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Nephrolithiasis XX

The document discusses nephrolithiasis, also known as kidney stones. Kidney stones form when minerals and salts crystallize in the kidneys and are made up of calcium, oxalate, uric acid, cystine or struvite. The nephron filters blood and produces urine, and kidney stones can cause pain, blood in the urine, and block urine flow. Diagnostic tests include ultrasounds, CT scans, urine tests, and x-rays. Treatment involves pain medication, increased fluid intake, medical expulsion therapy, shockwave lithotripsy, or surgery to remove stones. Nurses monitor for pain and complications, encourage fluid intake, and assess for infection when urine flow is

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61 views

Nephrolithiasis XX

The document discusses nephrolithiasis, also known as kidney stones. Kidney stones form when minerals and salts crystallize in the kidneys and are made up of calcium, oxalate, uric acid, cystine or struvite. The nephron filters blood and produces urine, and kidney stones can cause pain, blood in the urine, and block urine flow. Diagnostic tests include ultrasounds, CT scans, urine tests, and x-rays. Treatment involves pain medication, increased fluid intake, medical expulsion therapy, shockwave lithotripsy, or surgery to remove stones. Nurses monitor for pain and complications, encourage fluid intake, and assess for infection when urine flow is

Uploaded by

zebzeb STEMA
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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NEPHROLITHIASIS

GROUP 11:
DIVINE GRACE SY
CYNTHIA C. PONCEJA
Nephrolithiasis
Nephrolithiasis
Nephrolithiasis
NEPHRO - refers to the kidney

LITHIASIS - means stones

(also called renal calculi or urolithiasis)


What are kidney stones?


Kidney stones - are hard insoluble crystallized minerals
and salts that have formed out of the filtrate produced
by the nephron that form inside your kidneys. Diet,
excess body weight, some medical conditions, and
certain supplements and medications are among the
many causes of kidney stones.

WHAT IS THE
ROLE OF THE
NEPHRON?
-The nephron is the functional part of the kidneys that filters the blood
(renal corpuscle), reabsorbs minerals/water and secretes waste (renal
tubule), and produces the substance called urine which will drain down
into the ureters, be stored in the bladder, and voided out via the urethra.
The nephron consists of the following parts:
RENAL CORPUSCLE
Glomerulus
Bowman ’s capsule
RENAL TUBULE
FACTS ABOUT KIDNEY STONES

Kidney stones can vary in size.

Most stones tend to form within the kidney.

They can migrate throughout the urinary system.

Most stones can be passed (very painful) if they are

less than 5.
TYPES OF KIDNEY
STONES:

CALCIUM
OXALATE
-most common type of kidney stone, and they
tend to form in acidic urine. This type of stone is
composed of calcium and oxalate, and forms
when there is a high concentration of calcium or
oxalate in the filtrate.
STRUVITE
STONES
-This type of stone is also called an infection stone
because it forms in urine that is infected with
bacteria form in response to an infection, such as a
urinary tract infection. These stones can grow
quickly and become quite large, sometimes with
few symptoms or little warning.
URIC ACID
STONES
-Uric acid stones can form in people who don’t drink
enough fluids or who lose too much fluid, those
who eat a high-protein diet, and those who have
gout. Certain genetic factors also may increase your
risk of uric acid stones. Uric acid stones happen
when you have too much uric acid in your urine.
CYSTINE
STONES
-These stones form in people with a hereditary
disorder that causes the kidneys to excrete too
much of the amino acid, cystine. This condition is
called cystinuria. This type of kidney stone is rare.
This disease results from a birth defect that causes
the kidney to let too much cystine into the urine.
This type of stone is almost always diagnosed
during childhood.
SIGNS AND SYMPTOMS OF KIDNEY
STONES
Severe pain on either side of your lower back

More vague pain or stomach ache that doesn't go away

Blood in the urine

Nausea or vomiting

Fever and chills

Urine that smells bad or looks cloudy

Asymptomatic

The patient may feel like they need to void but a small amount is voided.

Can have blood in the urine due to stone scraping the ureter (hematuria)

COMPLICATIONS OF RENAL STONE


Obstruction

Hydronephrosis or Hydroureteronephrosis

Damage to the nephrons

Infection
ANATOMY
AND
PHYSIOLOGY
KEY POINTS:
The renal system eliminate wastes from the body,
controls levels of electrolytes and metabolites, controls
the osmoregulation of blood volume and pressure, and
regulates blood pH.
The renal system organs include the kidneys, ureter,
bladder, and urethra. Nephrons are the main functional
component of the kidneys.
The respiratory and cardiovascular systems have certain
functions that overlap with renal system functions.
Metabolic wastes and excess ions are filtered out of the
blood, combined with water, and leave the body in the
form of urine.
A complex network of hormones controls the renal
system to maintain homeostasis.
PATHOPHYSIOLOGY
MEDICAL,
PHARMACOLOGICAL &
SURGICAL
MANAGEMENT
DIAGNOSTIC
PROCEDURE

KUB (X-RAY
OF THE
KIDNEYS,
URETERS, AND
BLADDER)
IVP
(INTRAVENOUS
PYELOGRAM):
ULTRASOUND OR
CT SCAN
URINE
TESTS
PHARMACOLOGIC
OPIOID ANALGESIC AGENTS - nonsteroidal
anti-inflammatory drugs (NSAIDs).

ALLOPURINOL (ZYLOPRIM) - is used to treat


gout and certain types of kidney stones.
D
DIIE
ETT
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.
For uric stones: low purine. Purines make up 15 percent of the
uric acid found in the body. Too much uric acid can lead to
problems, including kidney stones and gout.
For cystine stones: lowprotein diet; alkalinization of urine
For oxalate stones: dilute urine; limited oxalate
STONE
REMOVAL
PROCEDURES

URETEROSCOPY EXTRACORPOREAL
SHOCK WAVE
LITHOTRIPSY (ESWL)

Extracorporeal shock wave


Ureteroscopy with laser
lithotripsy (ESWL) uses shock waves
lithotripsy is used to break up
to break a kidney stone into small
kidney stones by that were not
pieces that can more easily travel
passed and remain lodged in the
through the urinary tract and pass
ureter.
from the body.
PERCUTANEOUS
NEPHROSTOMY
- is a procedure used to
remove kidney stones from
the body when they can't
pass on their own. A scope
is inserted through a small
incision in your back to
remove the kidney stones.
NURSING
NURSING
RESPONSIBILITIES
RESPONSIBILITIES AND
AND
NURSING
NURSING
CONSIDERATION
CONSIDERATION

ASSESSMENT

Assess for pain and discomfort


Assess for associated symptoms
Observe for signs of urinary tract
infection
Observe urine for blood; strain for
stones or gravel.
Focus history on factors that
predispose patient
Assess patient’s knowledge
ACUTE
ACUTE PAIN
PAIN RELATED
RELATED
TO
TO INFLAMMATION,
INFLAMMATION,
OBSTRUCTION,
OBSTRUCTION, AND
AND
ABRASION
ABRASION OF
OF THE
THE
URINARY
URINARY TRACT
TRACT

INTERVENTION

Administer opioid analgesics (IV or intramuscular) with IV NSAID as prescribed.


Encourage and assist patient to assume a position of comfort.
Assist patient to ambulate.
Monitor pain closely and report promptly increases in severity.
Provide comfort measure like touch, repositioning and quiet environment.
Accept client’s description of pain.
Monitor skin color and temperature.
Apply warm compresses to back.
Encourage adequate rest periods
Encourage verbalization of feelings about the pain such as tolerating pain.
Accept client’s description of pain
Observe nonverbal cues and pain behaviours
Refer to the physician regarding the progress of condition.
IMPAIRED
IMPAIRED URINARY
URINARY
ELIMINATION
ELIMINATION RELATED
RELATED
TO
TO BLOCKAGE
BLOCKAGE OF
OF URINE
URINE
FLOW
FLOW BY
BY STONES
STONES

INTERVENTION

Administer fluid orally or I.V. (if vomiting)


Monitor total urine output and patterns of voiding.
Strain all urine through strainer or gauxe.
For outpatient treatment, the patient may use a coffee filter to strain urine
Help patient to walk, if possible.
Encourage fluid intake up to 3000 ml/day.
Encourage client to verbalize fears and concerns.
Check frequently for bladder distention and observe for overflow.
Adhere to a regular bladder or diversion appliance emptying schedule.
Emphasize importance of keeping area clean and dry.
Refer to the physician regarding the progress of condition.
RISK
RISK FOR
FOR INFECTION
INFECTION
RELATED
RELATED TO
TO
OBSTRUCTION
OBSTRUCTION OF
OF URINE
URINE
FLOW
FLOW

INTERVENTION

Assess urine for color, cloudiness and odor.


Obtain vital signs and monitor for fever, signs and symptoms of infection and impending sepsis
(tachycardia, hypotension).
Ensure that the patient understands the signs and symptoms of stone formation, obstruction,
and infection.
Maintain adequate hydration.
Promote adequate rest.
Administer parenteral or oral antibiotics as prescribed.
Educate client of proper perineal care.
Teach proper self- care technique
Maintain aseptic technique in doing the perineal care.
Refer to the physician for the progress of the risk for infection.
EVALUATION

EXPECTED PATIENT OUTCOMES

Reports relief of pain


States increased knowledge of health seeking behaviors to
prevent recurrence
Experiences no complications

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