan discusses renal calculi, also known as kidney stones. It covers the definition, incidence, risk factors, pathophysiology, clinical manifestations, diagnostic evaluation, medical and surgical management, nursing management, and health education regarding renal calculi. 2. Risk factors for renal calculi include metabolic abnormalities, climate, diet, genetics, lifestyle, and certain medical conditions. Symptoms can include pain in the flank area, hematuria, nausea, and vomiting. Diagnostic tests include blood tests, urine analysis, x-rays, ultrasounds, and CT scans. 3. Treatment involves pain management, increased fluid intake, medications, surgery such as lithotripsy, and following a diet

1. SUB- MEDICAL SURGICAL NURSING
LESSON PLAN ON: RENAL CALCULI
Presented By:-
MR. Amos P. Talsandekar
Assistant Professor
D. Y. Patil College of Nursing, Kplhapur

2. Name of the student : MR. Amos Talsandekar
Subject : Medical Surgical Nursing
Unit : 06
Topic : Renal Calculi
Group : 2nd
Year B.Sc (N)
Number of the Students : 50
Date : -
Time : -
Name of evaluator : -
Medium of Instruction : English
Method of Teaching : Lecture cum discussion method
Duration : 45 min
Venue : 2nd
Year B.Sc (N) Class room.
Previous knowledge : Student will have knowledge regarding Anatomy & Physiology of Renal System.
AV-Aids : Black board, Chart, PPT, OHP, Flash card, Pamplets, Chits

3. TIME SPECIFIC
OBJECTIVE
CONTENT TEACHER
ACTIVITY
STUDENT
ACTIVITY
AV
AIDS
EVALUATION
02 min UROLITHIASIS (RENAL CALCULI)
Urinary obstruction refers to any anatomic or
functional condition that blocks or impedes the flow of
urine and urinary calculi is one of the common causes
for obstruction. Alteration in renal function occurs and
treatment requires loca5tion and relief of the blockage.
02 min Define Renal
Calculi
DEFINITION OF UROLITHIASIS
(RENAL CALCULI)
Urolithiasis refers to stones (calculi) in the
urinary tract.
Which are
functions if
kidney ?
Listening & taking
notes.
O
H
P
What is Renal
Calculi?
02 min Discuss the
incidence of
Renal Calculi.
INCIDENCE
Each year an estimated 500,000 people in the
United States have nephrolithiasis. Majority of patients
are between 20-55 years of age. Stone formation more
common in whites than in African Americans.
Incidence is also higher in persons with a family
history of stone formation. Recurrence of stones can
Writing on
chalk board
and Explaining
Listening carefully C
H
A
L
K
What is the
incidence of Renal
Calculi?

4. TIME SPECIFIC
OBJECTIVE
CONTENT TEACHER
ACTIVITY
STUDENT
ACTIVITY
AV
AIDS
EVALUATION
occur in up to 50% of patient.
B
O
A
R
D
05 min
Enumerate the
Risk factors of
Renal Calculi.
RISK FACTORS
METABOLIC
Abnormalities that result in increased urine
levels of calcium, oxaluric acid, uric acid, or citric acid
CLIMATE
Warm climate that cause increased fluid loss, low urine
volume and increased solute concentration of urine.
DIET
- Large intake of dietary protein that increases uric
acid excretion.
- Excessive amount of tea or fruit juices that elevate
urinary oxalate level
- Large intake of calcium & oxalate
- Low fluid intake that increases urinary
concentration.
What is the
normal
calcium level
in urin ?
Listening carefully
and asking the
doubts.
F
L
A
S
H
C
A
R
D
What are the
Etiological factors
of Renal Calculi?

5. TIME SPECIFIC
OBJECTIVE
CONTENT TEACHER
ACTIVITY
STUDENT
ACTIVITY
AV
AIDS
EVALUATION
GENETIC FACTOR
Family history of stone formation, gout or renal
acidosis.
LIFE STYLE
Sedentary occupation , immobility
02 min LOCATION OF STONE FORMATION
P
P
T

6. TIME SPECIFIC
OBJECTIVE
CONTENT TEACHER
ACTIVITY
STUDENT
ACTIVITY
AV
AIDS
EVALUATION
03 min Enlist the causes
of Renal Calculi
TYPES OF RENAL CALCULI &
ETIOLOGY
What types of
calculi find in
the kidney ?
Listeining carefully,
asking the doubts and
taking nots
P
P
T
What are the
causes of Renal
Calculi?
TYPES OF
URINARY STONE
CAUSE
Calcium oxalate
Idiopathic, hyper calciuria,
family history, excessive intake
of vitamin D, excessive intake
of milk & alkali
Calcium phosphate
Alkaline urine, hyper
parathyroidism
UTI, ammonia rich urine
Uric acid Gout(disease characterized by
inflammation of joint), acid
urine
Cystine Acid urine
05 min Explain the PATHOPHYSIOLOGY

7. TIME SPECIFIC
OBJECTIVE
CONTENT TEACHER
ACTIVITY
STUDENT
ACTIVITY
AV
AIDS
EVALUATION
Pathophy-
siology of Renal
Calculi.
Super saturation
Nucleation / Crystallization
Traveling of particle down to urinary tract
Particles get trapped in some narrower points
Aggregation of crystals & formation of stone due to action
of chelating agents
Obstruction of urine flow
Clinical manifestation
What are the
organs of the
urinary
system ?
Listening carefully
and asking doubts.
C
H
A
R
T
How Renal Calculi
Occur ?
05 min Describe clinical CLINICAL MANIFESTATIONS

8. TIME SPECIFIC
OBJECTIVE
CONTENT TEACHER
ACTIVITY
STUDENT
ACTIVITY
AV
AIDS
EVALUATION
manifestation of
Renal Calculi
Stones in the Renal pelvis :
- Intense deep ache in costovertebral region.
- Hematuria
- Pain originate in the renal area radiating anteriorly
& downward towards bladder in females& testes in
males.
- Diarrhea & abdominal discomfort
- Nausea & vomiting
Stone in the ureter:
- Acute, wave like pain
- Pain radiates to thigh & genitalia
- Desire to void, less urine is passed
- Hematuria
What do you
mean
Hematuria ?
Listening carefully
& taking notes.
B
L
A
C
K
B
O
A
R
D
What are the
clinical
manifestation of
Renal Calculi?
03 min Illustrate the
diagnostic
evaluation for
Renal Calculi.
DIAGNOSTIC EVALUATION
- - History collection & physical examination
- Blood studies
pH
Calcium
Uric acid
What is the pH
level of the
blood ?
Listen carefully,
taking notes &
answer the
question.
B
L
A
C
K
B
O
What Diagnostic
evaluation you will
do for Renal
Calculi?

9. TIME SPECIFIC
OBJECTIVE
CONTENT TEACHER
ACTIVITY
STUDENT
ACTIVITY
AV
AIDS
EVALUATION
Creatinine
Sodium
- X-ray- of pelvic region shows the position of the
calculi.
- Cystoscopy- It is the Endoscopy of the Urinary
bladder via the ureters.
- Ultrasound- Ultrasound shows the position and
size of the calculi.
- IVP- Intravenous pyelogram is an X-ray
examination if kidney, ureters and Urinary bladder
that use iodine Contrast Material
-Urine culture- To detect the infection
- Spinal CT scan- Spinal CT technique to find out
Stone.
- Urin analysis- Hematuria, Pyurea. pH less than 5.5
indicate uric acid stone.
A
R
D

10. TIME SPECIFIC
OBJECTIVE
CONTENT TEACHER
ACTIVITY
STUDENT
ACTIVITY
AV
AIDS
EVALUATION
05 min Explain medical
management for
Renal Calculi.
TREATMENT
Medical Management
- Opioid analgesics to prevent shock and syncope.
- Hot bath or moist heat over flank area to decrease
pain
- Increase fluid intake- 2 to3 liter per day.
Calcium stones
- Cellulose sodium phosphate(calcibind)-: Drug
used to treat Hypercalciumia
- diuretics
Uric acid stones
- Allopurinol- Used to treat reduce level of uric acid.
Cystine stones
-Penicillamine- It is chelating agent It attacks other
chemicals in our body.
Explaining
Listen carefully,
taking notes and
answer the
question.
P
P
T
What is the
medical
management for
Renal Calculi.?

11. TIME SPECIFIC
OBJECTIVE
CONTENT TEACHER
ACTIVITY
STUDENT
ACTIVITY
AV
AIDS
EVALUATION
05 min
Discuss the
surgical
management of
the Renal
Calculi.
SURGICAL THERAPY
LITHOTRIPSY
- Percutaneous ultrasonic lithotripsy:- An
ultrasonic probe is placed in the renal pelvis via a
percutaneous nephroscope and positioned against
the stone . Ultrasound waves break stone into sand
like particle.
- Extracorporeal shock waves lithotripsy: - A
high- voltage spark generator produces high-energy
acoustic shock waves that break stone without
damaging surrounding tissue.
Other surgical procedure
Pyelolithotomy[incision into the renal pelvis to
remove stones]
- Ureterolithotomy[incision into ureter to remove
ureter stone]
Cystotomy[incision to bladder to remove bladder
stone]
What is the
renal pelvis ?
Listening carefully.
P
P
T
What is the
surgical
management for
Renal Calculi ?
03 min Discuss the
Nutritional
NUTRITIONAL THERAPY

12. TIME SPECIFIC
OBJECTIVE
CONTENT TEACHER
ACTIVITY
STUDENT
ACTIVITY
AV
AIDS
EVALUATION
therapy for
Renal Calculi.
The following food contains high levels of purine,
calcium & oxalate which should be avoided or
minimized.
PURINE
High: sardine, mussels, liver, kidney, meat soup, sweet
breads.
Moderate: chicken, salmon, crab, veal, mutton, pork,
beef.
CALCIUM
Milk, cheese ice cream, dried fruits, nuts, chocolates,
cocoa, fish with fine bones
OXALATE
Spinach,cabbage, tomatoes, bets, nuts, celery,
chocolates, cocoa, instant coffee, tea.
Writing on
chalk board
and Explaining
Listen carefully,
taking notes and
answer the
question.
C
H
A
L
K
B
O
A
R
D
What are the
Nutritional therapy
for Renal Calculi?
05 min Nursing Management

13. TIME SPECIFIC
OBJECTIVE
CONTENT TEACHER
ACTIVITY
STUDENT
ACTIVITY
AV
AIDS
EVALUATION
Explain the
nursing
management for
Renal calculi.
Nursing Priorities
1. Alleviate pain
2. Maintain adequate renal function
3. Prevent complication
4. Provide information about disease.
Nursing Assessment
- Assess for pain and discomfort including severity,
location.
-Assess for associated symptoms, including nausea,
vomiting, and diarrhea.
-Observe urine for blood.
-Obtain a history of diet and occupation of the patient.
-Assess the socioeconomic status if the client.
-Assess in which climate patient is living.
-See if any blood relation person having renal calculi or
not.
- Assess patient knowledge regarding renal stone.
See for any other complication regarding kidney.
Explain Listen carefully,
asking doublets.
P
P
T
What is the
nursing
management for
Renal calculi ?
03 min Teach health
education for
Renal calculi
HEALTH EDUCATION: -
- Explain causes of kidney stone and ways to prevent
recurrence.
- -Advice client regarding which type of diet patient
should take.
- Encourage patient to fallow regmain to avoide
further ston formation, including fluid intake.
- If patient having surgery, instruct about sign and
Explaining and
asking the
doubts.
Listen carefully,
asking doublets &
answer the
questions.
B
L
A
C
K
What type of
health education
will you give to
patient?

14. TIME SPECIFIC
OBJECTIVE
CONTENT TEACHER
ACTIVITY
STUDENT
ACTIVITY
AV
AIDS
EVALUATION
symptoms and complication.
-Advice patient to take plenty of fluids 3000 to 4000 ml
per day.
-Advice patient to take medication regurly as per
doctor order.
- Encourage increase mobility whenever possible.
- Provide instruction for any necessary home care and
fallowup.
B
O
A
R
D
02 min SUMMARY:-
At the end of my class I would like to ask few
question & summaries the topic so we learn about
Introduction, Definition, Incidence, Etiological & Risk
Factors, Pathophysiology, Clinical Manifestation,
Diagnostic Evaluation, Medical Management, Nursing
Management & Health Education About Renal calculi.
01 min CONCLUSION
So far we have learned about Renal calculi and
their applications in nursing practices, it is a very
important subject use it as whenever and wherever
necessary.

15. ASSIGNMENT
1. Write down the detail Nursing management to the patient of Renal calculi.
TEST
Answer the following (Time- 30 min)
1. Define renal calculi. (02)
2. Write down etiological factors for Renal calculi (03)
3. Write down risk factors and clinical manifestation for Renal calculi. (05)
4. Write Nursing care plan in detail. (05)