8. Kidney stones form when there is a decrease in urine volume and/or an excess of stone-forming substances in the urine. The most common type of kidney stone contains calcium in combination with either oxalate or phosphate. Other chemical compounds that can form stones in the urinary tract include uric acid and the amino acid cystine.
13. Dehydration from reduced fluid intake or strenuous exercise without adequate fluid replacement increases the risk of kidney stones. Obstruction to the flow of urine or prolonging despite the urge to urinate can also lead to stone formation. Kidney stones can also result from infection in the urinary tract; these are known as struvite or infection stones.
27. Hypercalciuria (high calcium in the urine), another inherited condition, causes stones in more than half of cases. In this condition, too much calcium is absorbed from food and excreted into the urine, where it may form calcium phosphate or calcium oxalate stones.
35. Conditions associated with an increased risk of kidney stones include hyperparathyroidism, kidney diseases such as renal tubular acidosis, and some inherited metabolic conditions including cystinuria and hyperoxaluria. Chronic diseases such as diabetes and HPN are also assoc. with an increased risk of developing kidney stones.
51. Some medications also raise the risk of kidney stones. These medications include some diuretics, calcium-containing antacids, and the protease inhibitor indinavir (Crixivan), a drug used to treat HIV infection
58. Case Presentation: Nephro/Urolithiasis Nephro/Urolithiasis The Assessment… Nausea and Vomiting Abdominal or Flank Pain Renal Colic Radiating to the groin Uretral colic –pain that radiates towards the genetalia and thigh Cold Moist Skin Hematuria
59.
60.
61. used to identify non-radio opaque stones.IV Pyelogram
65. Retrograde Pyelogram is performed to identify filling defects from obstructions such as stones or tumors). At the same time narrow parts can be widened, stones taken out, pieces of the lining taken out, and diseased parts burnt out as needed.Retrograde Pyelogram
68. Stone analysis – freely passed stones or removed thru special procedures are recovered and chemical analysis is carried out to determine their composition.
69. provides a clear indication of underlying disorder (e.g. uric acid metabolism disturbances and calcium metabolism disorders)
70. 24 hr urine test- to measure calcium, uric acid, creatinine, normal pH and total volumeLet’s Make it Simple Lte’s Make it Simple
71.
72. For the creatinine clearance test, tell the patient that he need not to restrict fluids but should not eat too much meat before the test, and should avoid strenuous exercise during the collection period.
73. For the urea clearance test, instruct him to fast from midnight before the test and to avoid exercising before and after the test.
74.
75. Keep emergency resuscitation equipment readily available in case the patient has an anaphylactic reaction to the contrast medium. Closely observe him for adverse reactions during and after the test.
76. MIO after any invasive test. Notify the doctor if the patient can’t void or if hematuria persists after the third voiding.
108. Encourage to follow a regimen to avoid further stone formation( e.g. diet modification, fluid intake of 3000- 4000 ml in 24 hrs active lifestyle)
109. Educate on signs and symptoms that indicate stone formation or complication ( fever, decrease urine output, pain, hematuria.Relieve Pain Relieve Pain Teaching Self-care
126. SexPressure on kidney structures Stasis of urine Accumulation of urine Low-Moderate pressure Infection in the calculi Infection in the calculi Pressure on renal arteries Kidney may dilate slowly Pressure on the renal pelvis wall Ischemia No obvious loss of function TUBULAR DAMAGE Group 3 Group 3 Group 3 N C M - 1 0 2
133. ↑ urinary urgencyGroup 3 Group 3 Group 3 N C M - 1 0 2
134.
135. Visualizations tests, such as Retrograde Pyelogram or Renal Ultrasound, show concave (early stage) or convex (later stage) calyces as dilation progresses.
136. Urinalysis: inability to concentrate urine, proteinuria, possibly, pyuria (if presence of infection) or hematuria
137. Extensive Disease: atrophied proximal and distal tubles and obstructionGroup 3 Group 3 Group 3 N C M - 1 0 2
142. Risk for Infection Related to Urinary StasisGroup 3 Group 3 Group 3 N C M - 1 0 2
143.
144. Patients who have only one kidney, who have immune-compromising disorders such as diabetes or HIV, or who have received a transplant should be treated promptly.
145. Affected Renal Function: Low Na, Protein, and K -Designed to stop progression to Renal Failure before surgery Group 3 Group 3 Group 3 N C M - 1 0 2
146.
147. A catheter (small tube) inserted through the urethra into the bladder to drain urine from the bladder.
148. A stent (hollow tube) in the ureter (between the kidney and bladder) to keep the ureter open.
149. A nephrostomy tube can inserted through the patient's lower back to drain urine directly from the kidney (percutaneousnephrostomy).
156. Observe or monitor signs and symptoms associated with pain. Some people deny the experience of pain when it is present. Attention to associated signs may help the nurse in evaluating pain.Group 3 Group 3 Group 3 N C M - 1 0 2
160. Insert indwelling (Foley) catheter as ordered. To relieve bladder distention by maintaining normal excretion of urine
161. Instruct patient or caregiver on signs and symptoms of over distended bladder
162. Perform Credé’s method over bladder. Credé’s method (pressing down over the bladder with the hands) increases bladder pressure, and this in turn may stimulate relaxation of sphincter to allow voidingGroup 3 Group 3 Group 3 N C M - 1 0 2
163.
164. Encourage intake of cranberry juice daily. This keeps urine acidic. This helps prevent infection because cranberry juice metabolizes to hip puric acid, which maintains an acidic urine; acidic urine is less likely to become infected.
165. Assess amount, frequency, and character (e.g., color, odor, and specific gravity) of urineGroup 3 Group 3 Group 3 N C M - 1 0 2
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