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Med Surg I > Wk 5 Nephrolithiasis > Flashcards

Wk 5 Nephrolithiasis Flashcards

1
Q

These are a picture of…

A

Struvite (staghorn) kidney stones

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2
Q

What might a patient have is their ureter is completely obstructed?

A

Nephrostomy tube

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3
Q

How is a nephrostomy tube placed?

A

Surgically inserted into the renal pelvis via a small flank incision

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4
Q

What is a nephrostomy tube attached to?

A

External bag for closed drainage

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5
Q

What happens to the urine in a patient with a nephrostomy tube?

A

It goes directly into the bag, it bypasses the ureter, bladder, etc.

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6
Q

A nephrostomy tube is considered a __ option

A

temporary

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7
Q

If there is excessive pain or drainage around the exit site of a nephrostomy tube, what could that mean?

A

There could be a possible blockage

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8
Q

How would you know if there was a blockage in a nephrostomy tube?

A

There may be excessive pain or drainage around the exit site

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9
Q

What do you need to irrigate a nephrostomy tube?

A

A provider’s order

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10
Q

What are 2 things to consider when irrigating a nephrostomy tube?

A

Strict aspetic technique

Gently instill no more than 5 ml of sterile NS

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11
Q

Why is there only 5ml that can be irrigated into a nephrostomy tube?

A

Because you are irrigating into the renal pelvis which is a very small space

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12
Q

What is the gold standard diagnostic exam to diagnose nephrolithiasis?

A

Non-contrast spiral CT (CT/KUB)

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13
Q

What are 5 other diagnostic tests or procedures for nephrolithiasis?

A

Careful history and physical

Ultrasound

IVP

Urinalysis

Retrieval/analysis of stones

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14
Q

What 3 things are you looking for on a UA for nephrolithiasis?

A

Hematuria

Crystalluria

pH

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15
Q

What are 5 types of kidney stones?

A

Calcium oxalate

Calcium phosphate

Uric acid

Cystine

Struvite

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16
Q

What is the most common type of kidney stone?

A

Calcium oxalate

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17
Q

What is a struvite kidney stone made out of?

A

Magnesium ammonium phosphate

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18
Q

A kidney stone is one of the strongest…

A

Pain sensations known to man

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19
Q

Pain from a kidney stone can be so bad that it can cause…

A

hemodynamic compromise (vital signs)

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20
Q

What may be a priority action/next best action in a patient with a kidney stone?

A

Treating their pain

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21
Q

Would management of pain be a priority action in a patient who is post-op?

A

No, it will not KILL the patient

22
Q

What is kidney stone pain often called?

A

Renal colic

23
Q

What is renal colic treated with?

A

NSAIDs and opiods

24
Q

A patient with kidney stones may have what 2 GI symptoms?

A

Nausea

Vomiting

25
Q

When will the provider want the patient to pass the stone spontaneously?

A

If the stone is small, less than 4mm

26
Q

When will the provider want to remove the stone?

A

When it’s larger than 4mm.

27
Q

What will the provider do to remove the stone?

A

Put a stent in the ureter to make it and the urethra large so the stone will pass

Or surgically remove

28
Q

If a patient has frequent kidney stones you should teach them how to do what 2 things?

A

Keep adequate hydration

How to strain urine

29
Q

What are examples of a low oxolate diet?

A

Dark roughage

Spinch

Cocoa

Nuts

30
Q

Does a patient who frequently gets calcium oxalate kidney stones need to be on a low calcium diet?

A

Evidence says stones may not come from dietary calcium sources

31
Q

If a patient gets frequent kidney stones that are made up of uric acid, what type of diet should they be on?

A

Low purine

32
Q

What foods have purine in them? (3)

A

All alcohol

Some fish, seafood, shellfish

Some meats like bacon and turkey

33
Q

What is an endourologic procedure?

A

Minimally invasive techniques are used to inspect the urinary tract and perform surgery

34
Q

What is a lithotripsy?

A

A procedure that disintegrates (pulverizes) stones via shock waves

35
Q

A procedure that disintegrates (pulverizes) stones via shock waves is called a…

A

Lithotripsy

36
Q

What type of procedure is a lithotripsy?

A

Endourologic procedure

37
Q

What are 3 internal (direct) approaches to a lithotripsy?

A

Cystoscopic

Percutaneous

Laser

38
Q

What does percutaneous mean?

A

Of or through the skin

39
Q

What is an indirect (external) approach to a lithotripsy?

A

Stones may be broken down and washed out

40
Q

What is the major advantage to an external/indirect lithrotripsy?

A

Non-invasive

41
Q

What are 3 complications of an external (indirect) lithotripsy?

A

Hemorrhage

Infection

Retention of stone fragments

42
Q

Is hematuria expected after a lithotripsy?

A

Yes

43
Q

If a HCP places a stent to pass a kidney stone, when will it typically be removed?

A

1-2 weeks later

44
Q

What would not be an expected finding after a lithotripsy?

A

Decreased urine output, that would indicate an obstruction

45
Q

What is the goal for kidney stones for nurses?

A

Patient education - lower risk factors through lifestyle and dietary changes

46
Q

How much fluid intake should you encourage a patient to drink to prevent kidney stones (unless contraindicated)?

A

3 L per day

47
Q

Should you force fluids once a patient has a kidney stone?

A

No. Evidence does not support this.

48
Q

What are nursing implications for the patient who has kidney stones?

A

Reduce risk factors

49
Q

How does the nurse reduce risk factors for a patient who is hospitalized? (4)

A

Encourage ambulation

Stand/sit up to void bladder on regular basis

Turn q2

Adequate fluid intake

50
Q

Why should you filter urine?

A

To catcht the stone to analyze it

51
Q

What is the main reason a patient with kidney stones would be admitted?

A

Their pain is uncontrolled

52
Q

What is often ordered for a patient who is hospitalized with a kidney stone?

A

PCA pump

Med Surg I (41 decks)

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