Upload
ringer21
View
1.083
Download
1
Tags:
Embed Size (px)
DESCRIPTION
Citation preview
Kidney Stones
Natalie BennettChristina KaranasosJessica Reetz
Stone Formation
Highly concentrated urine constituents crystallize and harden to form calculi.
Contributing factors: Altered pH Age/gender Urine stasis and/or retention UTI Dehydration Genetics Climate Underlying disorders Diet
(Hanson, 2005) and (Lewis, et al., 2007)
Types of Stones
Calcium oxalate
Calcium phosphate
Struvite
Uric acid
Cystine
(Morton, Iliescu, and Wilson, 2002)
Diagnostic Tests
Urinalysis IVP Abdominal ultrasound CT KUB Cystoscopy
(MayoClinic, 2008)
Treatment
TREAT THE PAIN!!!
Lithotripsy
Ureteroscopy
Surgical removal
Percutaneous nephrolithotomy
Nutritional therapy
(Hanson, 2005)
Trivia
What are common signs and symptoms of kidney
stones?
Answer Severe flank or lower abdominal pain Dysuria Hematuria N/V Chills and fever (if infection is present) Blocked urinary flow Anxiety Pallor and/or cool, clammy skin
(Moe, 2006) and (National Kidney Foundation, 2009)
Trivia
Case Study #2: The MD orders an IVP (intravenous pyelogram). What question
do you need to ask S.R. before the test is
conducted?
Answer
Ask if patient is allergic to shellfish or iodine.
*Note: If patient is severely dehydrated, IVP may cause renal shutdown.
Trivia
This is the famous logo of which band?
Answer
The Rolling Stones!!!!!
Trivia
List nursing interventions for the following diagnosis: Acute pain r/t effects of renal
stone and inadequate pain control or comfort measures
Answer
PQRST pain assessment Pain control measures to prevent break
through pain Administer pain meds as ordered Teach use of nonpharmacologic
techniques
(Lewis, et al., 2007)
Trivia
Case Study #4: What are the two most common types
of stones?
Answer
Calcium and struvite stones
(Lewis, et al., 2007)
Trivia
What is the name of this famous landmark?
Answer
Stonehenge!!!
Trivia
Case Study #10: Because S.R.’s stone has been reported as calcium oxalate, what type of diet would be recommended?
Answer
Increase fluid intake Consume adequate amounts of
calcium Limit dietary oxalates Limit sodium intake
(Krieg, 2005)
Trivia
What is the name of the first book in the Harry Potter
series?
Answer
Harry Potter and the Sorcerer’s Stone!!!
Trivia
What commonly prescribed drug increases the risk of developing kidney
stones due to increased renal excretion of calcium?
Answer
Lasix
*Note: Topamax and Indinavir also increase the risk for kidney stones.
(Deglin and Vallerand, 2007) and (WebMD, 2006)
Trivia
True/False: It is important to force fluids on a patient with a kidney stone.
Why or why not?
Answer
False. It is not effective in assisting the patient to pass the stone and may exacerbate the pain.
(Lewis, et al., 2007)
Trivia
Name two nursing diagnosis besides pain and list two interventions for each.
Answer
Impaired urinary elimination Monitor I&O’s and urine characteristics Teach patient to drink adequate amounts of
liquids Teach s/s of UTI
Anxiety Remain with and calm patient Provide education on condition Teach relaxation techniques
Trivia
Fill in the Blank:
The term __________ refers to the stone, and _________ refers to stone
formation.
Answer
The term calculus refers to the stone, and lithiasis refers to stone formation.
(Lewis, et al., 2007)
Trivia
What’s the name of the
“modern stone-age family, from the town of Bedrock (They’re a page right out of
history…)”
Answer
The Flintstones!!!
Trivia
Case Study #7: S.R. was discharged with instructions to strain all urine and return if she experienced pain unrelieved by pain meds or increased N/V.
What specific instructions will you give S.R. about her urine, fluid intake, meds, and activity?
Answer
Urine: check for cloudy, malodorous urine, presence of blood (may be tea colored)
Fluid intake: ensure adequate hydration (6-8 glasses/day), avoid overhydration
Meds: teach about side effects, don’t take more than directed
Activity: teach pt. that ambulation will help with passage of stone
ReferencesDeglin, J. & Vallerand, A. (2005). Davis’s drug guide for nurses (10th ed.). Philedelphia: F. A. Davis Company.
Flagg, L. (2007). Dietary and holistic treatment of recurrent calcium oxalate kidney stones: Review of literature to guide patient education. Urologic Nursing, 27, 113-121.
Guan, N. (2009). Melamine-contaminated powdered formula and urolithiasis in young children. The New England Journal of Medicine, 360, 1067-1074.
Hanson, K. (2005). Minimally invasive and surgical management of urinary stones. Urologic Nursing, 25, 458-464.
Krieg, C. (2005). The role of diet in the prevention of common kidney stones. Urologic Nursing, 25, 451-456.
Lewis, S., Heitkemper, M., Dirksen, S., O’Brien, P., & Bucher, L. (2007). Medical surgical nursing: Assessment and management of clinical problems (7th ed.). St. Louis: Mosby Elsevier.
Mayo Clinic. (2008). Kidney stones. Retrieved April 20, 2009 from http://www.mayoclinic.com/health/kidney-stones/ds00282.
Moe, O. (2006). Kidney stones: Pathophysiology and medical management. The Lancet, 367, 333-344.
Morton, A., Iliescu, E., & Wilson, J. (2002). Nephrology: Investigation and treatment of recurrent kidney stones. Canadian Medical Association Journal, 166, 213-218.
Moyer, M., O’Gara, J., & Burrus, L. (1988). General anesthesia for extracorporeal shock wave lithotripsy. Journal of the American Association of Nurse Anesthetists, 56, 121-125.
Schardt, D. (2009). Skipping stones: How to avoid kidney stones. Nutrition Action Healthletter, 9-11.
Stegall, M. (2001). Urinary tract stones: Causes, complications and treatment. British Journal of Nursing, 10.
Taylor, E. & Curhad, G. (2008). Fructose consumption and the risk of kidney stones. Kidney International, 73, 207-212.
U.S. Department of Health and Human Services. (2007). Kidney stones in adults. Retrieved April 20, 2009 from http://kidney.niddk.nih.gov/kudiseases/pubs/pdf/KidneyStonesAdults.pdf.