Renal calculi

NURSING MANAGEMENT OF RENAL CALCULI

1. Renal calculi Presented by Monika Devi Msc.(N) HCN, SRHU

2. introduction A kidney stone is a hard solid mass of material that forms in the kidney from the substances in the urine . Kidney stones or calculi develop as a result of various metabolic disorders which affect the fate of calcium and other mineral elements in the body. Stones may be formed in the kidney, urinary bladder, ureter and urethra

3. definition A kidney stone, also known as a renal calculus or nephrolith, is a solid piece of material which Is formed in the kidneys from minerals in urine

4. etiology Unknown Risk factor:- Imbalance of pH in urine Alkalic : - Calcium stone Acidic:- Uric & cristine stone Gout Hyperparathyroidism

5. Cont… RISK FACTORS :- Immobility Sedentary life style Dehydration Metabolic disturbances History of renal calculi

6. Cont… High mineral content in drinking water Dietary intake UTI Prolonged Indwelling Catheterization

7. types There are mainly 5 types:- 1 . Calcium oxalate stone (Is the most common 80% ) 2. Calcium phosphate stone 3 . Struvite stone (Triple stone ) 4. Uric acid stone 5 . Cystic stone

8. types 1.Calcium oxalate stone :- ( Is the most common 80% )- Caused by super -saturation of urine with calcium & oxalate Calcium oxalate stone tend to form in alkaline chemistry ( Avoid food high in oxalate(beer, wheat germ, spinach ).

9. Cont.. 2 . Calcium phosphate stone:- (5-10%):- Caused by super -saturation of urine with calcium phosphate. Calcium phosphate stone tend to form in alkaline chemistry (Avoid food high in calcium (Milk & dairy product)

10. Cont… 3. Struvite stone (Triple phosphate stone):- Caused by urea splitting bacteria (Proteus, Pseudomonas, Klebsiella, Staphylococcus). more common in women then the man because of UTI Struvite stone tend to form in alkaline chemistry

11. Cont… 4. Cystic stone (10-15%):- Caused by cystine crystal formation. Cystic stone tend to form in Acidic urine ( cystine source Avoid meat milk ,cheese, Egg)

12. Cont… 5. Uric acid stone (5-10%):- Caused by excessive dietary purine or gout Uric acid stone tend to form in Acidic urine (Avoid purine sources eg . Meats, gravies, red wine)

13. pathophysiology Urine saturation Supersaturation Crystal nucleation Aggregation Retention and growth

14. Clinical manifestation Severe pain in the side and back, below the ribs Pain that spreads to the lower abdomen and groin Pain that comes in waves and fluctuates in intensity Pain on urination Cloudy or foul-smelling urine Nausea and vomiting Fever and chills if an infection is present Urinating small amounts of urine

15. Diagnostic evaluation Blood Urine-analysis Cystoscopy X-ray CT scan, MRI Intravenous urogram (IVU) or intravenous pyelogram USG KUB

16. Cystoscopy

17. Intravenous pyelogram

18. ultrasound

19. Medical management Analgesic Spasmodic e.g. Buscopan NSAIDs e.g. Steroid Maintain I/O charting Provide rest

20. Surgical management Close procedure:- Lithotripsy (Extracorporeal Shockwave lithotripsy (ESWL)- Noninvasive Percutaneous Nephrolithotomy

21. lithotripsy

22. Usg shock waves crush stones

23. Percutaneous Nephrolithotomy

24. Cont…

25. Open procedure Ureterolithotomy Pyelolithotomy Nephrolithotomy Partial or total nephrectomy

26. prevention Avoid protein intake ;- usually protein is restricted to 60g/day to decrease urinary excretion of calcium and uric acid. A sodium intake of 3 to 4 g/day is recommended . Table salt and high-sodium foods should be reduced, because sodium competes with calcium for reabsorption in the kidneys. Low-calcium diets are not generally recommended ,except for true absorptive hypercalciuria. Evidence shows that limiting calcium, especially in women, can lead to osteoporosis and does not prevent renal stones.

27. Cont.. Avoid intake of oxalate-containing foods (e.g . spinach , strawberries, tea, peanuts, wheat bran). During the day , drink fluids (ideally water)everyday1 to 2 hours. Drink two glasses of water at bedtime and an additional glass at each night time awakening to prevent urine from becoming too concentrated during the night

28. Cont.. Avoid activities leading to sudden increases in environmental temperatures that may cause excessive sweating and dehydration. Contact your primary health care provider at the first sign of a urinary tract infection.

29. Nutritional therapy Foods high in purine, calcium, or oxalate : Purine : High: Sardines, herring, mussels, liver, kidney, goose, venison, meat soups sweetbreads Moderate: Chicken, salmon, crab, veal, mutton, bacon, pork, beef, ham Calcium : milk, cheese, ice cream, yogurt, sauces containing milk, all beans (except green beans), lentils, fish with fine bones (sardines, kippers herring, salmon); dried fruits, nuts, chocolate, cocoa. Oxalate: spinach, rhubarb, asparagus, cabbage, tomatoes, beets, nuts, celery, parsley, runner beans, chocolate, cocoa, instant coffee, Ovaltine , tea; Worcestershire sauce

30. Nursing diagnosis 1. Acute pain related to irritation and spasm from stone movement in the urinary tract as manifested by complaints of pain , facial grimacing, restlessness. Goal :- To reduce pain. Intervention:-

31. Cont… 2 . Anxiety related to uncertain outcome and lack of knowledge regarding possible surgery as manifested by expressions. Goal:- To reduce anxiety. Intervention:-

32. Cont… 3. Impaired urinary elimination related to trauma or blockage of ureters or urethra as manifested by decreased urinary output and bloody urine. Goal:- To increase the urine out put. Intervention

33. Cont… 4. Risk for infection related to introduction of bacteria following manipulations of the urinary tract and obstructed urinary blood flow. Goal:- To reduce the risk of infection. Intervention

34. Nursing diagnosis 5. Acute pain r/t obstructing urinary Calculus. 6. Altered urinary elimination related To presence of urinary calculi 7. Risk for infection r/t obstructing Urinary calculus. 8. Altered renal peripheral tissue Perfusion r/t post renal Obstruction

35. summary

36. bibliography Brunner and Suddarth's text book of medical –surgical nursing twelfth edition . Page no. 1295. Lewis’s medical –surgical nursing , assessment and management of clinical problems , second edition . Page no. 1131.

37. Thank You