Wk 5 Nephrolithiasis Flashcards
These are a picture of…
Struvite (staghorn) kidney stones
What might a patient have is their ureter is completely obstructed?
Nephrostomy tube
How is a nephrostomy tube placed?
Surgically inserted into the renal pelvis via a small flank incision
What is a nephrostomy tube attached to?
External bag for closed drainage
What happens to the urine in a patient with a nephrostomy tube?
It goes directly into the bag, it bypasses the ureter, bladder, etc.
A nephrostomy tube is considered a __ option
temporary
If there is excessive pain or drainage around the exit site of a nephrostomy tube, what could that mean?
There could be a possible blockage
How would you know if there was a blockage in a nephrostomy tube?
There may be excessive pain or drainage around the exit site
What do you need to irrigate a nephrostomy tube?
A provider’s order
What are 2 things to consider when irrigating a nephrostomy tube?
Strict aspetic technique
Gently instill no more than 5 ml of sterile NS
Why is there only 5ml that can be irrigated into a nephrostomy tube?
Because you are irrigating into the renal pelvis which is a very small space
What is the gold standard diagnostic exam to diagnose nephrolithiasis?
Non-contrast spiral CT (CT/KUB)
What are 5 other diagnostic tests or procedures for nephrolithiasis?
Careful history and physical
Ultrasound
IVP
Urinalysis
Retrieval/analysis of stones
What 3 things are you looking for on a UA for nephrolithiasis?
Hematuria
Crystalluria
pH
What are 5 types of kidney stones?
Calcium oxalate
Calcium phosphate
Uric acid
Cystine
Struvite
What is the most common type of kidney stone?
Calcium oxalate
What is a struvite kidney stone made out of?
Magnesium ammonium phosphate
A kidney stone is one of the strongest…
Pain sensations known to man
Pain from a kidney stone can be so bad that it can cause…
hemodynamic compromise (vital signs)
What may be a priority action/next best action in a patient with a kidney stone?
Treating their pain
Would management of pain be a priority action in a patient who is post-op?
No, it will not KILL the patient
What is kidney stone pain often called?
Renal colic
What is renal colic treated with?
NSAIDs and opiods
A patient with kidney stones may have what 2 GI symptoms?
Nausea
Vomiting
When will the provider want the patient to pass the stone spontaneously?
If the stone is small, less than 4mm
When will the provider want to remove the stone?
When it’s larger than 4mm.
What will the provider do to remove the stone?
Put a stent in the ureter to make it and the urethra large so the stone will pass
Or surgically remove
If a patient has frequent kidney stones you should teach them how to do what 2 things?
Keep adequate hydration
How to strain urine
What are examples of a low oxolate diet?
Dark roughage
Spinch
Cocoa
Nuts
Does a patient who frequently gets calcium oxalate kidney stones need to be on a low calcium diet?
Evidence says stones may not come from dietary calcium sources
If a patient gets frequent kidney stones that are made up of uric acid, what type of diet should they be on?
Low purine
What foods have purine in them? (3)
All alcohol
Some fish, seafood, shellfish
Some meats like bacon and turkey
What is an endourologic procedure?
Minimally invasive techniques are used to inspect the urinary tract and perform surgery
What is a lithotripsy?
A procedure that disintegrates (pulverizes) stones via shock waves
A procedure that disintegrates (pulverizes) stones via shock waves is called a…
Lithotripsy
What type of procedure is a lithotripsy?
Endourologic procedure
What are 3 internal (direct) approaches to a lithotripsy?
Cystoscopic
Percutaneous
Laser
What does percutaneous mean?
Of or through the skin
What is an indirect (external) approach to a lithotripsy?
Stones may be broken down and washed out
What is the major advantage to an external/indirect lithrotripsy?
Non-invasive
What are 3 complications of an external (indirect) lithotripsy?
Hemorrhage
Infection
Retention of stone fragments
Is hematuria expected after a lithotripsy?
Yes
If a HCP places a stent to pass a kidney stone, when will it typically be removed?
1-2 weeks later
What would not be an expected finding after a lithotripsy?
Decreased urine output, that would indicate an obstruction
What is the goal for kidney stones for nurses?
Patient education - lower risk factors through lifestyle and dietary changes
How much fluid intake should you encourage a patient to drink to prevent kidney stones (unless contraindicated)?
3 L per day
Should you force fluids once a patient has a kidney stone?
No. Evidence does not support this.
What are nursing implications for the patient who has kidney stones?
Reduce risk factors
How does the nurse reduce risk factors for a patient who is hospitalized? (4)
Encourage ambulation
Stand/sit up to void bladder on regular basis
Turn q2
Adequate fluid intake
Why should you filter urine?
To catcht the stone to analyze it
What is the main reason a patient with kidney stones would be admitted?
Their pain is uncontrolled
What is often ordered for a patient who is hospitalized with a kidney stone?
PCA pump
