Urinary Tract Calculi Chapter 45 10 th edition

Urinary Tract Calculi § 1 to 2 million in United States have nephrolithiasis §

Urinary Tract Calculi § Etiology and pathophysiology § Stone formation § No single theory

Urinary Tract Calculi § Etiology and pathophysiology § Stone formation § Mucoprotein forms matrix

Urinary Tract Calculi Copyright © 2017, Elsevier Inc. All Rights Reserved.

Urinary Tract Calculi § Types § Calcium phosphate § Calcium oxalate § Uric acid

Urinary Tract Calculi § Clinical manifestations § Renal colic § Sudden severe pain due

Urinary Tract Calculi § Clinical manifestations § “Kidney stone dance” § Mild shock with

Urinary Tract Calculi § Diagnostic studies § Noncontrast helical (spiral) CT § Ultrasound §

Urinary Tract Calculi § Diagnostic studies § Retrieval and analysis of stones § Serum

Urinary Tract Calculi § Interprofessional Care § Acute attack § Treat pain: opioids §

Urinary Tract Calculi § Interprofessional Care § Prevention of further stone development § Patient

Urinary Tract Calculi § History § Previous episodes § Prescribed and OTC medications §

Urinary Tract Calculi § Interprofessional Care § Management of acute attack § Administer opioids

Urinary Tract Calculi § Interprofessional Care § Evaluation of the cause of stone formation

Urinary Tract Calculi § Interprofessional Care § Patients with active stone formation § Teaching

Urinary Tract Calculi § Interprofessional Care § Treatment of struvite stones § Antibiotics to

Urinary Tract Calculi § Interprofessional Care § Indications for endourology, lithotripsy, or open surgical

Urinary Tract Calculi § Interprofessional Care § Endourologic procedures for stones § Cystoscopy §

https: //www. onhealth. com/content/1/ki dney_stones https: //multiplesclerosisnewstoday. com/20 17/03/27/multiple-sclerosis-patients-facehigher-risk-developing-kidney-bladderstones/ Copyright © 2017, Elsevier Inc.

Urinary Tract Calculi § Interprofessional Care § Lithotripsy § Laser lithotripsy § Extracorporeal shock-wave

Urinary Tract Calculi § Interprofessional Care § Surgical therapy § Nephrolithotomy § Pyelolithotomy §

Interprofessional Care § Nutritional Therapy § Adequate fluid intake § Forcing fluids: contraindicated §

Nursing Management Urinary Tract Calculi § Nursing Assessment § Subjective data § Objective data

Nursing Management Urinary Tract Calculi § Nursing Diagnoses § Impaired urinary elimination § Acute

Nursing Management Urinary Tract Calculi § Planning § Relief of pain § No urinary

Nursing Management Urinary Tract Calculi § Nursing Implementation § Teach methods to prevent recurrence

Nursing Management Urinary Tract Calculi § Nursing Implementation § Teach management of acute episode

Nursing Management Urinary Tract Calculi § Evaluation § Maintain free flow of urine with

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Urinary Tract Calculi § 1 to 2 million in United States have nephrolithiasis § More common in men § Average at onset: 20– 55 years § Increased incidence § White persons § Family history of stone formation § Previous history § Summer months Copyright © 2017, Elsevier Inc. All Rights Reserved.

Urinary Tract Calculi § Etiology and pathophysiology § Stone formation § No single theory for all cases § Factors involved § Metabolic § Genetic § Climatic § Lifestyle § Occupational influences Copyright © 2017, Elsevier Inc. All Rights Reserved.

Urinary Tract Calculi § Etiology and pathophysiology § Stone formation § Mucoprotein forms matrix § Affected by § Urinary p. H (alkaline) § Solute load § Inhibitors in urine § Other factors § Obstruction with urinary stasis § UTI § Genetics Copyright © 2017, Elsevier Inc. All Rights Reserved.

Urinary Tract Calculi § Clinical manifestations § Renal colic § Sudden severe pain due to obstruction § Flank area, back, or lower abdomen § Common sites of obstruction § Ureteropelvic junction (UPJ) § Dull pain in costovertebral flank § Renal colic § Ureterovesicular junction (UVJ) Copyright © 2017, Elsevier Inc. All Rights Reserved.

Urinary Tract Calculi § 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 Copyright © 2017, Elsevier Inc. All Rights Reserved.

Urinary Tract Calculi § Diagnostic studies § Noncontrast helical (spiral) CT § Ultrasound § Complete urinalysis to assess for § Hematuria § Crystalluria § Urinary p. H Copyright © 2017, Elsevier Inc. All Rights Reserved.

Urinary Tract Calculi § Diagnostic studies § Retrieval and analysis of stones § Serum calcium, phosphorus, sodium, potassium, bicarbonate, uric acid, BUN, creatinine measurements Copyright © 2017, Elsevier Inc. All Rights Reserved.

Urinary Tract Calculi § Interprofessional Care § Acute attack § Treat pain: opioids § Infection § Obstruction § Tamsulosin (Flomax) § Terazosin (Hytrin) § Assessment of cause Copyright © 2017, Elsevier Inc. All Rights Reserved.

Urinary Tract Calculi § Interprofessional 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 Copyright © 2017, Elsevier Inc. All Rights Reserved.

Urinary Tract Calculi § Interprofessional Care § Management of acute attack § Administer opioids to relieve renal colic pain § Tamsulosin (Flomax) or terazosin Copyright © 2017, Elsevier Inc. All Rights Reserved.

Urinary Tract Calculi § Interprofessional Care § Evaluation of the cause of stone formation § Family history § Geographic location § Nutritional assessment § Intake of vitamins A and D § Activity pattern § Prolonged illness, disease, surgery Copyright © 2017, Elsevier Inc. All Rights Reserved.

Urinary Tract Calculi § Interprofessional Care § Patients with active stone formation § Teaching § Adequate hydration § Dietary sodium restrictions § Dietary changes § Drugs to minimize stone formation Copyright © 2017, Elsevier Inc. All Rights Reserved.

Urinary Tract Calculi § Interprofessional Care § Treatment of struvite stones § Antibiotics to control infection § Acetohydroxamic acid § Surgical removal of stone Copyright © 2017, Elsevier Inc. All Rights Reserved.

Urinary Tract Calculi § Interprofessional Care § Indications for endourology, lithotripsy, or open surgical stone removal include § Stones too large for passage § Stones associated with bacteriuria § Causing impairment in renal function § Causing persistent pain, nausea, or paralytic ileus Copyright © 2017, Elsevier Inc. All Rights Reserved.

Urinary Tract Calculi § Interprofessional Care § Endourologic procedures for stones § Cystoscopy § Flexible ureteroscope § Cystolitholapaxy § Cystoscopic lithotripsy § Percutaneous nephrolithotomy Copyright © 2017, Elsevier Inc. All Rights Reserved.

https: //www. onhealth. com/content/1/ki dney_stones https: //multiplesclerosisnewstoday. com/20 17/03/27/multiple-sclerosis-patients-facehigher-risk-developing-kidney-bladderstones/ Copyright © 2017, Elsevier Inc. All Rights Reserved.

Urinary Tract Calculi § Interprofessional Care § Lithotripsy § Laser lithotripsy § Extracorporeal shock-wave lithotripsy (ESWL) § Percutaneous ultrasonic lithotripsy § Electrohydraulic lithotripsy Copyright © 2017, Elsevier Inc. All Rights Reserved.

Nursing Management Urinary Tract Calculi § Planning § Relief of pain § No urinary tract obstruction § Knowledge of ways to prevent recurrence of stones Copyright © 2017, Elsevier Inc. All Rights Reserved.

Nursing Management Urinary Tract Calculi § 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) Copyright © 2017, Elsevier Inc. All Rights Reserved.

Nursing Management Urinary Tract Calculi § Nursing Implementation § Teach management of acute episode § Drug information § Self-monitor urinary p. H or urine output § Pain management and comfort measures § Strain all urine § Ambulation https: //www. allinahealth. o rg/mdex/ND 0883 G. HTM Copyright © 2017, Elsevier Inc. All Rights Reserved.

Nursing Management Urinary Tract Calculi § Evaluation § Maintain free flow of urine with minimal hematuria § Report satisfactory pain relief § Verbalize understanding of disease process and measures to prevent recurrence Copyright © 2017, Elsevier Inc. All Rights Reserved.