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RENAL CALCULUS, Reference: CNE, M. M., Jeffrey Kwong, D., Roberts, D.,…
RENAL CALCULUS
Pathophysiology:
Stones formed anywhere in urinary tract, but is commonly formed in kidneys
Urolithiasis = urinary calculi formed in ureters
Nephrolithiasis = kidney calculi formed in renal parenchyma
Signs & Symptoms:
Infection, UTI, Sharp pain, Ureteral colic, Dull aching pain of kidney, flank/lower abdomen/back pain (renal colic), dehydration, fever, diaphoresis, nausea/vomiting, pallor
Urinary frequency
Medications
:
Opioids to relieve pain, NSAIDs if no contraindications
a-Adrenergic blockers: Tamsulosin (Flomax) -relax smooth muscle of ureters
Antibiotics needed if kidney infection occurred
Related Disorders:
Kidney damage if serious
Diet high in Calcium (hypercalcemia), vitamin D, protein, oxalate, purines, alkali
Hyperparathyroidism, gout
Independent Nursing Intervention:
Encourage exercising and walks
Encourage fluid intake up to 3000 mL/day,
unless contraindicated
Monitor pt pain, obstruction, tissue trauma, secondary hemorrhage and infection, increased heart rate
for bleeding or hematoma formation.
Teach Nutritional therapy: depending on type of calculi:
Decrease purine foods: chicken, salmon, bacon, pork,
calcium enriched foods
Oxylated food: chocolate, spinach, asparagus, cabbage, tomatoes, coffee
Drink adequate water, consume low sodium
Inform and prepare the client for surgical procedures if
prescribed by doctor to remove calculus.
Priority Nursing Assessment:
Elevated values of RBC, WBC, Bacteria in Urinalysis report
changes in intake / output
Fever or increased severe pain
Changes in lab values, BUN, creatinine, uric acid levels, ekg, presence of edema, change in LOC
Collaborative Nursing Intervention:
Order: Radiography for urinary tract, CT scan, Renal ultrasound, Fluoroscopy- to visualize the stone, Administer analgesics to relieve pain.
Order a stone analysis to determine treatment, urinalysis and pH of urine
Doctor order: Percutaneous lithotripsy, Uretolithotomy, Nephrostomy, Pyelolithotomy, nephroctomy,
ureteral stent- for passing of stone, increasing fluids up to 3000 ml per day.
Nutritionist on what to consume for future preventatives
Urologist if any kidney damage occurs
Delegated Tasks:
UAP= monitor vitals, temperature, Assist the client in performing relaxation techniques to assist in relieving pain, encourage pt ambulation, assist pt with repositioning for comfort.
Reference:
CNE, M. M., Jeffrey Kwong, D., Roberts, D., Hagler, D., & Dnp, C. R. (2019). Ch47, Lewis's medical-surgical nursing E-book: Assessment and management of clinical problems (11th ed.). Elsevier Health Sciences.