Renal Stone Management
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The document discusses renal stones (nephrolithiasis), including their definition, etiology, risk factors, pathophysiology, types, clinical manifestations, diagnostic studies, management, nursing management, prevention, and questions. Renal stones are formed by crystallization of substances in the urine, and can be caused by metabolic, lifestyle, or genetic factors. Common types include calcium oxalate, calcium phosphate, uric acid, cystine, and struvite stones. Treatment may involve medical management, extracorporeal shock wave lithotripsy (ESWL), or surgical procedures like ureteroscopy. Nursing focuses on pain management, education, and preventing infection and recurrence.
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Renal Stone Management
- 2. TOPIC RENAL STONE PRESENTED BY MR.ROMAN BAJRANG RELIANCE INSTITUTE OF NURSING
- 4. DEFINITION • Nephrolithiasis refers to renal stone disease; urolithiasis refers to the presence of stones in the urinary system. Stones, or calculi, are formed in the urinary tract from the kidney to bladder by the crystallization of substances excreted in the urine • Edited by:- MR. ROMAN BAJRANG
- 5. ETIOLOGY Edited by:- MR. ROMAN BAJRANG
- 7. RISK FACTORS METABOLIC HISTORY OF RENAL DISTURBANCES CALCULI DEHYDRATION SEDENTARY LIFE STYLE IMMOBILITY
- 8. RISK FACTORS HIGH MINERAL CONTENT IN DRINKING WATER DIETARY INTAKE UTI & H/O FEMALE GENITAL MUTILATION PROLONGED INDWELLING CATHETERISATION NEUROGENIC BLADDER Editedby:-MR.ROMANBAJRANG
- 9. PATHOPHYSIOLOGY • Slow urine flow, resulting in supersaturation of the urine with the particular element that first become crystallized and later become stone
- 10. PATHOPHYSIOLOGY • Damage to the lining of the urinary tract
- 11. PATHOPHYSIOLOGY • Decreased inhibitor substances in the urine that would otherwise prevent supersaturation and crystalline aggregation Edited by:- MR. ROMAN BAJRANG
- 12. TYPES OF STONES • Calcium Phosphate • Calcium oxalate • Uric acid • Cystine • Struvite Editedby:-MR.ROMANBAJRANG
- 13. CLINICAL MANIFESTSTIONS • Severe abdominal or flank pain • Frequency and dysuria • Oliguria and anuria in obstruction
- 14. CLINICAL MANIFESTSTIONS • Hematuria • Renal colic • Nausea • hydronephrosis
- 20. DIAGNOSTIC STUDIES RETROGRADE PYELOGRAM CT SCAN 24 HOUR URINE SPECIMEN LAB INVESTIGATIONS
- 21. MANAGEMENT
- 22. MEDICAL • DRUG THERAPY Opioid agents NSAIDS Spasmolytic agents Edited by:- MR. ROMAN BAJRANG
- 23. COMPLIMENTARY THERAPY •Hypnosis, imagery, therapeutic or healing touch, acupuncture and breathing techniques •Positioning the client to comfortable position aids in pain reduction
- 24. OTHER TECHNIQUES • Avoiding over hydration and under hydration • Strain the urine • Send any strained stone to laboratory to aid in preventive treatment in the future
- 25. SPECIFIC APPROACHES URINARY STONE CHARACTERIS TICS PREDISPOSING FACTORS THERAPEUTIC MEASURES Calcium oxalate 35-40 Small often possible to get trapped in ureter ,more frequent in men Idiopathic hypercalciuria hyperoxaluria ,Independent of urinary pH ,family history Increase hydration Reduce dietary oxalate Give thiazide diuretics cellulose phosphate,(chelate calcium and prevent GI absorption), potassium citrate(alkaline urine), cholestyramine(bind oxalate), calcium lactate(precipitate oxalate in GI tract) Reduce daily sodium intake
- 26. SPECIFIC APPROACHES URINARY STONE CHARACT ERISTICS PREDISPOSING FACTORS THERAPEUTIC MEASURES Calcium Mixed Alkaline urine, Treat underlying phosphate stones primary cause and other 8-10% with hyperthyroidism stones struvite or oxalate stones
- 27. SPECIFIC APPROACHES URINARY STONE CHARACTERIS TICS PREDISPOSING FACTORS THERAPEUTIC MEASURES Struvite 3 to 4 times urinary tract Antimicrobial agents 10-15 % common in infections acetohydroxamic acid women ≥ Surgical interventions men,always Measures to acidify urine in association with urinary tract infection
- 28. SPECIFIC APPROACHES URINARY STONE CHARACTERI STICS PREDISPOSING FACTORS THERAPEUTIC MEASURES Uric acid 5-8 % Predomi nant in men high incidence in jewish men Gout, acid urine ,inherited conditions Reduce urinary concentration of uric acid Alkanize urine with potassium citrate Administer allopurinol Reduce dietary purines
- 29. SPECIFIC APPROACHES URINARY STONE CHARACTERISTICS PREDISPOSING FACTORS THERAPEUTIC MEASURES Cystine 1-2 % Genetic autosomal recessive defect,defective absorption of gi cystine from gi tract and kidney excess concentrations causing stone formation Acid urine Increase hydration Give α pencillamine and tiopronin to prevent cystine crystallization Potassium citrate to alkaline urine
- 32. SURGICAL MANAGEMENT RETROGRADE URETEROSCOPY ESWL ANTEGRADE NEPHROSTOURETE ROLITHOTOMY OPEN URETERO- LITHOTOMY MIDURETER Edited by:- MR. ROMAN BAJRANG
- 33. SURGICAL MANAGEMENT ESWL/ureteroscopy Antegrade nephrostoureterolithotomy Stenting alone Open ureterolithotomy DISTALURETER
- 35. OPEN SURGICAL PROCEDURES NEPHROLITHO TOMY PYELOLITHOT OMY URETHROLIT HOTOMY CYSTOTOMY Edited by:- MR. ROMAN BAJRANG
- 37. NURSING DIAGNOSIS • Acute pain related to irritation and spasm from stone movement in the urinary tract as manifested by complaints of pain, facial grimacing, restlessness
- 38. • Anxiety related to uncertain outcome and lack of knowledge regarding possible surgery as manifested by expressions NURSING DIAGNOSIS
- 39. • Ineffective therapeutic regimen management related to lack of knowledge as manifested by repeated questions NURSING DIAGNOSIS
- 40. • Impaired urinary elimination related to trauma or blockage of ureters or urethra as manifested by decreased urinary output and bloody urine NURSING DIAGNOSIS
- 41. • Risk for infection related to introduction of bacteria following manipulations of the urinary tract and obstructed urinary blood flow NURSING DIAGNOSIS
- 42. 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.
- 43. • Low-calcium diets are not generally recommended,except for true absorptive hypercalciuria. Evidence shows thatlimiting calcium, especially in women, can lead to osteoporosis and does not prevent renal stones. • Avoid intake of oxalate-containing foods (eg,spinach,strawberries,rhubarb,tea,peanuts, wheat bran). PREVENTION
- 44. • During the day,drink fluids (ideally water) every1 to 2 hours. • Drink two glasses of water at bedtime and an additional glass at each nighttime awakening to prevent urine from becoming too concentrated during the night. PREVENTION
- 45. • 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 PREVENTION
- 46. JOURNAL PRESENTATIONS Edited by:- MR. ROMAN BAJRANG
- 47. QUESTIONS ???
- 48. ? a)Cystic fibrosis b) sjogrens syndrome c) gout d) myasthenia gravis Genetic factor involved in renal calculi formation:
- 49. ? a) nephrolithiasis b)ureterolithiasis c ) cystolithiasis d ) cholelithiasis Stone in the kidney is called as
- 50. ? a)Allopurinol b)thiazide diuretic c)pencillamine d)potassium citrate Uric acid stones can be reduced or prevented by the use of:
- 51. ? a)Morphine b)ketorolac c)propanthelene d)tramadol hydrochloride Preferred opioid agent used in renal calculi pain management initially is: