NURSING MANAGEMENT OF RENAL CALCULI

1. RENAL CALCULI
Presented by
Monika Devi
Msc.(N)
HCN, SRHU

2. INTRODUCTION
 A kidney stone is a hard solid mass of material that
forms in the kidney from the substances in the
urine.
 Kidney stones or calculi develop as a result of
various metabolic disorders which affect the fate of
calcium and other mineral elements in the body.
 Stones may be formed in the kidney, urinary
bladder, ureter and urethra

3. DEFINITION
A kidney stone, also
known as a renal
calculus or nephrolith,
is a solid piece of
material which Is
formed in the kidneys
from
minerals in urine

4. ETIOLOGY
 Unknown
Risk factor:-
 Imbalance of pH in urine
Alkalic: - Calcium stone
Acidic:- Uric & cristine stone
 Gout
 Hyperparathyroidism

5. CONT…
RISK FACTORS :-
 Immobility
 Sedentary life style
 Dehydration
 Metabolic disturbances
 History of renal calculi

6. CONT…
 High mineral content in drinking water
 Dietary intake
 UTI
 Prolonged Indwelling Catheterization

7. TYPES
There are mainly 5 types:-
1. Calcium oxalate stone (Is the most common
80% )
2. Calcium phosphate stone
3. Struvite stone (Triple stone)
4. Uric acid stone
5. Cystic stone

8. TYPES
1.Calcium oxalate stone :-
(Is the most common 80% )-
 Caused by super -saturation of urine with
calcium & oxalate
 Calcium oxalate stone tend to form in alkaline
chemistry
 ( Avoid food high in oxalate(beer, wheat germ,
spinach).

9. CONT..
2. Calcium phosphate stone:-
 (5-10%):- Caused by
 super -saturation of urine with calcium
phosphate.
 Calcium phosphate stone tend to form in
alkaline chemistry
 (Avoid food high in calcium (Milk & dairy
product)

10. CONT…
3. Struvite stone (Triple phosphate stone):-
 Caused by urea splitting bacteria (Proteus,
Pseudomonas, Klebsiella, Staphylococcus).
more common in women then the man
because of UTI
 Struvite stone tend to form in alkaline
chemistry

11. CONT…
4. Cystic stone (10-15%):-
 Caused by cystine crystal formation.
 Cystic stone tend to form in Acidic urine ( cystine
source Avoid meat milk ,cheese, Egg)

12. CONT…
5. Uric acid stone (5-10%):-
 Caused by excessive dietary purine or gout
 Uric acid stone tend to form in Acidic urine
(Avoid purine sources eg. Meats, gravies, red
wine)

13. PATHOPHYSIOLOGY
 Urine saturation
 Supersaturation
 Crystal nucleation
 Aggregation
 Retention and growth

15. CLINICAL MANIFESTATION
 Severe pain in the side and back, below the ribs
 Pain that spreads to the lower abdomen and groin
 Pain that comes in waves and fluctuates in
intensity
 Pain on urination
 Cloudy or foul-smelling urine
 Nausea and vomiting
 Fever and chills if an infection is present
 Urinating small amounts of urine

16. DIAGNOSTIC EVALUATION
 Blood
 Urine-analysis
 Cystoscopy
 X-ray
 CT scan, MRI
 Intravenous urogram (IVU) or intravenous
pyelogram
 USG
 KUB

17. CYSTOSCOPY

18. INTRAVENOUS PYELOGRAM

19. ULTRASOUND

20. MEDICAL MANAGEMENT
 Analgesic
 Spasmodic e.g. Buscopan
 NSAIDs e.g. Steroid
 Maintain I/O charting
 Provide rest

21. SURGICAL MANAGEMENT
Close procedure:-
 Lithotripsy (Extracorporeal Shockwave
lithotripsy (ESWL)-
 Noninvasive
 Percutaneous Nephrolithotomy

22. LITHOTRIPSY

23. USG SHOCK WAVES CRUSH STONES

24. PERCUTANEOUS NEPHROLITHOTOMY

25. CONT…

26. OPEN PROCEDURE
 Ureterolithotomy
 Pyelolithotomy
 Nephrolithotomy
 Partial or total nephrectomy

27. 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.
 Low-calcium diets are not generally
recommended ,except for true absorptive
hypercalciuria. Evidence shows that limiting
calcium, especially in women, can lead to
osteoporosis and does not prevent renal stones.

28. CONT..
 Avoid intake of oxalate-containing foods (e.g.
spinach, strawberries, tea, peanuts, wheat bran).
 During the day, drink fluids (ideally
water)everyday1 to 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

29. CONT..
 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.

30. NUTRITIONAL THERAPY
 Foods high in purine, calcium, or oxalate:
 Purine:
High: Sardines, herring, mussels, liver, kidney,
goose, venison, meat soups sweetbreads
Moderate: Chicken, salmon, crab, veal, mutton,
bacon, pork, beef, ham
 Calcium: milk, cheese, ice cream, yogurt, sauces
containing milk, all beans (except green beans),
lentils, fish with fine bones (sardines, kippers
herring, salmon); dried fruits, nuts, chocolate, cocoa.
 Oxalate: spinach, rhubarb, asparagus, cabbage,
tomatoes, beets, nuts, celery, parsley, runner beans,
chocolate, cocoa, instant coffee, Ovaltine, tea;
Worcestershire sauce

32. NURSING DIAGNOSIS
1. Acute pain related to irritation and spasm from
stone movement in the urinary tract as
manifested by complaints of pain, facial
grimacing, restlessness.
Goal :-
To reduce pain.
Intervention:-

33. CONT…
2. Anxiety related to uncertain outcome and lack of
knowledge regarding possible surgery as
manifested by expressions.
Goal:-
To reduce anxiety.
Intervention:-

34. CONT…
3. Impaired urinary elimination related to trauma or
blockage of ureters or urethra as manifested by
decreased urinary output and bloody urine.
Goal:-
To increase the urine out put.
Intervention

35. CONT…
4. Risk for infection related to introduction of
bacteria following manipulations of the urinary
tract and obstructed urinary blood flow.
Goal:-
To reduce the risk of infection.
Intervention

36. NURSING DIAGNOSIS
5. Acute pain r/t obstructing urinary Calculus.
6. Altered urinary elimination related To presence
of urinary calculi
7. Risk for infection r/t obstructing Urinary
calculus.
8. Altered renal peripheral tissue Perfusion r/t
post renal Obstruction

37. SUMMARY

38. BIBLIOGRAPHY
 Brunner and Suddarth's text book of medical –surgical
nursing twelfth edition . Page no. 1295.
 Lewis’s medical –surgical nursing , assessment and
management of clinical problems , second edition .
Page no. 1131.

39. THANK YOU