Urinary Tract Calculi Chapter 46 Copyright 2014 by

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 © 2014 by Mosby, an imprint of Elsevier Inc.

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

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

Case Study i. Stockphoto/Thinkstock § 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 pinktinged. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Case Study i. Stockphoto/Thinkstock § 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? Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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

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

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 © 2014 by Mosby, an imprint of Elsevier Inc.

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

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

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

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

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

Urinary Tract Calculi § Collaborative care § Struvite stones § Antibiotics § Acetohydroxamic acid

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.

Urinary Tract Calculi § Collaborative care § Endourologic procedures for stones § Cystoscopy § Flexible ureteroscope § Cystolitholathopaxy § Cystoscopic lithotripsy § Percutaneous nephrolithotomy 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.

Urinary Tract Calculi § Collaborative care § Surgical therapy § Nephrolithotomy § Pyelolithotomy §

Collaborative Care § Nutritional therapy § Adequate fluid intake § Forcing fluids: contraindicated §

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

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

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 © 2014 by Mosby, an imprint of Elsevier Inc.

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

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 © 2014 by Mosby, an imprint of Elsevier Inc.