Calculi

renal calculi presentation for nurses

1. Urinary calculi ( urolithiasis ) or// Nephrolithiasis (renal calculi ) patel ankita .m. first year m.sc nursing C.m patel college of nuring

2. Definitions: Nephrolithiasis (renal calculi) means stone in kidney that occur due to concentration of dissolved minerals in the kidney. Urolithiasis (urinary calculi) means stone in urinary tract that occur due to concentration of dissolved minerals in urinary tract.

3. Etiology :- Hyperparathyroidism Increase calcium level Elevated uric acid(gout) Excessive intake of dietary calcium Infection of urinary tract Low fluid intake Medications lie diuretics Family history of stone Obstruction of urinary tract High minerals in drinking water High mineral and protein containing diet Previous history of urinary calculi Sedentary life style Neurogenic bladder

4. Pathophysiology :-

5. Clinical manifestation:- Severe abdominal pain or low back pain Hematuria Dysuria Discomfort Nausea & vomiting Fever if infection is present Painful urination Oliguria Pyuria Local tenderness

6. Diagnosis :- History & physical examination X-ray USG IVP Urine analysis Blood test- serum calcium level, serum uric acid level

7. Management :- Management of urinary calculi depend size & location of stone. If stone is less than 5mm it is likely to pass through the ureter and spontaneously come out with adequate hydration but if stone is more than 5mm than surgical management is indicated.

8. A. Medical & therapeutic management: 1. Pain management- Pain medications like NSAIDS or antispasmodic Antiemetic for nausea and vomiting. 2. Increase fluid intake- Increase fluid intake is most effective strategy for small size stone. Advice patient to increase daily intake of fluid upto 3 to 4 liters per day. Maintain I/o chart. 3. Diet modification: Diet modification is necessary to prevent reoccurrence of stone. Ask patient to limit calcium, sodium and protein in diet.

9. B. Surgical management: 1. Endourological procedure: 2. Lithotripsy: - Laser lithotripsy: - Extracorporeal shock wave lithotripsy(ESWL): - PCNL( Percutaneous Nephrolithotomy ): 3. Open surgical procedure: 4. Partial or total nephrectomy :

10. Nursing management: 1. Relieve pain: Assess the characteristics of pain. Advice adequate rest. Advice patient to increase fluid intake. Use heat application for pain. Give antispasmodic and analgesics for pain as per prescription. 2. Maintain urinary elimination: Monitor patient for sign and symptoms of urinary obstruction such as oliguria . Administer fluid orally or I.V to reduce concentration of urine. Assist in adequate mobilization to help stone come out. Monitor for sign and symptoms of infection.

11. CONTINUE: 3. Health education: Patient is educated about adequate fluid intake, regular emptying and proper perineal hygiene. Advice to reduce food high in protein and calcium. Limit milk and milk products. Advice patient to drink glass of warm water before bed. Advice patient to take medications as per doctor’s prescription.

12. Pre & post operative care: 1. Pre operative care:- Collect history Perform detail assessment Perform laboratory data Obtain written concent Explain about surgery Keep patient NBM 6 hours prior surgery Administer pre medications. Transfer patient to operative room.

13. 2. Post operative care:- Receive patient on operation bed. Perform immediate assessment that includes vital sign, pain, urinary drainage etc. Keep patient NBM for two hours. Monitor I/O chart. Take proper catheter care that include aseptic technique while handling it. Perform bladder irrigation to avoid UTIs. Perform urine analysis daily to check colour , volume, odour , presence of blood etc. Advice patient to increase fluid intake. Takes adequate steps to prevent infection. Advice patient to implement diet modification as advised. Give antibiotics, analgesics as per doctors prescription.

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