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NEPHROLITHIASIS

Presented to :Mrs. Sarabjit Mam

Presented by: L Premeshwori Devi

M. Sc Nursing 1styear

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Risk factor

Immobility and sedentary life style, which

increase stasis.

Dehydration which leads to supersaturation

Metabolic disturbance that result in an

increase in calcium and other ions in theurine

Previous history of urinary calculi

Living in stone belts area

High mineral content in drinking water A diet high in purines, oxalates, calcium

supplements, animal proteins

UTIs

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Contd

Prolonged indwelling catheterization

Neurogenic bladder

History of female genital mutilation

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ETIOLOGY

The two primary causative factors are

1 Urinary stasis

2 Supersaturation of urine

Stasis of urine from bladder neck obstruction,

continent urinary diversion andimmobilization increase the risk of

development of stone because the crystal

in unmoving urine precipitate more readily.

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Contd

Infection

Foreign bodies

Failure to empty the bladder completely

Metabolic disorders

Obesity and weight gain. Lack of inhibitors such as citrate and

magnesium

Medication such as acetazolamide,

absorbable alkalis (e.g. calcium carbonateand sodium bicarbonate)

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Types of calculi

Calcium stones.Most kidney stones are

calcium stones, usually in the form of

calcium oxalate. Oxalate is a naturally

occurring substance found in food. Some

fruits and vegetables, as well as nuts and

chocolate, have high oxalate levels. liveralso produces oxalate. Dietary factors, high

doses of vitamin D, several metabolic

disorders can increase the concentration of

calcium or oxalate in urine. Calcium stonesmay also occur in the form of calcium

phosphate.

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Contd Struvite stones.Struvite stones form in

response to an infection, such as a urinarytract infection. These stones can grow

quickly and become quite large.

Uric acid stones.Uric acid stones can

form in people who don't drink enoughfluids or who lose too much fluid, those

who eat a high-protein diet, and those who

have gout. Certain genetic factors also may

increase risk of uric acid stones.

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Contd

Cystine stones.These stones form in

people with a hereditary disorder that

causes the kidneys to excrete too much of

certain amino acids

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PathophysiologyUrine saturation

Supersaturation

Crystal nucleation

Aggregation

Retention and growth

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Clinical manifestation

Sudden onset of sharp and severe pain

cause by the movement of the calculus andconsequent irritation.

Renal colic originates deep in the lumbar

region and radiates around the side and

down towards the testicle for male and thebladder in the female.

Ureteral colic radiates towards the genitelia

and thigh.

Nausea and vomiting. Pallor.

Grunting respiration

Elevated blood pressure and pulse.

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Diagnostic evaluation

History collection

Physical examination

Blood analysis

24 hours urine test

X ray (KUB)

Ultrasonography

Intravenous urography or

Retrograde pyelography.

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Medical management The goals of medical management are

increase fluids, reduce pain, minimizecalculus formation by implementing diet

change and administering medication.

Increase fluids

Encourage the clients to increase fluids to3 to 4L daily, unless contraindicated, to

ensure urine output of 2.5 to 3L. Increase

fluid may decrease pain, prevent an

increase in stone size and preventinfection.

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Contd..

Prevent stone recurrence

Diet modification and medication may be

required to prevent further calculus

formation.

Implement Dietary changes

Clients with oxalate stone should avoid

high oxalate foods such as tea, tomatoes,

instant coffee, cola drinks, beer, green

beans, spinach, cabbage, chocolate, citrus

fruits, apples, grapes, peanuts and peanutsbutter.

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Contd

If the stone is composed of uric acid, the

client should follow a low purines diet,

which involve limiting such as cheeses,

wine, bony fish and organs meats.

Administer medication

For hypercalciuric clients thiazide diuretics

such as hydrochlorothiazide.

For low urine citrate level potassium and

sodium citrate should be provided.

Calcium oxalate stones may be treated

with vitamin B6(pyridoxine), magnesium

oxide or cholestyramine.

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Surgical management Endourologic procedure

Lithotripsy

A Laser lithotripsy

B Extracorporeal shock wave lithotripsy

C Percutaneous lithotripsy

Open surgical procedure.

Ureterolithotomy( removal of stone from the

ureter)

Cystolithotomy(bladder calculi)

Pyelolithotomy (renal pelvis)

Nephrolithotomy(renal calyx)

Nephrectomy (partial or complete)

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Nursing diagnosis

Acute pain related to irritation and spasm

from stone movement in the urinary tract

Nursing intervention

Assess the location and severity of pain

Provide hot bath and moist heat to the flankarea.

Administer analgesic

Encourage the patient to drink more water.

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Contd

Impaired urinary elimination related to

mechanical obstruction of urinary flow.

Nursing intervention

Determines the clients previous pattern of

elimination and compare with the current

situation.

Maintain intake and output chart.

Encourage the patient to drink more water.

Administer medication.

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Contd

Risk for deficient fluid volume related to

nausea and vomiting.

Nursing interventions

Weigh the client and compare with recent

weigh history

Assess skin turgor

Encourage oral intake

Monitor intake and output balance.

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Contd

Risk for infection related to stasis of urine

Nursing interventions

Observe sign and symptoms of infection.

Administer medication

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Contd

Deficient knowledge regarding condition

,prognosis and treatment

Nursing interventions

Assess the knowledge

Explain about the causes of the disease

Educate the patient about the treatment

and self care

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Bibliography

Suddarths & Brunner; Text book ofMedical Surgical Nursing; 10thEdition;

Published by Lippincott; Page no 1337 to

1341 Black M Joycee; Textbook of Medical

Surgical Nursing; Published by Elssevier;1st

Edition; Page no 748 to 756.

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Thank You