T6: Urinary Tract Calculi Flashcards
Urinary Tract Calculi
kidney stones: mostly caused by dehydration
what reduced the risk of recurrent stone formation
keeping urine dilute and free flowing
lithotripsy
crushing of a stone with laser
clinical manifestations of kidney stones
-Renal colic
-Sudden severe pain due to obstruction
- SUDDEN Flank area, back, or lower abdomen
Renal colic
term used for the sharp, severe pain, which results from the stretching, dilation, and spasm of the ureter in response to the obstructing stone.
Common sites of obstruction
-Ureteropelvic junction (UPJ); Dull pain in costovertebral flank, Renal colic
-Ureterovesicular junction (UVJ)
where do men and women complain of pain with kidney stones
men: groin/testiculat pain
women: labia pain
Urinary Tract Calculi Diagnostics
-Noncontrast helical (spiral) CT
-Ultrasound
-Complete urinalysis to assess for Hematuria, Crystalluria, Urinary pH
-Retrieval and analysis of stones
-Serum calcium, phosphorus, sodium, potassium, bicarbonate, uric acid, BUN, creatinine measurements
nursing care for acute kidney stone attacj
opioid for renal colic pain
-TAMSULOSIN (FLOMAX)
HINT HINT: Tamsulosin (Flomax)
α-adrenergic blockers that relax the smooth muscle in the ureter, can be used to facilitate stone passage by relaxing the smooth muscle in the ureters.
Prevention of kidney stones
watch diet, stay hydrated, avoid milk and dairy - low sodium diet, avoid vitamin D rich foods and organ meets - restrict citrus fruits
intake of what vitamins may precipitate kidney stones
vitamin A &D
Teaching for stones
-Adequate hydration
-Dietary sodium restrictions
-Dietary changes
-Drugs to minimize stone formation
Treatment of struvite stones
-Antibiotics to control infection
-Acetohydroxamic acid
-Surgical removal of stone
Struvite stones
scrape down the ureters: contain bacteria that produce ammonia and make the urine alkaline
Indications for endourology, lithotripsy, or open surgical stone removal include
*stones too large for spontaneous passage (usually greater than 7 mm)
* stones associated with bacteriuria or symptomatic infection
* stones causing impaired renal function
* stones causing persistent pain, nausea, or paralytic ileus
* inability of patient to be treated medically
* patient with only one kidney
Endourologic procedures for stones
-Cystoscopy (Flexible ureteroscope)
-Cystolitholapaxy
-Cystoscopic lithotripsy
-Percutaneous nephrolithotomy
Laser lithotripsy
Used to fragment ureteral and large bladder stones,. A ureteroscope is used to get close to the stone. A small fiber is inserted up the endoscope so that the tip (which emits the laser energy) can come in contact with the stone.
Surgical therapy
-Nephrolithotomy
-Pyelolithotomy
-Ureterolithotomy
-Cystotomy
Nutritional Therapy
-Adequate fluid intake (WATER)
-Forcing fluids: contraindicated
-Low-sodium diet
Teach methods to prevent recurrence
*Adequate fluid intake is important to produce a urine output of approximately 2 L/day.
*Moderately active, ambulatory persons should drink about 3 L/day.
*Fluid intake will need to be higher in the active person who works outdoors or who regularly engages in athletic activities.
*Dietary restriction of purines may be helpful for the patient at risk for developing uric acid stones.
uTeach management of acute episode
-Self-monitor urinary pH or urine output
-Pain management and comfort measures
-Strain all urine
-Ambulation
