Urinary Tract Calculi

Question 1

What is Urinary Tract Calculi

Answer 1

Nephrolithiasis-Kidney stones

Question 2

What causes stone formation

Answer 2

No single etiology
Factors involved
Metabolic
Genetic
Climate- Heat/dehydration?
Lifestyle

Question 3

What is Hydronephrosis

Answer 3

Dilation or enlargement of the renal pelvises and calyces secondary to obstruction and increased pressure.
Chronic pyelonephritis and renal atrophy may develop

Question 4

Types of Urinary Tract Calculi

Answer 4

Calcium phosphate- Most common
Calcium oxalate
Uric acid
Cystine
Struvite (magnesium ammonium phosphate)

Question 5

Clinical manifestations

Answer 5

Renal Colic- Pain in kidneys
Nausea/vomiting
Common sites of obstruction
Ureteropelvic junction (UPJ)- Where at?
Dull pain in costovertebral flank
Renal colic
Ureterovesicular junction (UVJ)- Where ureters meet bladder

“Kidney stone dance”
Pain moves to lower quadrant of abdomen as stone nears UVJ
Testicular versus labial pain
Both sexes experience groin pain
UTI symptoms

Question 6

Diagnostic studies

Answer 6

Noncontrast spiral CT (CT/KUB)
Ultrasonography
Intravenous pyelorography (IVP)- Xray exam for kidneys using iodine contrast
Complete urinalysis to assess for
Serum calcium, phosphorus, sodium, potassium, bicarbonate, uric acid, BUN, creatinine measurements

Question 7

Nursing Assessment

Answer 7

History
Previous episodes
Prescribed and OTC medications
Dietary supplements
Family history

Question 8

Collaborative care Acute attack

Answer 8

Treat pain
Infection
Obstruction
Tamsulosin (Flomax), Terazosin (Hytrin)
Assessment of the cause
Prevention of further stone development

Adequate Hydration

Question 9

Collaborative care
Patients with active stone formation

Answer 9

Teaching- Prevent future stone formation

Question 10

Tx for Struvite stones

Answer 10

Antibiotics
Acetohydroxamic acid
Surgical removal

Question 11

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

Answer 11

Stones too large for passage
Association with bacteriuria
Causing impairment in renal function
Causing persistent pain, nausea, or paralytic ileus

Question 12

Endourologic procedures for stones

Answer 12

Cystoscopy
Flexible ureteroscope
Cystolitholathopaxy
Cystoscopic lithotripsy
Percutaneous nephrolithotomy

Question 13

Collaborative care
Lithotripsy..

Answer 13

shock waves to break up stones

Question 14

Surgical therapy

Answer 14

Nephrolithotomy-Kidney
Pyelolithotomy-Pelvis
Ureterolithotomy-Ureter
Cystotomy-Bladder

Question 15

Nutritional therapy

Answer 15

Adequate fluid intake- Cannot force fluids
Forcing fluids: contraindicated
Low-sodium diet

Question 16

Nursing management planning

Answer 16

Relief of pain
No urinary tract obstruction
Knowledge of ways to prevent further recurrence of stones

Question 17

Nursing implementation

Answer 17

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- uric acid stones )

Teach management of acute episode
Drug information
Self-monitor urinary pH
Pain management and comfort measures
Strain all urine
Ambulation

Question 18

Evaluation

Answer 18

Maintain free flow of urine with minimal hematuria
Report satisfactory pain relief
Verbalize understanding of disease process and measures to prevent recurrence