RENAL CALCULUS, references: Lewis, S. L., Bucher, L., Heitkemper, M. M.,…
SIGNS AND SYMPTOMS
severe pain that begins suddenly. sharp pain in the flank area, back, or lower abdomen.
nausea and vomitting
have hard time being still - go from walking to sitting to lying down, and then repeat
may be in milk shock with cool, moist skin.
men: experience testicular pain
women: experience pain in the groin
dysuria, fever, and chills.
COLLABORATIVE NURSING INTERVENTIONS
surgical therapies (nephrolithotomy, ureterolithotomy, cystotomy)
Many factors are involved in the incidence and types of stone formation (metabolic, dietary, genetic, climatic, lifestyle, and occupational influences
A mucoprotein is formed in the kidneys as a matrix for the stone.
other important factors in the development of stones include obstruction with associated urinary stasis and UATI with urea-spliting bacteria.
Allopurinol - reduce dietary purines
INDEPENDENT NURSING INTERVENTIONS
teach patient about the course, dosage, schedule, and potential side effects of drugs used to reduce the risk of stone formation
educate patient about adequate fluid intake to produce a urine output approximately 2L/day
teach patient self monitor urinary pH or urine output
PRIORITY NURSING ASSESSMENT
Past health history
recent or chronic UTI. Immobilization. Previous urinary tract stones, obstruction, or kidney disease with urinary stasis. Gout, benign prostatic hyperplasia, hyperparathyroidism, chronic diarrhea
prior use of medication for prevention of stones or treatment of UTI, allopurinol, analgesics, loop diuretics, thiazide diuretics
surgery or other treatment
external urinary diversion, long-term indwelling urinary catheter
guarding, back pain, fever, dehydration
skin: warm flushed skin or pallor with cool, moist skin (milk shock)
GI: Abdominal distention, absence of bowel sounds
Urinary: Oliguria, hematuria, tenderness on palpation of renal areas, passage of stone or stones
Increase BUN and serum creatinine. Elevate uric acid, calcium, phosphorus, oxalate.
collect urine sample
help patient ambulate
help to change position if patient is immobile to maximize urinary flow
Urinary tract infection - due to obstruction
Lewis, S. L., Bucher, L., Heitkemper, M. M., & Harding , M. M. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems (10th ed.). St. Louis, MO: Elsevier, Inc.