Renal calculi

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1. PRESENTED BY MR. ABHIJIT BHOYAR M. SC. NURSING RENAL STONE OR RENAL CALCULI

2. OVERVIEW OF URINARY SYSTEM

3. INTRODUCTION Kidney stones (also called renal calculi, nephrolithiasis or urolithiasis ) are hard deposits made of minerals and salts that form inside your kidneys. Diet, excess body weight, some medical conditions, and certain supplements and medications are among the many causes of kidney stones. Kidney stones can affect any part of your urinary tract — from your kidneys to your bladder. Often, stones form when the urine becomes concentrated, allowing minerals to crystallize and stick together.

4. DEFINITION: Stones are formed in the urinary tract when urinary concentrations of substances like calcium oxalate, calcium phosphate and uric acid increased.

5. INCIDENCE: Up to 4% of the populations in the United States have Urolithiasis. About 12% of the male populations have a renal stone by age 70 years. More than 200,000 Americans require hospitalization for treatment of stones each year. The recurrence rate for calcium oxalate stones is about 50% within 5 year.

6. CAUSES & RISK FACTOR’S Factors that increase risk of developing kidney stones include: Family or personal history. -  If someone in family has had kidney stones, Dehydration.  Not drinking enough water each day can increase your risk of kidney stones. People who live in warm, dry climates and those who sweat a lot may be at higher risk than others

7. Certain diets.  - Eating a diet that's high in protein, sodium (salt) and sugar may increase risk of some types of kidney stones. This is especially true with a high-sodium diet. Too much salt in diet. Obesity.  -High body mass index (BMI), large waist size and weight gain have been linked to an increased risk of kidney stones. Digestive diseases and surgery .  -Gastric bypass surgery, inflammatory bowel disease or chronic diarrhea can cause changes in the digestive process that affect your absorption of calcium and water, increasing the amounts of stone-forming substances in urine

8. Other medical conditions  such as renal tubular acidosis, cystinuria , hyperparathyroidism and repeated urinary tract infections also can increase risk of kidney stones. Certain supplements and medications ,  such as vitamin C, dietary supplements, laxatives (when used excessively), calcium-based antacids, and certain medications used to treat migraines or depression, can increase risk of kidney stones

9. TYPES OF RENAL STONES Types of kidney stones include: 1.Calcium stones.   Most kidney stones are calcium stones, usually in the form of calcium oxalate. Oxalate is a substance made daily IN liver or absorbed from diet. Certain fruits and vegetables, as well as nuts and chocolate, have high oxalate content. Dietary factors, high doses of vitamin D, intestinal bypass surgery and several metabolic disorders can increase the concentration of calcium or oxalate in urine. Calcium stones may also occur in the form of calcium phosphate. This type of stone is more common in metabolic conditions, such as renal tubular acidosis.

10. 2. Struvite stones.   Struvite stones form in response to a urinary tract infection . These stones can grow quickly and become quite large, sometimes with few symptoms or little warning. 3. Uric acid stones.   Uric acid stones can form in people who lose too much fluid because of chronic diarrhea or malabsorption , those who eat a high-protein diet, and those with diabetes or metabolic syndrome. Certain genetic factors also may increase your risk of uric acid stones. 4. Cystine stones.   These stones form in people with a hereditary disorder called cystinuria that causes the kidneys to excrete too much of a specific amino acid

11. LOCATION OF CALCULI IN THE URINARY TRACT.

12. PATHOPHYSIOLOGY Super saturation of urine Because of fluid loss dehydration, low urine volume super saturation of urine develops. Formation of crystals     Precipitate and unite     Stone formation

13. SYMPTOM’S

14. Passing kidney stones can be quite painful, but the stones usually cause no permanent damage if they're recognized in a timely fashion A kidney stone usually will not cause symptoms until it moves around within your kidney or passes into your ureters — the tubes connecting the kidneys and the bladder. If it becomes lodged in the ureters , it may block the flow of urine and cause the kidney to swell and the ureter to spasm, which can be very painful

15. signs and symptoms Severe, sharp pain in the side and back, below the ribs Pain that radiates to the lower abdomen and groin Pain that comes in waves and fluctuates in intensity Pain or burning sensation while urinating Pain caused by a kidney stone may change — for instance, shifting to a different location or increasing in intensity — as the stone moves through your urinary tract

16. Other signs and symptoms may include: Pink, red or brown urine Cloudy or foul-smelling urine A persistent need to urinate, urinating more often than usual or urinating in small amounts Nausea and vomiting Fever and chills if an infection is present

17. DIAGNOSTIC EVALUATION HISTORY & PHYSICAL EXAMINATION BLOOD TEST- IT HELPS TO KNOW THE CALCIUM LEVEL, URIC ACID LEVEL AND INFECTIONS FROM THE BLOOD. URINE TEST- TO KNOW THE PROPER FUNCTIONING OF THE KIDNEY AND THE INFECTIONS. RADIOIMAGING TEST- X RAY, MRI, ULTRASONOGRAPHY, Etc

18. MANAGEMENT MEDICAL MANAGEMENT Hydrochlorothiazide : Prevent calcium reabsorption in renal tubules. Allopurinol: used to prevent uric acid calculi. Sodium bicarbonate and sodium citrate : to maintain urine P H Alpha penicillamine and tiopronin : to prevent cystine crystallization.

19. The first approach is directed toward management of the acute attack. This involves treating the symptoms of pain, infection, or obstruction as indicated for the individual patient. At frequent intervals, opioids are typically required for relief of renal colic pain. Many stones pass spontaneously. The second approach is directed toward evaluation of the cause of the stone formation and the prevent of further development of stones.

20. SURGICAL MANAGEMENT Cystolithalopaxy Cystoscopic lithotripsy Percutaneous nephrolithotom

21. LITHOTRIPSY Extracorporeal shock wave lithotripsy (ESWL). ESWL uses sound waves to create strong vibrations (shock waves) that break the stones into tiny pieces that can be passed in your urine. The procedure lasts about 45 to 60 minutes and can cause moderate pain, so you may be under sedation or light anesthesia to make you comfortable

22. If the stone is too large or if Endourologic and lithotripsy procedures fail to remove it, an open surgical procedure is performed. A ureterolithotomy is the surgical removal of a calculus from the ureter through a flank incision for higher stones or an abdominal incision for lower ones. A Penrose drain and ureteral catheter are usually placed postoperatively for healing and drainage of urine.

23. Cystolithotomy , removal of bladder calculi through a suprapubic incision, is used only when stones cannot be crushed and removed transurethrally . A stone is removed from the renal pelvis by Pyelolithotom y and from the renal calyx by a nephrolithotomy . Rarely, a partial or total nephrectomy is necessary because of kidney damage, over whelming renal infection, or abdominal renal parenchyma, which can be responsible for stone formation.

24. URETEROSCOPY URETEROSCOPE MAY BE USED FORTHE LOWER URINARY TRACT STONE

25. NUTRITIONAL MANAGEMENT Provide adequate amount of fluid more than 3 liter per day. Limitation of coffee and tea. Limiting the oxalate rich foods. eg. Dark roughage, Spinach, cabbage, tomatoes, chocolate, tea, coffee. Limiting the purine and calcium rich foods.eg. Shellfish, liver, kidney, meat, chicken, mutton, pork, beef, milk, cheese, ice cream.

26. NURSING MANAGEMENT ASSESSMENT Assessment the general condition of the patient Assess the all sign and symptoms pain, discomfort, nausea, vomiting, and diarrhea. Observation for sign of urinary tract infection, chills, fever, dysuria, frequency hesitancy. Assess family history, nutritional history. Assess the knowledge about renal stones and measures to prevent their occurrence or recurrence is also assessed .

27. PRE-OPERATIVE NURSING DIAGNOSIS 1 . Acute pain related to irritation and spasm from stone movement in the urinary tract. Goal : Minimize pain level 2.Impaired urinary elimination related to blockage of ureters. Goal : Maintains free flow of urine 3.Fear and anxiety related to disease condition and prognosis. Goal : minimize the anxiety level

28. POST-OPERATIVE NURSING DIAGNOSIS 4.Pain related to surgery or surgical incision Goal : relief pain 5.Risk for injury related to postoperative complications. Goal : prevent injury. 6. Ineffective therapeutic regimen management related to lack of knowledge regarding disease process. Goal : Acquisition of knowledge.

29. Prevention Prevention of kidney stones may include a combination of lifestyle changes and medications LIFESTYLE CHANGES You may reduce your risk of kidney stones if you: Drink water throughout the day.   For people with a history of kidney stones, doctors usually recommend drinking enough fluids to pass about 2.1 quarts (2 liters ) of urine a day. Your doctor may ask that you measure your urine output to make sure that you're drinking enough water. If you live in a hot, dry climate or you exercise frequently, you may need to drink even more water to produce enough urine. If your urine is light and clear, you're likely drinking enough water.

30. 2. Eat fewer oxalate-rich foods.   If you tend to form calcium oxalate stones, your doctor may recommend restricting foods rich in oxalates. These include rhubarb, beets, okra, spinach, Swiss chard, sweet potatoes, nuts, tea, chocolate, black pepper and soy products. 3. Choose a diet low in salt and animal protein.   Reduce the amount of salt you eat and choose non-animal protein sources, such as legumes. Consider using a salt substitute, such as Mrs. Dash .

31. 4. Continue eating calcium-rich foods, but use caution with calcium supplements.   Calcium in food doesn't have an effect on your risk of kidney stones. Continue eating calcium-rich foods unless your doctor advises otherwise. Ask your doctor before taking calcium supplements, as these have been linked to increased risk of kidney stones. Diets low in calcium can increase kidney stone formation in some people .

32. COMPLICATIONS Infection and sepsis Obstruction of the urinary tract Hydronephrosis Hydroureter Renal failure Renal hematoma Hypertension

33. BIBLIOGRAPHY Lippincott “Medical surgical nursing” 10th edition Joyce M Black ” Medical surgical nursing” Brunner And Suddharth “Medical surgical nursing”

34. THANK YOU!!!

35. EXAMPLES how to write nursing care plan If the patient admitted with the complaints of back pain, having discomfort and fever,

36. ASSESSMENT NURSING DIADNOSIS GOAL PLANNING/INTERVENTION IMPLEMENTATION RATIONAL EVALUATION Subjective data