Presented by: Venus L.

Bactol

UROLITHIASIS
refers to calcifications or presence of
stones in the Urinary System.
ETIOLOGY:
-Men between 30 and 50 years old
-Immobility and sedentary lifestyle
which increase stasis.
-Dehydration, which leads to super
saturation
-Metabolic isturbances resulting to
increase calcium and ions in the urine.
-History of Urinary Calculi
-Diet in high in Purine, Oxalates, Calcium
-UTI
-Prolonged indwelling catheterization

Types of Stones:
Calcium Stones
-Is the most common, up to 90% of stones.
-Are usually composed of calcium
phosphate or calcium oxalate.
It caused by four main function:
A high rate of bone reabsorption.
Gut absorption of abnormally large
amounts of calcium, as in milk-alkali
syndrome, sarcoidosis, and
excessive intake of vitamin D
Impaired renal tubular absorption
of filtered calcium
Structural abnormalities, such as
sponge kidney

Oxalate
-relatively Insoluble in urine.
-Its solubility is affected only slightly by
changes in pH
Oxalate stones may be related to the
following:
Hyperabsorption of oxalate
Postileal resection or small bowel
bypass surgery
Overdose of ascorbic acid (vitamin
C)
Familial oxaluria
Concurrent of fat malabsorption

Struvite Stones
-Also called triple phosphate
-Composed of carbonate apatite and
magnesium ammonium phosphate
-It cause by a certain bacteria, usually
Proteus, which contain enzyme ureas.
This enzyme splits urea into two
components ammonia molecule, which
increase the urine pH (usually Alkaline).
This ph is prone from bacteria.
-This stones formed in the manner are
STAGHORN CALCULI

Signs and Symptoms:

-Sharp excruciating severe pain of
sudden onset radiating from flank into
the groin.
-Nausea and vomiting reflex action to
pain
-Restlessness, diaphoresis, rapid pulse
-Oliguria- obstruction made by stones
-Hematuria- due to abrasive action of
stone as it moves down

Nursing Diagnosis: Acute pain related to

irritation and spasm from stone
movement in the urinary tract
Nursing Management:
1.Fluids (3000 ml/day) unless contraindicated
2.Strain all urine for passage of stone(80-90 of
stones pass out spontaneously)
3.Adjust urine ph
Ca stones
4.Limit dairy products
5.Acid ash diet ( cranberry/prune juice, meat,
eggs, fish, poultry, grapes, whole grain citrus
fruits, Vit. C
Oxalate stones
6.Avoid excess tea, chocolates, spinach
Acidic stones

7.Alkalinize urine
Na Bicarbonate tablets
Alkaline - ash diet ( milk, vegetables,
fruits, salmon)
Uric Acid stones
8.Avoid purine foods
Organ meat
Shellfish
Meat groups
Gravy
Legumes
Salted anchovies
Mushrooms
Sardines
9.Encourage ambulation
MIO notify doctor for anuria or
hematuria
10. Continue prescribed Medication
Pain control ( analgesic)

Here is an example of a low fat low sodium

recipe for one day:
Breakfast - Try scrambling eggs with diced
mushrooms and red and green peppers. Add a
sprinkle of shredded mozzarella if you like.
Youll get plenty of flavor without the sodium.
If you prefer cereal, oatmeal with a sliced
banana is a good choice.
Lunch - a fresh salad with sliced grilled chicken
on top. Avoid commercial salad dressing, which
is very high in sodium and fat. Try squeezing a
bit of lemon juice over your salad, or mix a bit
of olive oil and vinegar.
Dinner - Cook some pasta and stir-fry your
choice of fresh veggies using a non-stick
cooking spray such as Pam. Add garlic if you
like. Toss with the pasta and enjoy!

Dx Studies:
Urinalysis: color may be yellow, dark brown,
bloody. commonly shows rbcs, wbcs, crystals
(cystine, uric acid, calcium oxalate), casts,
minerals, bacteria, pus; ph may be less than 5
(promotes cystine and uric acid stones) or higher
than 7.5 (promotes magnesium, struvite,
phosphate, or calcium phosphate stones).
Serum and Urine bun/cr: abnormal (high in
serum/low in urine) secondary to high
obstructive stone in kidney causing
ischemia/necrosis.
CBC:
>HB/HCT: abnormal if patient is severely
dehydrated or polycythemia is present
(encourages precipitation of solids), or patient is
anemic (hemorrhage, kidney
dysfunction/failure).
>RBCS: usually normal.
>WBCS: may be increased, indicating
infection/septicemia

caliectasis is a dilation of the calices

which can be caused by obstruction or
infection.
A KUB is an x-ray of the abdomen and
pelvis (to evaluate the kidneys, ureters,
and bladder), and an
IVP (intravenous pyelogram) is another
x-ray exam of the kidneys, ureters, and
bladder which uses contrast.
Those exams are being suggested if the
patient is having symptoms of infection
or obstruction.

Creatinine
is produced from creatine, a molecule of
major importance for energy production in
muscles
-transported through the bloodstream to the
kidneys. The kidneys filter out most of
the creatinine and dispose of it in the urine.
-Because the muscle mass in the body is
relatively constant from day to day,
the creatinine level in the blood normally
remains essentially unchanged on a daily
basis. The kidneys maintain the
blood creatinine in a normal range.
-has been found to be a fairly reliable
indicator of kidney function

The ratio of BUN to creatinine is usually

between 10:1 and 20:1. An increased
ratio may be due to a condition that
causes a decrease in the flow of blood
to the kidneys, such as congestive heart
failure ordehydration. It may also be
seen with increased protein, from
gastrointestinal bleeding, or increased
protein in the diet. The ratio may be
decreased with liver disease (due to
decrease in the formation of urea)
and malnutrition.