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Renal Calculi: Signs, Types, Diagnosis and Nursing Care
- 1. RENAL CALCULI COURSE: ADULT HEALTH NURSING 3:THEORY COURSE COORDINATOR: DR.SAWSAN MUSTAFA DONE BY : OBIEDA MANSOUR PRESENTATION
- 2. Outline : Definition Causes Signs and symptoms Types Clinical manifestation diagnostic procedures Management Patient education Nursing diagnosis Nursing interventions References
- 3. Definition Urolithiasis is the formation of stony concretions in the urinary system and its affect men more than women urinary calculi may be found anywhere from the kidney to the urethra
- 4. Risk factors Age gender Obesity heredity Gastric bypass surgery Immobilization or obstruction lead to urinary stasis Metabolic disorders Anatomic kidney or urinary tract abnormalities High blood pressure Diet: high levels of protein, salt, or sugar can cause stones to form, as can dehydration because less urine is produced
- 5. Causes cont. Chronic dehydration Infection Hypercalcemia
- 6. Sings and symptoms severe flank pain / groin /genitalia blood in urine Vomiting, nausea and diarrhea white blood cells or pus in the urine burning sensation during urination persistent urge to urinate fever and chills if there is an infection (elevated wbc ) Dysuria , frequency and urgency
- 8. Calcium oxalate stones Calcium oxalate stones are the most common type of kidney stone. Risk factors: High Protein diet High Oxalate diet High Sodium diet High Sugar diet
- 10. Calcium Oxalate thiazide diuretics have shown to reduce the recurrence rates by up to 70%.[It is the only medical therapy directed at reducing urinary calcium
- 13. Uric acid stones The aim of treatment in uric acid stones is to increase the solubility of uric acid in urine. It is achieved by increasing the urine volume and by alkali therapy. Allopurinol is a useful adjunct to the therapy.
- 15. Cystine stones The aim of treatment is to reduce the concentration of free cystine and increase its solubility in urine. A high fluid intake up to 4-5 L/day OR 4-5 lit/day and alkalinization of urine with target urine pH >7 is desirable
- 16. Struvite stones Struvite (magnesium ammonium phosphate) white to yellowish or brownish-white pyramidal crystals Struvite stones form in alkaline urine from infection with urea-splitting microorganisms. Antibiotics are the mainstay of the therapy with occasional use of acetohydroxamic acid
- 17. Diagnostic procedures Blood testing Urine testing X-ray Ct-scan Analysis of passed stones
- 18. Diagnostic findings Urinalysis: Color may be yellow, dark brown, bloody. Commonly shows RBCs, WBCs, crystals (cystine, uric acid, calcium oxalate), casts, minerals, bacteria, pus; pH may be less than 5 Urine culture: May reveal UTI Serum and urine BUN/Cr: Abnormal (high in serum/low in urine) Serum chloride and bicarbonate levels: Elevation of chloride and decreased levels of bicarbonate Biochemical survey: Elevated levels of magnesium, calcium, uric acid, phosphates, protein, electrolytes. x-ray: Shows presence of calculi and/or anatomical changes in the area of the kidneys or along the course of the ureter.
- 19. Assessment Assess for pain and discomfort, including severity, location, and radiation of pain. Assess for associated symptoms, including nausea, vomiting, diarrhea, and abdominal distention. 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. Focus history on factors that predispose patient to urinary tract stones or that may have precipitated current episode of renal or ureteral colic. Assess patient’s knowledge about renal stones and measures to prevent recurrence.
- 20. Management Encourage increased fluid intake and ambulation. 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. Strain urine through gauze. Crush any blood clots passed in urine, and inspect sides of urinal and bedpan for clinging stones. 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 with the appropriate antibiotic agent before efforts are made to dissolve the stone.
- 21. Stone Removal Procedures Ureteroscopy: stones fragmented with use of laser, electrohydraulic lithotripsy, or ultrasound and then removed. Extracorporeal shock wave lithotripsy (ESWL). Percutaneous nephrostomy; endourologic methods. Electrohydraulic lithotripsy. Chemolysis (stone dissolution): alternative for those who are poor risks for other therapies, refuse other methods, or have easily dissolved stones (striate). Surgical removal is performed in only 1% to 2% of patients.
- 22. Nutritional therapy Fluid and diet therapy - encourage patient to drink high amounts of water every day to prevent dehydration - restrict oxalate food (peanuts, tea, beans, coffee) - IV fluids - Low protein diet - Purine diet avoid (organ meats , shellfish, spinach,etc_) - Eat a diet high in vegetables - Avoid animal protein and high methionine foods (fish )
- 23. Patient education 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 , sodium competes with calcium for reabsorption in the kidneys Drink fluids every 1 to 2 hours Avoid intake of oxalate-containing food (spinach, strawberries, tea, peanuts) Avoid activities leading to sudden increase in environmental temperatures that may cause excessive sweating and dehydration Ambulation may help to move stones through urinary tract Intake of vitamin D
- 24. Nursing Diagnosis Acute Pain related to inflammation, obstruction, and abrasion of the urinary tract Impaired urinary elimination Risk for Deficient Fluid Volume Deficient knowledge regarding prevention of recurrence of renal stones
- 25. Diagnosis Outcome Interventions Acute Pain related to inflammation, obstruction, and abrasion of the urinary tract Patient will report no pain Assess pain characteristics (location, severity, alleviating factors etc.) positioning morphine administration to prevent shock and syncope non-pharmacological intervention for pain moist heat to the flank area
- 26. Diagnosis outcome Interventions Impaired urinary elimination related to Stimulation of the bladder by calculi as evidenced by Urgency and frequency Patient will Void in normal amounts and usual pattern. Record I&O and of urine Determine patient’s normal voiding pattern and note variations. Promote sufficient intake of fluids. Offer fruit juices ,particularly cranberry juice.to help acidify the urine Check laboratory studies (electrolytes, BUN, Cr). Obtain urine for culture and sensitivities
- 27. Diagnosis Outcome Interventions Risk for Deficient Fluid Volume Patient will Maintain adequate fluid balance Monitor and document I&O Weigh daily Note incidence and characteristics and frequency of vomiting and diarrhea Promote fluid intake to 3–4 L day within cardiac tolerance. Monitor vital signs Encourage appropriate diet
- 28. Diagnosis Outcome Interventions Deficient knowledge regarding prevention of recurrence of renal stones Patient will Verbalize understanding of needs Assess ability to learn or perform desired health- related care. Consider the patient’s learning style Assess barriers to learning Identify cultural influences on health teaching Review dietary regimen Recall and analyze disease process and future expectations