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kindey stone KINDEY STONE, PERTINENT ASSESSMENT FINDINGS - Coggle Diagram
KINDEY STONE
Kidney stone formation is common, and most stone formers have no known systemic disease as the cause of their stone formation but may have one or more metabolic abnormalities that result from a combination of genetic predisposition and environmental factors. Calcium stones are by far the most common, accounting for 80% of all stones; uric acid stones are found in about 10% of stone formers, struvite in about 5%, and other types of stones are considered rare.
Urine is produced when your kidneys eliminate waste and fluid from your blood. When you have too much of certain wastes in your blood and not enough fluid, these wastes might pile up in your kidneys and bind together. Kidney stones are clumps of waste that form in the kidneys. It can also be formed when there are high amount of salt and minerals in the urine.
pharm/non-pharm
Opioid analgesic agents (to prevent shock and syncope) and nonsteroidal anti-inflammatory drugs (NSAIDs).
Increased fluid intake to assist in stone passage, unless patient is vomiting; patients with renal stones should drink eight to ten 8oz glasses of water daily or have IV fluids prescribed to keep the urine dilute.
For calcium stones: reduced dietary protein and sodium intake; liberal fluid intake; medications to acidify urine, such as ammonium chloride and thiazide diuretics if parathormone [production]
is increased.
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For oxalate stones: dilute urine; limited oxalate intake (spinach, strawberries, rhubarb, chocolate, [tea,]
peanuts, and wheat bran).
NURSING INTERVENTIONS
listed:
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-Crush any blood clots passed in urine, and inspect sides of urinal and bedpan for clinging [stones.]
-Instruct patient to report decreased urine volume, bloody or cloudy urine, fever, and pain.
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-Monitor vital signs for early indications of infection; infections should be treated with the appropriate antibiotic agent before efforts are made to dissolve the [stone.]
PATIENT EDUCATION
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Encourage patient to follow a regimen to avoid further stone formation, including [maintaining] a high fluid intake.
Encourage patient to drink enough to excrete 3,000 to 4,000 mL of urine every 24 [hours.]
Recommend that patient have urine cultures every 1 to 2 months the first year and periodically [thereafter.]
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Encourage increased mobility whenever possible; discourage excessive ingestion of vitamins (especially vitamin D) and minerals.
If patient had surgery, instruct about the signs and symptoms of complications that need to be reported to the physician; emphasize the importance of follow-up to assess kidney function and to ensure the eradication or removal of all kidney [stones] to the patient and family.
If patient had ESWL, encourage patient to increase fluid intake to assist in the passage of stone fragments; inform the patient to expect hematuria and possibly a bruise on the treated side of the back; instruct patient to check his or her temperature daily and notify the physician if the temperature is greater than 38 C (about 101 F), or the pain is unrelieved [by] the prescribed medication.
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