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Annie Giordano Dominique Dibacco Alexander

Lew Bethany Lucas Tithyda Pal

December 12 2013

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Medical

Diagnosis:

Renal Calculi

Signs and

Symptoms

Complementary

and Alternative

Medications/

Therapies

Medications/

Remedies &

NursingImplications

Pathophysiology

Labs, Normal

values,

Factors/com

plications

Co-existing

Diagnoses

and Chronic

Problems

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◦ Severe pain in the side and back,

below the ribs.

◦ Pain that radiates to lower abdomen

and groin

◦ Pain that comes in waves and

fluctuates in intensity.◦ Pain with urination

◦ Pink, red, or brown urine

◦ Cloudy or foul smelling urine

◦ Nausea and vomiting

◦ Persistent urge to urinate

◦ Urinating more often than usual

◦ Fever and chills if an infection ispresent

◦ “The worst pain I have ever had.” 

There are usually only signs/symptoms when the stone movesaround in kidney or passes into the ureter.

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The Size, Location, Type, and Number of stones are

important factors in determining different treatments.

Allopurinol is a medication that decreases uric acid in level in

the blood (used to treat gout and serious kidney stones)

Most patients (85%) have kidney stones about 5mm so they

can pass through normal urination in about 2-3 days. Some

stones may take weeks to months to pass.

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Remedies (for normal 5mm stones):

◦  drink 2-3 quarts of water per day to help move stone

along, painkillers such as NSAIDs (ibroprofen, asprin)

Alpha blockers (such as tamsulosin) can relax muscles in

urinary tract make it easier to pass stone

Treatment for severe attacks: strong opioid pain killers for

severe kidney stone attack. These medications are not givenuntil a confirmed kidney stone is in an imaging study.

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Increased Fluid Intake!

Dietary Changes

◦ Calcium Oxalate stones: to reduce oxalate, eat LESS spinach, beets,

nuts, chocolate, coffee, black tea, wheat bran, and beans.

◦ Uric Acid stones: reduce purine by eating LESS meat, sardines,herring, liver, venison, and red meat.

Surgery

◦ Stones in bladder: cystoscopy or cystolitholapaxy

◦ Stones throughout urinary tract: Lithostripsy

◦ Staghorn stones: percutaneous nephrolithotomy (PNL),

monotherapy, combinations of PNL and shock wave lithotripsy

(SWL), SWL monotherapy, and open surgery.

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Urine Samples: test for acidity, presence of blood

(hematuria), infection, and crystals, increased number of

WBCs.

◦ Clean catch, 24-hour urine sample

Standard X-rays of the abdomen first step to detect stones

Renal Ultrasound

Spiral or helical computer tomography (CT) scans

◦ If no stones appear on CT scan, next method is IVP (intravenous

pylegram)

Blood Tests including BUN, creatinine, phosphate, sodium,

potassium, and bicarbonate.

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Medullary sponge kidney (MSK)

Urinary Tract Infection (UTI)

Hyperparathyroidism

Cystinuria

Diabetes/Obesity/Hypertension

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Stones form when crystals are in a supersaturatedconcentration, causing them to precipitate and unite in thekidneys

Stones are usually the size of a small pebble (less than 5mm)and take weeks/months to form.

Risk factors:◦ Metabolic◦ Climate◦ Diet◦ Genetics◦ Lifestyle◦ Obstruction with urinary stasis and UTI with urea-splitting bacteria.◦ Urine pH (either too high or too low), higher concentration of solute,

and inhibitors.

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Calcium oxalate (35-40%)

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Struvite (10-15%)

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Calcium phosphate (8-10%)

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Uric Acid (5-8%)

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Cystine (1-2%)

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Primary NursingDiagnosis:

Acute Pain

Nursing Diagnoses For Renal

Calculi

Secondary Nursing

Diagnosis:

Impaired Urinary

Elimination

Secondary Nursing

Diagnosis:

Deficient

Knowledge

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ACUTE PAIN related to effects of renal calculi andinadequate pain control or comfort measures, as

evidenced by complaints of severe pain and discomfort

from patient.

Interventions:

◦ Assess patient for pain (scale 0-10)

◦ Position patient for comfort

◦ Administer pain medication as needed.

◦ Relaxation techniques such as meditation, distraction, and

teaching

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DEFICIENT KNOWLEDGE related to lack of informationabout the causes of renal calculi, as evidenced by

questions about how to prevent kidney stones in the

future.

Interventions:

◦ Describe the disease process

◦ Explain the importance of increased activity level

◦ Encourage proper fluid intake and prescribed diet

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IMPAIRED URINARY ELIMINATION related to traumaor blockage of the ureters or urethra and evidenced by

decreased urinary output and blood in the urine

Interventions:

◦ Monitor urinary elimination including frequency, consistency,

odor, volume, and color.

◦ Teach patient to drink 16 oz. of liquid with meals and

throughout the day

◦ Teach patient signs and symptoms of urinary tract infection.

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Lewis, S. L., Dirksen, S. R., Heikemper, M. M., Bucher, L., &Camera, I. M. (2010). Medical-surgical nursing: Assessment

and management of clinical problems. St. Louis, MI: Mosby

Elsevier.

Ladwig, G. B, & Ackley, B. J. (2014). Mosby’s guide to nursing

diagnosis. Maryland Heights, Missouri: Elsevier Inc.