healthteaching3rdyrnephrolitiasis

8/3/2019 healthteaching3rdyrnephrolitiasis

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Objectives:

General:

To be able to know what is Nephrolitiasis. To be able to know the different Nursing Interventions about Nephrolitiasis.

Specific:

To be able to know the definition of Nephrolitiasis To be able to know the sigs and symptoms of the disease To be able to know what spesific medications are to be given to those patients who are

diagnosed with Nephrolitiasis

To be able to know the different management to those patient with nephrolitiasis.Definition:

A kidney stone, also known as a renal calculus is a solid concretion or crystal aggregation formed in the

kidneys from dietary minerals in the urine. Urinary stones are typically classified by their location in

the kidney (nephrolithiasis), ureter (ureterolithiasis), or bladder (cystolithiasis), or by their chemical

composition (calcium-containing, struvite, uric acid, or other compounds). Kidney stones are a

significant source ofmorbidity. 80% of those with kidney stones are men. Men most commonly

experience their first episode between age 3040 years, while for women the age at first presentation is

somewhat later.

Kidney stones typically leave the body by passage in the urine stream, and many stones are formed and

passed without causing symptoms. If stones grow to sufficient size (usually at least 3 millimeters(0.12 in)) they can cause obstruction of the ureter. Ureteral obstruction causes postrenal

azotemia and hydronephrosis (distension and dilation of the renal pelvis and calyces), as well

as spasm of the ureter. This leads to pain, most commonly felt in the flank (the area between the ribs

and hip), lower abdomen and groin (a condition called renal colic). Renal colic can be associated

with nausea, vomiting, fever, blood in the urine, pus in the urine, and painful urination. Renal colic

typically comes in waves lasting 20 60 minutes, beginning in the flank or lower back and often

radiating to the groin or genitals. The diagnosis of kidney stones is made on the basis of information

obtained from the history, physical examination, urinalysis, and radiographic studies. Ultrasound

examination and blood tests may also aid in the diagnosis.

When a stone causes no symptoms, watchful waiting is a valid option. For symptomatic stones, pain

control is usually the first measure, using medications such as non-steroidal anti-inflammatory

drugs(NSAIDs) or opioids. More severe cases may require surgical intervention. For example, some

stones can be shattered into smaller fragments using extracorporeal shock wave lithotripsy (ESWL).

Some cases require more invasive forms of surgery. Examples of these are cystoscopic procedures such

as laser lithotripsy, or percutaneous techniques such as percutaneous nephrolithotomy. Sometimes, a
http://en.wikipedia.org/wiki/Enterolithhttp://en.wikipedia.org/wiki/Crystalhttp://en.wikipedia.org/wiki/Dietary_mineralhttp://en.wikipedia.org/wiki/Urinehttp://en.wikipedia.org/wiki/Urolithiasishttp://en.wikipedia.org/wiki/Kidneyhttp://en.wikipedia.org/wiki/Ureterhttp://en.wikipedia.org/wiki/Urinary_bladderhttp://en.wikipedia.org/wiki/Bladder_stonehttp://en.wikipedia.org/wiki/Calciumhttp://en.wikipedia.org/wiki/Struvitehttp://en.wikipedia.org/wiki/Uric_acidhttp://en.wikipedia.org/wiki/Disease#Morbidityhttp://en.wikipedia.org/wiki/Azotemia#Postrenal_azotemiahttp://en.wikipedia.org/wiki/Azotemia#Postrenal_azotemiahttp://en.wikipedia.org/wiki/Hydronephrosishttp://en.wikipedia.org/wiki/Renal_pelvishttp://en.wikipedia.org/wiki/Calyx_(kidney)http://en.wikipedia.org/wiki/Spasmhttp://en.wikipedia.org/wiki/Painhttp://en.wikipedia.org/wiki/Flankhttp://en.wikipedia.org/wiki/Groinhttp://en.wikipedia.org/wiki/Renal_colichttp://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Hematuriahttp://en.wikipedia.org/wiki/Pyuriahttp://en.wikipedia.org/wiki/Dysuriahttp://en.wikipedia.org/wiki/Medical_diagnosishttp://en.wikipedia.org/wiki/Medical_historyhttp://en.wikipedia.org/wiki/Physical_examinationhttp://en.wikipedia.org/wiki/Urinalysishttp://en.wikipedia.org/wiki/Projectional_radiographyhttp://en.wikipedia.org/wiki/Medical_ultrasonographyhttp://en.wikipedia.org/wiki/Medical_ultrasonographyhttp://en.wikipedia.org/wiki/Blood_testhttp://en.wikipedia.org/wiki/Watchful_waitinghttp://en.wikipedia.org/wiki/Analgesichttp://en.wikipedia.org/wiki/Analgesichttp://en.wikipedia.org/wiki/Non-steroidal_anti-inflammatory_drughttp://en.wikipedia.org/wiki/Non-steroidal_anti-inflammatory_drughttp://en.wikipedia.org/wiki/Opioidhttp://en.wikipedia.org/wiki/Extracorporeal_shock_wave_lithotripsyhttp://en.wikipedia.org/wiki/Invasiveness_of_surgical_procedureshttp://en.wikipedia.org/wiki/Cystoscopyhttp://en.wikipedia.org/wiki/Laser_lithotripsyhttp://en.wikipedia.org/wiki/Percutaneoushttp://en.wikipedia.org/wiki/Percutaneous_nephrolithotomyhttp://en.wikipedia.org/wiki/Percutaneous_nephrolithotomyhttp://en.wikipedia.org/wiki/Percutaneoushttp://en.wikipedia.org/wiki/Laser_lithotripsyhttp://en.wikipedia.org/wiki/Cystoscopyhttp://en.wikipedia.org/wiki/Invasiveness_of_surgical_procedureshttp://en.wikipedia.org/wiki/Extracorporeal_shock_wave_lithotripsyhttp://en.wikipedia.org/wiki/Opioidhttp://en.wikipedia.org/wiki/Non-steroidal_anti-inflammatory_drughttp://en.wikipedia.org/wiki/Non-steroidal_anti-inflammatory_drughttp://en.wikipedia.org/wiki/Analgesichttp://en.wikipedia.org/wiki/Analgesichttp://en.wikipedia.org/wiki/Watchful_waitinghttp://en.wikipedia.org/wiki/Blood_testhttp://en.wikipedia.org/wiki/Medical_ultrasonographyhttp://en.wikipedia.org/wiki/Medical_ultrasonographyhttp://en.wikipedia.org/wiki/Projectional_radiographyhttp://en.wikipedia.org/wiki/Urinalysishttp://en.wikipedia.org/wiki/Physical_examinationhttp://en.wikipedia.org/wiki/Medical_historyhttp://en.wikipedia.org/wiki/Medical_diagnosishttp://en.wikipedia.org/wiki/Dysuriahttp://en.wikipedia.org/wiki/Pyuriahttp://en.wikipedia.org/wiki/Hematuriahttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Renal_colichttp://en.wikipedia.org/wiki/Groinhttp://en.wikipedia.org/wiki/Flankhttp://en.wikipedia.org/wiki/Painhttp://en.wikipedia.org/wiki/Spasmhttp://en.wikipedia.org/wiki/Calyx_(kidney)http://en.wikipedia.org/wiki/Renal_pelvishttp://en.wikipedia.org/wiki/Hydronephrosishttp://en.wikipedia.org/wiki/Azotemia#Postrenal_azotemiahttp://en.wikipedia.org/wiki/Azotemia#Postrenal_azotemiahttp://en.wikipedia.org/wiki/Disease#Morbidityhttp://en.wikipedia.org/wiki/Uric_acidhttp://en.wikipedia.org/wiki/Struvitehttp://en.wikipedia.org/wiki/Calciumhttp://en.wikipedia.org/wiki/Bladder_stonehttp://en.wikipedia.org/wiki/Urinary_bladderhttp://en.wikipedia.org/wiki/Ureterhttp://en.wikipedia.org/wiki/Kidneyhttp://en.wikipedia.org/wiki/Urolithiasishttp://en.wikipedia.org/wiki/Urinehttp://en.wikipedia.org/wiki/Dietary_mineralhttp://en.wikipedia.org/wiki/Crystalhttp://en.wikipedia.org/wiki/Enterolith


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tube (ureteral stent) may be placed in the ureter to bypass the obstruction and alleviate the symptoms,

as well as to prevent ureteral stricture after ureteroscopic stone removal.

Epidemiology

The prevalence of urinary calculi is estimated to be 5 percent in the general population, with an annual

incidence of as much as 1 percent.2Men are twice as likely as women to develop calculi, with the first

episode occurring at an average age of 30 years.3Women have a bimodal age of onset, with episodes

peaking at 35 and 55 years. Without preventive treatment, the recurrence rate of calcium oxalate calculi

increases with time and reaches 50 percent at 10 years.3

TABLE 1

Risk Factors for the Development of Urinary Calculi

Risk factor Mechanisms

Bowel disease Promotes low urine volume; acidic urine depletes available citrate;

hyperoxaluria

Excess dietary meat (including

poultry)

Creates acidic urinary milieu, depletes available citrate; promotes

hyperuricosuria

Excess dietary oxalate Promotes hyperoxaluria

Excess dietary sodium Promotes hypercalciuria

Family history Genetic predisposition

Insulin resistance Ammonia mishandling; alters pH of urineGout Promotes hyperuricosuria

Low urine volume Allows stone constituents to supersaturate

Obesity May promote hypercalciuria; other results similar to excess dietary

meat

Primary hyperparathyroidism Creates persistent hypercalciuria

Prolonged immobilization Bone turnover creates hypercalciuriaRenal tubular acidosis (type 1) Alkaline urine promotes calcium phosphate supersaturation; loss

of citrate

Pathophysiology:

Non-Modified

Congenital

Modifiable:

Trauma, ascending UTI

Increased Concentration ofurine

Cyst

Decreased Glomerular filtration rate

Blunt force Infection Hereditary
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Signs & Symptoms:

The main symptom is severe pain that starts suddenly and may go away suddenly:

Pain may be felt in the belly area or side of the back Pain may move to groin area (groin pain) or testicles (testicle pain)

Other symptoms can include:

Abnormal urine color Blood in the urine Chills Fever Nausea Vomiting

Clinical Clues to the Diagnosis of Urinary Calculi

Evaluation Possible findings

Laboratory evaluationsComplete blood count Leukocytosis with struvite calculi

Serum chemistry Elevation in creatinine levels with obstructing calculi; hypokalemia and

hyperchloremia with renal tubular acidosis; elevated serum calcium

levels with parathyroid diseaseSerum parathyroid hormone

levels

Elevated in hyperparathyroidism

Urinalysis Microscopic or gross hematuria; acidic urine; alkaline urine (with struvite

Formation of crystals

Kidneys

Monitor dicreased GFR

H2O retention

Major dicrease GFR

Obstructi

Restlessnes

Dicreased Urine O.Pain

Ureters

Fluid & Electrolyte Imbalance

Fluid volume excess
http://health.allrefer.com/health/groin-pain-info.htmlhttp://health.allrefer.com/health/testicle-pain-info.htmlhttp://health.allrefer.com/health/urine-abnormal-color-info.htmlhttp://health.allrefer.com/health/urine-bloody-or-dark-info.htmlhttp://health.allrefer.com/health/fever-info.htmlhttp://health.allrefer.com/health/nausea-and-vomiting-info.htmlhttp://health.allrefer.com/health/nausea-and-vomiting-info.htmlhttp://health.allrefer.com/health/nausea-and-vomiting-info.htmlhttp://health.allrefer.com/health/nausea-and-vomiting-info.htmlhttp://health.allrefer.com/health/fever-info.htmlhttp://health.allrefer.com/health/urine-bloody-or-dark-info.htmlhttp://health.allrefer.com/health/urine-abnormal-color-info.htmlhttp://health.allrefer.com/health/testicle-pain-info.htmlhttp://health.allrefer.com/health/groin-pain-info.html


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Evaluation Possible findings

calculi); pyuria; crystals from involved calculi

24-hour urinalysis Elevated urinary calcium, oxalate, and sodium levels; decreased urinary

volume and citrate levels

Radiographic evaluations

Abdominal, kidney, andupper bladder radiography Urinary calculi larger than 2 mm may be visible.

CT (stone protocol) Nearly all calculi are visible on CT. Evaluates renal parenchyma,hydronephrotic changes, and surrounding organs for other etiologies of

abdominal pain.

Intravenous pyelography Calculi visible on scout film. Delay in contrast excretion if obstruction is

present. Calculi may appear as filling defect.

MRI Conventional MRI is not useful for imaging calculi.

Ultrasonography Calculi appear as hyperechoic lesions that cast acoustic shadows. Not

reliable for ureteral calculi. May demonstrate dilation of collecting

system.

Treatment:

Increasing fluid intake ofcitrate-rich fluids (especially citrate-rich fluids suchas lemonade and orange juice), with the objective of increasing urine output to more than

2 liters per day

Attempt to maintain a calcium (Ca) intake of 1000 1200 mg per day Limiting sodium (Na) intake to less than 2300 mg per day Limiting vitamin C intake to less than 1000 mg per day (A positive association between

animal protein consumption and recurrence of kidney stones has been shown in men, but notyet in women.])

Limiting animal protein intake to no more than 2 meals daily, with less than 170 230 gram perday

Limiting consumption of foods containing high amounts ofoxalate (suchas spinach, strawberries, nuts, rhubarb, wheat germ, dark chocolate, cocoa, brewed tea)

Drugs:

Urine alkalinization

Acetazolamide (Diamox) is a medication that alkalinizes the urine. In addition to acetazolamide

or as an alternative, certain dietary supplements are available that produce a similar

alkalinization of the urine.

Diuretics

thiazide and thiazide-like diuretics this drugs inhibit the formation of calcium-containing

stones by reducing urinary calcium excretion

Allopurinol

interferes with the production of uric acid in the liver
http://en.wikipedia.org/wiki/Citratehttp://en.wikipedia.org/wiki/Lemonadehttp://en.wikipedia.org/wiki/Orange_juicehttp://en.wikipedia.org/wiki/Urinehttp://en.wikipedia.org/wiki/Calciumhttp://en.wikipedia.org/wiki/Sodiumhttp://en.wikipedia.org/wiki/Vitamin_Chttp://en.wikipedia.org/wiki/Protein_(nutrient)http://en.wikipedia.org/wiki/Kidney_stone#cite_note-Taylor2006-47http://en.wikipedia.org/wiki/Kidney_stone#cite_note-Taylor2006-47http://en.wikipedia.org/wiki/Kidney_stone#cite_note-Taylor2006-47http://en.wikipedia.org/wiki/Gramhttp://en.wikipedia.org/wiki/Oxalatehttp://en.wikipedia.org/wiki/Spinachhttp://en.wikipedia.org/wiki/Garden_strawberryhttp://en.wikipedia.org/wiki/Nut_(fruit)http://en.wikipedia.org/wiki/Cereal_germhttp://en.wikipedia.org/wiki/Wheat_germhttp://en.wikipedia.org/wiki/Types_of_chocolatehttp://en.wikipedia.org/wiki/Cocoa_solidshttp://en.wikipedia.org/wiki/Teahttp://en.wikipedia.org/wiki/Acetazolamidehttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Thiazide-like_diuretichttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Thiazide-like_diuretichttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Acetazolamidehttp://en.wikipedia.org/wiki/Teahttp://en.wikipedia.org/wiki/Cocoa_solidshttp://en.wikipedia.org/wiki/Types_of_chocolatehttp://en.wikipedia.org/wiki/Wheat_germhttp://en.wikipedia.org/wiki/Cereal_germhttp://en.wikipedia.org/wiki/Nut_(fruit)http://en.wikipedia.org/wiki/Garden_strawberryhttp://en.wikipedia.org/wiki/Spinachhttp://en.wikipedia.org/wiki/Oxalatehttp://en.wikipedia.org/wiki/Gramhttp://en.wikipedia.org/wiki/Kidney_stone#cite_note-Taylor2006-47http://en.wikipedia.org/wiki/Protein_(nutrient)http://en.wikipedia.org/wiki/Vitamin_Chttp://en.wikipedia.org/wiki/Sodiumhttp://en.wikipedia.org/wiki/Calciumhttp://en.wikipedia.org/wiki/Urinehttp://en.wikipedia.org/wiki/Orange_juicehttp://en.wikipedia.org/wiki/Lemonadehttp://en.wikipedia.org/wiki/Citrate


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Medical Management:

Nursing Interventions

The nurse should:

Perform pain assessments to include Visual Analog, numerical, or Wong-Baker scales asappropriate for patient population to assess level of pain and effectiveness of outcome with

pain interventions.

Provide pharmacological education. Narcotics are usually used liberally, such as parenteral(IM/IV) narcotics (ketorolac, [Toradol], meperedine [Demerol], morphine, and oral

narcotics/analgesic combinations (Department of the Navy Bureau of Medicine and Surgery,

2004). Use of narcotic medication needs to be explained as well as side effects, such as nausea,

vomiting, constipation, and caution with driving or operating machinery.

Review bowel patterns and suggest interventions to prevent constipation due to painmedication.
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Assess contributing factors of dehydration such as nausea, vomiting, and diarrhea andadminister antiemetics, such as metoclopramine (Reglan), prochlorperazine (Compazine),

granisetron (Kytril), or ondansetron (Zofran). Administer antidiarrheal agents such as

loperamide (Imodium), diphenoxylate, atropine (Lomotil), or paregoric and assess

effectiveness of outcomes. If severe nausea and vomiting occur, patients must be aware that

prevention of dehydration and electrolyte imbalance, may require IV hydration, prescription of

anti-emetics, and solutions such as such as Gatorade or Pedialyte to replace electrolytes lost

via the GI tract.

Assess for vital signs checking for orthostatic hypotension (lowering of blood pressure andincrease in pulse with positional changes) and monitoring patient weights.

Encourage increases in daily fluid intake, especially water, and monitor outcomes ofinterventions through patient voiding history and 24-hour urine reports. The most important

lifestyle change to prevent stones is drinking more fluids, especially water up to 2 quarts/day.

Educate the patient on completing a voiding diary to track daily urine output. Educate the patient on the importance of completing laboratory tests ordered, especially 24-

hour urines. This can become an imposition on the patient's quality of life, especially if he is

active and working.

Educate the patient on collecting urine specimens and straining urine. Educate the patient on diagnostic testing, including required dietary or bowel preparation to

reduce anxiety.

Educate the patient on the importance of weight loss, maintaining weight loss, and dailyexercise.

Provide counseling on health promotion and maintenance, stressing the importance offollowup care to evaluate causes of stone formation in an effort to prevent future recurrences.

References:

http://emedicine.medscape.com/article/437096-treatment

http://www.annualreviews.org/doi/abs/10.1146/annurev.me.39.020188.002023 http://www.aafp.org/afp/2006/0701/p86.html http://www.ccjm.org/content/76/10/583.full Medical Surgical Nursing by Joyce Black 11th edition Fundamentals of Nursing by Barbara Kozier 9th edition
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Health Teaching

Nephrolitiasis

(Renal Calculi/ Kidney Stones)

Submitted by:

III-C4

Bencion, Janine

De Guzman, Gerard

Garcia, Yras

Ilas, Kristina

Magandia, Afida

Orbeta, Alyssa Wendy

Reyes, Rose

Rowe, Charmaine

Silvestre, Elaine Marie

Soliven, Ben

Tahup, Angelyne

Submitted to:

Ms. Caridad Cabral R.N.

Clinical Instructor

Nov. 4 2011

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