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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