Acute renal Lithiasis

Question 1

what is urinary obstruction

Answer 1

• any anatomical or functional condition that blocks or impedes the flow of urine
• Stones obstruct the flow of urine out of the body
• urine cannot move through

Question 2

what are the risk factors?(6)

Answer 2

1. metabolic issues
2. dehydration
3. genetics
4. immobile
5. certain diet
6. high calcium and acid in urine

Question 3

where are the location of the stones

Answer 3

kidney, ureter, bladder

Question 4

what are the signs and symptoms

Answer 4

• very painful ( depending on the location of the stones )
• Kidney: patient will feel a real dull, costovertebral flank pain or renal colic
• Ureters: Intense colicky, patient may be in mild shock

Question 5

what are the signs and symptoms of kidney stones?

Answer 5

patient will feel a real dull, costovertebral flank pain or renal colic

Question 6

what are the signs and symptoms of ureter stones

Answer 6

Intense colicky, patient may be in mild shock (cool moist skin, N&V)

Question 7

what are the diagnosis

Answer 7

1. urinalysis
2. urine culture
3. cyctoscopy
4. Xray
   5 IVP

Question 8

management id renal lithiasis consist of two approach

Answer 8

1. treating the symptoms ( pain, infection, or obstruction)

2. evaluation of the cause of the stones formation and the prevention of further development of stones

Question 9

what informations should we obtain to examine cause/ prevention

Answer 9

1. family history of stone formation
2. geographic residence
3. nutritional assessment
4. activity pattern
5. history of disease and dehydration

Question 10

what is lithotripsy?

Answer 10

involves the use of sound waves to break renal stones into small particles that can be eliminated from urinary tract.

Question 11

how is surgery done?

Answer 11

• not commonly done

- surgeon removes the stones

Question 12

when is surgery an option to remove stones

Answer 12

when patient is very obese or have some other complex abnormalities

Question 13

Overall nursing care goal for patient with urinary tract calculi are

Answer 13

1. relief pain
2. ensure theres no urinary obstruction
3. Understand what patient can do to prevent stones
4. If theres infection get it treated

Question 14

Nursing care for acute renal lithiasis

Answer 14

1. pain control
2. monitor urine amount/ colour
3. “Strain” urine
4. Ambulation
5. Pt education

Question 15

how do we control pain?

Answer 15

• pain is on and off

- pain is controlled by narcotics or any type of urinary analgesics or urinary antipasmic

Question 16

how do we asses urine amount/ colour

Answer 16

• look at the amount and colour
• sometimes hard to tell the amount because stone happens only in 1 kidney at the time so you don’t know which kidney is damaged by looking at foley.

Question 17

“strain” urine

Answer 17

• we want to strain the stones for analysis

- figure out what type and it will help with diagnosing the underlying problems

Question 18

Depending on the type of stones, diet should be modified to decrease foods that are high in substance that cause the calculi

Answer 18

1. purine
2. calcium
3. oxalate

Question 19

why does patient needs to ambulate?

Answer 19

• promotes movement of stone from the upper to lower urinary tract
• Keep in mind safety and risk for fall ( dont let patiend walk alone)

Question 20

Patient education: what is the main objective?

Answer 20

to prevent reoccurrence of the stones

Question 21

how to we prevent recurrence of stones

Answer 21

• adequate fluid intake to produce a urine output of appropriate 3L/ day - helps urine to be more dilute so its not saturated with minerals
• diet limit oxylate ( spinach, cabbage, asparagus, tomatoes) and purines
• infection - be aware of S&S

Question 22

does lithotripsy have any incisions?

Answer 22

no

Question 23

what kind of procedure sedation lithotripsy uses

Answer 23

spinal anaesthetic or general, conscious sedation

Question 24

how do we deal with pain in after lithotripsy

Answer 24

we give patient narcotics and decrease to ibuprofen or other analgesics

Question 25

what is common after a lithotripsy procedure?

Answer 25

• hematuria is common

- Assess colour (gradual pink to yellow)

Question 26

what is placed after lithotripsy

Answer 26

• self-retaining ureteral stent is often placed after procedures to promote passage of sand from the fragmented stone and to prevent obstruction cause by its buildup in the ureter.

Question 27

when is the stent removed?

Answer 27

1 to 2 weeks after lithotripsy

Question 28

what complications may occur with lithotripsy

Answer 28

1. haemorrhage
2. sepsis
3. abscess formation

Question 29

what is the advantage of lithotripsy compared to open surgery

Answer 29

1. decrease length of hospitalization

2. faster healing