Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Urinary Tract Calculi Chapter 46

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Urinary Tract Calculi  1 to 2 million in United States have nephrolithiasis  More common in men  Average age at onset: 20–55 years  Increased incidence  White persons  Family history of stone formation  Previous history  Summer months

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.  Etiology and pathophysiology  Stone formation  No single etiology for all cases  Factors involved  Metabolic  Genetic  Climate  Lifestyle  Occupational influences Urinary Tract Calculi

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Urinary Tract Calculi

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Case Study  H.C., a 45-year-old man, comes into the ED with severe right flank pain.  He states that the pain just started this morning.  He also noticed that his urine is pink- tinged. iStockphoto/Thinkstock

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Case Study  H.C. is restless and asks if he can get up and walk, but he requires assistance to do so.  What other manifestations of urinary calculi would you assess for? iStockphoto/Thinkstock

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Urinary Tract Calculi  Types  Calcium phosphate  Calcium oxalate  Uric acid  Cystine  Struvite (magnesium ammonium phosphate)

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.  Clinical manifestations  Sudden severe pain due to obstruction  Common sites of obstruction  Ureteropelvic junction (UPJ)  Dull pain in costovertebral flank  Renal colic  Ureterovesicular junction (UVJ) Urinary Tract Calculi

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.  Clinical manifestations  “Kidney stone dance”  Mild shock with cool, moist skin  Pain moves to lower quadrant of abdomen as stone nears UVJ  Testicular versus labial pain  Both sexes experience groin pain  UTI symptoms Urinary Tract Calculi

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.  Diagnostic studies  Noncontrast spiral CT (CT/KUB)  Ultrasonography  Intravenous pyelorography (IVP)  Complete urinalysis to assess for  Hematuria  Crystalluria Urinary Tract Calculi

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.  History  Previous episodes  Prescribed and OTC medications  Dietary supplements  Family history Urinary Tract Calculi

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.  Collaborative care  Acute attack  Treat pain: opioids  Infection  Obstruction  Tamsulosin (Flomax)  Terazosin (Hytrin)  Assessment of the cause Urinary Tract Calculi

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.  Collaborative care  Prevention of further stone development  Patient and family history  Geographic residence  Nutritional assessment  Activity patterns  Immobilization or dehydration  Surgery of GI or GU tract Urinary Tract Calculi

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.  Collaborative care  Patients with active stone formation  Teaching  Adequate hydration  Dietary sodium restrictions  Dietary changes  Drugs to minimize stone formation Urinary Tract Calculi

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.  Collaborative care  Struvite stones  Antibiotics  Acetohydroxamic acid  Surgical removal Urinary Tract Calculi

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Urinary Tract Calculi  Collaborative care  Indications for endourologic stone removal, lithotripsy, or open surgical stone removal include  Stones too large for passage  Association with bacteriuria  Causing impairment in renal function  Causing persistent pain, nausea, or paralytic ileus

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.  Collaborative care  Endourologic procedures for stones  Cystoscopy  Flexible ureteroscope  Cystolitholathopaxy  Cystoscopic lithotripsy  Percutaneous nephrolithotomy Urinary Tract Calculi

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Urinary Tract Calculi

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Urinary Tract Calculi  Collaborative care  Lithotripsy  Laser lithotripsy  Extracorporeal shock-wave lithotripsy (ESWL)  Percutaneous ultrasonic lithotripsy  Electrohydraulic lithotripsy

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.  Collaborative care  Surgical therapy  Nephrolithotomy  Pyelolithotomy  Ureterolithotomy  Cystotomy Urinary Tract Calculi

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.  Nutritional therapy  Adequate fluid intake  Forcing fluids: contraindicated  Low-sodium diet Collaborative Care

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.  Nursing diagnoses  Impaired urinary elimination  Acute pain  Deficient knowledge Nursing Management Urinary Tract Calculi

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.  Planning  Relief of pain  No urinary tract obstruction  Knowledge of ways to prevent further recurrence of stones Nursing Management Urinary Tract Calculi

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.  Nursing implementation  Teach methods to prevent recurrence  Change of lifestyle and dietary habits  Adequate fluid intake: to produce approximately 2 L of urine per day  Dietary restriction (e.g., purines) Nursing Management Urinary Tract Calculi

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.  Nursing implementation  Teach management of acute episode  Drug information  Self-monitor urinary pH  Pain management and comfort measures  Strain all urine  Ambulation Nursing Management Urinary Tract Calculi

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.  Evaluation  Maintain free flow of urine with minimal hematuria  Report satisfactory pain relief  Verbalize understanding of disease process and measures to prevent recurrence Nursing Management Urinary Tract Calculi