Nursing Care Plans for Renal Calculi/Kidney stones.

Renal calculi, or nephrolithiasis, Kidney stones are stones that form in the kidneys from the crystallization of minerals and other substances that normally dissolve in the urine. Common nursing diagnosis in Nursing Care Plans for Renal Calculi/Kidney stones: Acute pain, Altered urinary elimination, Deficient knowledge (treatment plan), Impaired urinary elimination, Ineffective tissue perfusion: Renal, Risk for imbalanced fluid volume, Risk for infection, Risk for injury Nursing Nursing outcome diagnosis Acute pain y Verbalize related to s reduced inflammati pain level on, obstruction , and abrasion of urinary tract by migration of stones Nursing Interventions
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Evaluation

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Administer prescribed analgesic Encourage patient to assume position that brings some relief. Reassess pain frequently using pain scale. Administer antiemetic as indicated for nausea Position the patient for comfort

Altered Verbalize Urinary Assess degree of urinary understanding of Elimination: interference/disability eliminatio condition. n Ability of the y Determine client¶s previous y Identify urinary system to pattern of elimination and causative filter wastes, compare with current factors. conserve solutes, situation. (Refer to and o Frequency, specific NDs o Urgency, for o Burning, collect and o Incontinence, incontinence discharge urine o Nocturia/enuresis, /retention as in a healthy o Size and force of appropriate.) pattern urinary stream. y Achieve o Provides normal Urinary information about elimination Continence: degree of pattern or Control of the interference with participate in elimination of elimination or may measures to urine indicate bladder correct/comp infection ensate Self-Care: for defects. Toileting: y Demonstrate y Palpate bladder to assess Ability to toilet behaviors/tec retention. Fullness over self hniques to bladder following voiding prevent is indicative of inadequate urinary emptying/retention and

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requires intervention. Investigate pain which may be indicative of infection: o location, o duration, o intensity; o Presence of bladder spasms, back or flank pain o Determine client¶s usual daily fluid intake

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infection. Manage care of urinary catheter, or stoma and appliance following urinary diversion.

Renal Calculi/Kidney stones. Renal calculi, or nephrolithiasis, Kidney stones, are stones that form in the kidneys from the crystallization of minerals and other substances that normally dissolve in the urine. Renal calculi vary in size, with 90% less than 5 mm in diameter; some, however, grow large enough to prevent the natural passage of urine through the ureter. Renal calculi can form anywhere in the urinary tract, but they most commonly develop in the renal pelvis or calyces. Calculi may be solitary or multiple. Usualy these stones are composed of calcium salts. Other types are the struvite stones (which contain magnesium, ammonium, and phosphate), uric acid stones, and cystine stones. If the calculi remain in the renal pelvis or enter the ureter, they can damage renal parenchyma (functional tissue). Larger calculi can cause pressure necrosis. In certain locations, calculi cause obstruction, lead to hydronephrosis, and tend to recur. Renal calculi more common in males than females and are rare in blacks and children Causes for Renal Calculi/Kidney Stones

The precise cause of renal calculi is unknown, although Renal Calculi/Kidney stones are associated with dehydration, urinary obstruction, calcium levels, and other factors.
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Metabolic conditions such as renal tubular acidosis, elevated serum uric acid levels Hyperparathyroidism, renal tubular acidosis, elevated uric acid, defective metabolism of oxalate, a genetically caused defect in metabolism of cystine, and excessive intake of vitamin D or dietary calcium may predispose a person to renal calculi. Urinary tract infections associated with alkaline urine have been linked with calculus formation. Cystine stones are associated with hereditary renal disease Dehydration. Decreased water excretion concentrates calculus-forming substances. Patients who are dehydrated have decreased urine, with heavy concentrations of calculus-forming substances. Urinary obstruction leads to urinary stasis, a condition that contributes to calculus formation. Infection. Infected, scarred tissue may be a site for calculus development. In addition, infected calculi (usually magnesium ammonium phosphate or staghorn calculi) may develop if bacteria serve as the nucleus in calculus

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formation. Struvite calculus formation commonly results from Proteus infections, which may lead to destruction of renal parenchyma. Changes in urine pH. Consistently acidic or alkaline urine may provide a favorable medium for calculus formation, especially for magnesium ammonium phosphate or calcium phosphate calculi. Obstruction. Urinary stasis allows calculus constituents to collect and adhere, forming calculi. Obstruction also encourages infection, which compounds the obstruction. Immobilization. Immobility from spinal cord injury or other disorders allows calcium to be released into the circulation and, eventually, to be filtered by the kidneys. Renal Calculi/Kidney stones occur more often in men than in women

Complications for Renal Calculi/Kidney stones Calculi either remain in the renal pelvis and damage or destroy renal parenchyma, or they enter the ureter; large calculi in the kidneys cause pressure necrosis. Calculi in some sites cause obstruction, with resultant hydronephrosis, and tend to recur. Intractable pain and serious bleeding also can result from calculi and the damage they cause. Possible Complications for Renal Calculi/Kidney stones:
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Decrease or loss of kidney function Scarring, Kidney damage, Obstruction of the ureter (acute unilateral obstructive uropathy) stones Recurrence Urinary tract infection (UTI) renal colic

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