T6: Urinary Tract Calculi

Question 1

Urinary Tract Calculi

Answer 1

kidney stones: mostly caused by dehydration

Question 2

what reduced the risk of recurrent stone formation

Answer 2

keeping urine dilute and free flowing

Question 3

lithotripsy

Answer 3

crushing of a stone with laser

Question 4

clinical manifestations of kidney stones

Answer 4

-Renal colic
-Sudden severe pain due to obstruction
- SUDDEN Flank area, back, or lower abdomen

Question 5

Renal colic

Answer 5

term used for the sharp, severe pain, which results from the stretching, dilation, and spasm of the ureter in response to the obstructing stone.

Question 6

Common sites of obstruction

Answer 6

-Ureteropelvic junction (UPJ); Dull pain in costovertebral flank, Renal colic
-Ureterovesicular junction (UVJ)

Question 7

where do men and women complain of pain with kidney stones

Answer 7

men: groin/testiculat pain
women: labia pain

Question 8

Urinary Tract Calculi Diagnostics

Answer 8

-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

Question 9

nursing care for acute kidney stone attacj

Answer 9

opioid for renal colic pain
-TAMSULOSIN (FLOMAX)

Question 10

HINT HINT: Tamsulosin (Flomax)

Answer 10

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.

Question 11

Prevention of kidney stones

Answer 11

watch diet, stay hydrated, avoid milk and dairy - low sodium diet, avoid vitamin D rich foods and organ meets - restrict citrus fruits

Question 12

intake of what vitamins may precipitate kidney stones

Answer 12

vitamin A &D

Question 13

Teaching for stones

Answer 13

-Adequate hydration
-Dietary sodium restrictions
-Dietary changes
-Drugs to minimize stone formation

Question 14

Treatment of struvite stones

Answer 14

-Antibiotics to control infection
-Acetohydroxamic acid
-Surgical removal of stone

Question 15

Struvite stones

Answer 15

scrape down the ureters: contain bacteria that produce ammonia and make the urine alkaline

Question 16

Indications for endourology, lithotripsy, or open surgical stone removal include

Answer 16

*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

Question 17

Endourologic procedures for stones

Answer 17

-Cystoscopy (Flexible ureteroscope)
-Cystolitholapaxy
-Cystoscopic lithotripsy
-Percutaneous nephrolithotomy

Question 18

Laser lithotripsy

Answer 18

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.

Question 19

Surgical therapy

Answer 19

-Nephrolithotomy
-Pyelolithotomy
-Ureterolithotomy
-Cystotomy

Question 20

Nutritional Therapy

Answer 20

-Adequate fluid intake (WATER)
-Forcing fluids: contraindicated
-Low-sodium diet

Question 21

Teach methods to prevent recurrence

Answer 21

*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.

Question 22

uTeach management of acute episode

Answer 22

-Self-monitor urinary pH or urine output
-Pain management and comfort measures
-Strain all urine
-Ambulation