Introduction

Urolithiasis refers to stones (calculi) in the urinary tract. Stones are

formed in the urinary tract when the urinary concentration of
substances such as calcium oxalate, calcium phusphate, and uric acid
increases. Calculi vary in size form minute granular deposits to the size
of an orange. Factors that favor formation of stones include infection,
urinary stasis, immobility and altered calcium metabolism
(hypercalcemia and hypercalciuria). The problem occurs predominantly
in the third to fifth decades and affects men more than women.

When stones block the flow of urine, obstruction develops, producing

an increase in hydrostatic pressure and distending the renal

pelvis and proximal ureter. Some stones cause excruciating pain and
discomfort. If the stones lodged in the bladder usually produce
symptoms of irritation and may be associated with UTI and hematuria.
If stones obstruct the bladder neck, urinary retention occurs. If
infection is associated with a stone, the condition is far more serious,
with urosepsis threatening the patient’s life.
 REVIEW OF ANATOMY AND PHYSIOLOGY
URINARY SYSTEM

The primary function of the urinary system is to maintain the body’s state of homeostasis by
carefully regulating fluid and electrolytes,removing wastes and providing hormones that are
involve in red blood cell production,bone metabolism and hypertension.

1.KIDNEY

Kidneys are pair of bean-shaped,brownish-red structures located retroperitoneally on the

posterior wall of the abdomen-from the T12 to L3 in the adult.The average adult kidney
weighs approximately 113 to 170 g and is 10-12 cm long,6 cm wide and 2.5 cm
thick.Functions of kidney are for urine formation,excretion of waste pruducts,regulation of
electrolytes,regulation of acid-base balance,control of water balance,control of blood
pressure,renal clearance,regulation of RBC formation,synthesis of vit.D to active
form,secretion of prostaglandins,regulates calcium and phosphorus balance and activates
growth hormone.
The kidneys receive 20% t0 25% of the total cardiac output,which means that all of the
body’s blood circulates through the kidneys approximately 12 times per hour.

2.URETERS

Long fibromuscular tubes that connect each kidney to the bladder.These narrow
tubes,each 24-30 cm long,originate at the lower portion of the renal pelvis and terminate in
the trigone of the bladder wall.The left ureter is slightly shorter than the right.The lining of
the ureters is made up of transitional cell epithelium called urothelium which prevents
reabsorption of urine.The movement of urine from each renal pelvis through the ureter into
the bladder is facilitated by peristaltic contraction of the smooth muscles in the
ureter.There are 3 narrowed areas of each ureter:the ureteropelvic junction,the ureteral
segment and the ureterovesical junction.These 3 narrowed areas of ureters have a
propensity for obstruction by renal calculi(kidney stone)or stricture.Obstruction of the
ureteropelvic junction is the most serious because of its close proximity to the kidney and
the risk of associated kidney dysfunction.

3.URINARY BLADDER

The urinary bladder is a muscular, hollow sac located just behind the pubic bone. The
capacity of the adult bladder is about 300 to 500 ml. The bladder is characterized by its
central, hollow area, called the vesicle, which has two inlets (the ureters) and one outlet
(the urethra). The area surrounding the bladder neck is called the urethrovesical junction.
The angling of the ureterovesical junction is the primary means of providing antegrade, or
downward, movement of urine, also referred to as efflux of urine.this angling prevents
vesicoureteral reflux (retrograde or backward, movement of urine) from the bladder, up the
ureter, toward the kidney.
The wall of the bladder contains four layers. The outer most layer is the adventitia,
which is made up of connective tissue. Immediately beneath the adventitia is a smooth
muscle layer known as the detrusor. Beneath the detrusor is a submusosal layer of loose
connective tissue that serves as an interface between the detrusor and the innermost layer,
a mucosal lining. The inner layer contains specialized transitional cell epithelium, a
 membrane that is impermeable to water and prevents reabsorption of urine stored in the
bladder. The bladder neck contains bundles of involuntary smooth muscle that form a
portion of the urethral sphincter known as the internal sphincter.

4.URETHRA

The urethra arises from the base of the bladder: In the male,it passes through the
penis;in the female,it opens just anterior to the vagina.In the male,the prostate gland,which
lies just below the bladder neck,surrounds the urethra posteriorly and laterally.

NEPHRON

Each kidney has 1 million nephron,which usually allows for adequate renal function
even the opposite kidney is damaged.The nephrons are responsible for the initial formation of
urine.There are two nephron:cortical nephron which make up 80-85% of the total
number.Juxtamedullary nephrons make up the remaining 15-20%.

GLOMERULAR FILTRATION
The normal blood flow through the kidneys is about 1200mL/min.As blood flows into
the glomerulus from an afferent arteriole,filtration occurs.Under normal conditions,about 20%
of the blood passing through the glomeruli is filtered into the nephron,amounting to about 180
L/day.The filtrate consists of water,electrolytes and other small molecules.Efficient filtration
depends on adequate blood flow that maintains a consistent pressure through the glomerulus.

I.PATIENT’S PROFILE
Name: C.B.B.
Age: 47 y/o
Gender: Male
Status: Single
Address: Nicanor Zabala, Roxas, Palawan
Educational Attainment:Elementary Graduate
Occupation: Fisherman
Religion: Roman Catholic
Date and Time Admitted: August 12,2010
Chief Complaint: Anuria and pain on hypogastric area
Attending Physician: Lea I. Carretero-Celzo
Diagnosis/Impression: Kidney Stones
II.HEALTH HISTORY
A.Present Health History
2 days prior to admission,the patient experienced anuria and pain on hypogastric
area.He was admitted in Ospital ng Palawan last August 12,2010 at around 3:30pm.Upon
admission,the doctor perform incision on his bladder to expel the urine.He is under the service
of Dr.Celzo.

B.Past Health History

Stated that he experienced hospitalizations before(1995) with the diagnosis of T/C post
op cohesion s/p exlap c\Colostomy 20 to VA.He experienced vehicular accident when he was 17
y/o.Denies any allergy to food.Common cause of illness are cold,cough and fever.

C.Family Health History

Both mother and father has hypertension.family members doesn’t experienced
vehicular accident.Common cause of illness among family members are cough,cold and fever.
III.PATTERNS OF FUNCTIONING
PATTERNS OF FUNCTIONING
1.RESPIRATORY
No history of cough,asthma and
DOB.No history of PTB.He was not a
smoker.
2.CIRCULATORY
No hisrory of
hypertension;dizziness,palpitations,chest
pains and fainting;negative to any heart
surgery;capillary refill goes back within
1-2 seconds.
3.FOOD AND FLUID INTAKE
Mr.C.B.B eats 3x a day;he loves to eat
fish and vegetables,and also salty foods
like dried fish and “bagoong”.His
breakfast at 6am;lunch at 12nn and
dinner at 8pm.Denies any allergies ti
food.Usually drinks 8-9 glasses of water
per day.Doesn’t drink alcohol.
4.ELIMINATION
Mr.C.B.B. voids 2-3x a day’clear and
yellow urine.He usually moves his bowel
once a day every morning.No history of
constipation and diarrhea.
5.REGULATORY MECHANISM
No history of fever and chills.
6.HYGIENE
He takes a bath once a day at 3am;he
brush his teeth 2x a day,he change
clothes once a day;denies allergy to soap
and shampoo.Doesn’t have any belief
regarding hygiene.
CLINICAL EXAMINATION OTHER SOURCES
RR:20cpm;no cough,doesn’t
experienced DOB;doesn’t use
accessory muscles when
breathing;no nasal
discharges;no abnormal breath
sounds during auscultation.
BP:110/90
mmHg;PR:62bpm;presence of
swelling on his hands due to IV
insertion;negative to edema
and discoloured parts;doesn’t
complaints of
headache;negative to chest
pains;nailbeds are
pink;extremities of both upper
and lower are warm to touch.
He rates her health as 7 out of IVF:D5LR x KVO
10(1 worst-10 best);skin and
lips are dry;no dentures;poor
appetite;doesn’t complaints of
vomiting;skin folds returns to
place within 1-2 seconds when
lifted over the ventral
forearm;with ongoing IVF of
D5LR 1l x KVO.
Presence of Indwelling Foley
Catheter connected into urine
bag draining into yellowish
urine;has a total urine output
of 1990cc;negative to
abdominal
distention,tenderness;with
colostomy.
T:36.30C;skin is dry,warm to
touch,brown in color
Face:negative flushed rushes
and twitching paralysis.
Mr.C.B.B. feels unkempt due to
his condition;appears
clean;change his clothes once a
day.
Skin:dry;warm to touch;has no
lesions or bruises;brown in
color.
Head:hair are equally
distributed;has no
dandruff;dry.
Scalp:no lesions;negative to
pediculosis

7.ACTIVITY AND EXERCISE
Arises at 3am,prepares his self for
work;walking serves as his exercise in
the morning;doesn’t experienced joint
stiffness;no history of
gout,arthritis,paralysis.
8.REST AND SLEEP
Goes to bed at 9pm.Sleep at about 6
hours.Arises at 3am.Usually takes a nap
at about 1 hr everyday.Favorite sleeping
position is side lying position.Doesn’t use
mosquito net.
9.COMMUNICATION AND SPECIAL
SENSES
MR.C.B.B. is right handed.Doesn’t use
any eyeglasses and hearing aid.Denies
any visual and auditory disturbances.Can
speak Tagalog and Cuyunon.
10. COGNITION AND PERCEPTION
No history of convulsions
No history loss of consciousness No history
of epilepsy
11. PAIN AND DISCOMFORT
Experienced pain 2 days prior to admission
due to anuria. No other pain experienced
other than that.
12. RECREATION AND DIVERSION
He usually listened to radio when he do
relaxation, and talked to his parents
Skull:symmetric.appropriate in
size.
Nail:dirty;short nails
Mouth:clean;has no
lesions;negative
odors/halitosis.
Limited movements due to
IFC;can perform full ROM;no
fractures,any joint stiffness and
contracture deformities
Neck:symmetric;no abnormal
masses or swelling;(-) to
emlargement of the thyroid
gland and lymph nodes.
Looks sleepy;presence of
eyebags;sleeps is interrupted
by light and noisy
environment;sleeps for about
4-5 hours.
Eye:lashes are equally
distributed,sclera is white,has
no contact lenses,pupils are
round;(-) to ulcerations and eye
infections.
Ears:(-) to swelling and
lesions,mastoid process are
nontender when
palpated;denies any difficulty
of hearing.
Nose:same color as face;(-) to
epistaxis;denies any
disturbances in sense of smell.
Voice:can speak clearly and
understandably;cooperative
and answera questions.
Mrs. CBB is oriented to place,
time and persons: (-) to
seizures: doesn’t show loss of
consciousness: Express ideas
and feelings clearly.
Doesn`t experienced any pain
or discomfort
Doesn’t appears bored;
cooperative and happy; he
sleeps during his pass time
 He does praying regarding his
13.RELIGIOUS LIFE condition
Religious affiliation is Roman
Catholic; Doesn’t have any religious belief.
Went to church once a month.

Cooperative; answers
14. COPING MECHANISM questions; happy
He usually kept quiet when he has facing
stressful; situations; doesn’t seek any advice
from the members of the family.

15. ROLE AND RELATIONSHIP His sister and brother assisted

He is a fisherman and a breadwinner of their him in his daily activity and
family. requirement
 PALAWAN STATE UNIVERSITY
COLLEGE OF NURSING AND HEALTH SCIENCES
Puerto Princesa City

Name: C.B.B. Age: 47 y/o Ward: Medical

Diagnosis: Kidney Stones Attending Physician: Dr.Celzo

Date Laboratory Examination Results Normal Values Interpretation Clinical Significance

08-14-10 Urinalysis
Color Yellow Yellow-amber

Transparency Cloudy

Volume 10 cc

Specific gravity 1.015 1.003-1.030

pH reaction 6.0

Protein

Blood occult

Microscopic
WBC/hpf Innumerable
Differential Count 78% 50-70% Increased Increased with acute
Granulocytes infections,trauma or
Neutrophils surgery,leukemia,malignant
disease,necrosis;decreased with with
viral infections,bone marrow
suppressions,primary bone marrow
disease.

Agranulocytes
Platelet 130x109/L 150-450x109/L Decreased Increased in
malignancy,myeloproliferative
disease,rheumatoid arthritis and
postoperatively;about 50% of
patients with unexpected increase of
platelet count will be found to have
malignancy;Decreased in
thrombocytopenic purpura,acute
leukemia,aplastic anemia and during
cancer chemotherapy.

Blood Chemistry Creatinine 110.8 mmol/L m-71-115 mmol/L Within normal range Increased in nephritis and chronic
renal disease;Decreased in kidney
diseases.

BUN 3.1 mmol/L 0.80-3.87 mmol/L Within normal range

 Uric Acid 487.7 umol/L m-200-420 umol/L Increased Increased in acute
leukemia,lymphomas treated by
chemotherapy,toxaemia of
pregnancy,patients with marked
increases of IgG;Decreased in
defective tubular reabsorption
RBC/hpf 10-15

Mucus

08-14-10
Hematology 106 g/L m-135-180 g/L Decreased Decreased in various
Hemoglobin anemias,pregnancy,severe and
prolonged hemorrhage and with
excessive fluid intake;Increased in
polycythemia,chronic obstructive
pulmonary disease,failure of
oxygenation because of CHF and
normally in people living at high
altitude.
WBCs are the pathogens;they are
responsible for the ingestion of
WBC 10.6x109/L 5.0-10.0x109/L Slightly increase foreign bodies that enters our body.
 DRUG STUDY

DRUG DRUG CLASSES DOSAGE, MECHANISM ACTION INDICATION CONTRAINDICATIO ADVERSE EFFECTS NURSING RESPONSIBILITIES
NAME FREQUENCY N
& ROUTE

CEFUROXIME >Antibiotic >750 mg >Bactericidal; Inhibits >Lower respiratory >Contraindicated >Headache >Culture infection and
>Cephalospori >q8 synthesis of bacterial infection with allergy to >Dizziness arrange for sensitivity test
n >IV cell wall, causing cell cephalosporins or >Nephrotoxicity before and during therapy if
( 2nd death >UTI caused by penicillins >Nausea expected response is not
generation) Escherichia coli, >Vomoting seen.
Klebsiella pneumonia.
>Discontinue if
hypersensitivity reaction
occur

>this drug is specific for this

infection and should not be
used to self-treat other
problems.

>Avoid drinking alcohol for

3 days because severe
reactions often occur.
 DRUG STUDY

DRUG NAME DRUG CLASSES DOSE. MECHANISM OF INDICATION CONTRAINDICATION ADVERSE EFFECTS NURSING RESPONSIBILITIES
FREQUENCY, ACTION
& ROUTE

DICLOFENAC >Analgesic >75 mg >Inhibit prostaglandin >Acute or long term >Contraindicated >Fatigue >Administer drug with food
(nonopioid) >q 12 synthetase to cause treatment of mild to with allergy to >Dizziness or after meals if GI upset
>Anti- >IV antipyetic and anti- moderate pain NSAIDs, significant >Renal Impairment occur
inflammatory inflammatory effects, renal impairmint >Headache
>Antipyretic the exact mechanism >Take only the prescribed
>NSAID is unknown. >Use cautiously with dosage
allergies, GI
condition >Report for sore throat,
fever, rash, itching, weight
gain, swelling in ankles or
fingers, changes in vision,
and tarry stools.
 DRUG STUDY

DRUG NAME DRUG CLASSES DOSE, MECHANISM OF INDICATION CONTRAINDICATION ADVERSE EFFECT NURSING RESPONSIBILITIES
FREQUENCY, ACTION
& ROUTE

RANITIDINE >Histamine 2 >50 mg >Competitively >Treatment of heart >Contraindicated >Malaise >Administer drug with
(h2) >q 8 inhibits the actions of burn acid ingestion, with allergy to >Tachycardia meals or at bed time
antagonists >IV histamine at the H2 sour stomach ranitidine >Bradycardia
receptors of the >Nausea >Provide concurrent antacid
parietal cells of the >Vomoting therapy to relieve pain
stomach, inhibiting
basal gastric acid >Arrange for regular follow
secretion and gastric up including blood test, to
acid secretion that is evaluates effects
stimulated by food,
insulin, histamine,
cholinergic agonists,
gastrin, and
pentagastrin
 Palawan State University
College of Nursing and Health Sciences
Puerto Princesa City

NURSING CARE PLAN

CUES Nursing Diagnosis Rationale Objectives Expected Nursing Interventions Rationale Evaluation
Outcomes

Obj. Risk for infection After 1 hr. of nsg. After 1 hr. of

 Presence of r/t exposure to Intervention, the nursing
IFC environmental client’s SO will be intervention the
connected to pathogens able to: client and SO was
his bladder able to:
 Environment K – verbalize  State the  Discuss to the pt.  To have the
al exposure understanding of causative and SO the knowledge  Goal met
to pathogens individual causative factors individual causative and
 Insufficient factors factors awareness
knowledge to about the
avoid causative
exposure to factors
pathogens  Note risk factors for  To assess
 Decreased occurrence of causative
hemoglobin infection or
levels (106  Observe for signs of contributin
g/L) infection at g factors
 Presence of insertion site
incision site
in
hypogastric  Identify  Discuss to the client
area intervention  State and SO the possible  To  Goal met
s to methods interventions to reduce/cor
prevent/red that can prevent/reduce the rect
uce risk of reduce risk of infection existing risk
infection risk for a. Proper hand factors
infection washing
b. Observe sterile  Prevent
technique cross
contamina
For the health care tion
providers:
c. Cleanse
incisions using
povidone iodine
d. Proper  To
changing of eliminate
dressings microorgan
ism
 To protect
S – demonstrate wound
techniques or  Encourage the from  Partially
methods that can patient to perform invading met
prevent/reduce risk proper hand microorgan
for infection  Demonst washing ism
rate  Encourage the  To prevent
proper patient to observe cross
hand the healthcare contamina
washing provider in using tion
to help the sterile
reduce technique when
risk for performing wound
infection cleaning and
dressing and
 checking the
catheter
 Encourage the pt.
to become aware in
the causative
factors
A – maintain
positive outlook  Introduce self  Partially
towards health  Build rapport and met
trust

 State the purpose  To build

and explain strong
procedure nurse – pt.
 Maintain relationshi
positive  Include client in p
outlook planning of care  To gain
towards trust and
health encourage
pt. to
cooperate
 For the
effectivene
ss of plan
 Palawan State University
College of Nursing and Health Sciences
Puerto Princesa City

NURSING CARE PLAN

CUES Nursing Diagnosis Rationale Objectives Expected Outcomes Nursing Interventions Rationale Evaluation

Obj. High risk, fluid After 1 hr. of After 1 hr. of nsg.

 Presenc volume deficit r/t nsg. Intervention, the client
e of decreased oral Intervention, and SO was able to:
indwelli fluid intake the client and
ng foley SO will be able  Identified
catheter to:  State individual  Discuss to the  To have individual risk
 Knowle risk factors and pt. and SO the knowledg factors
dge K – identify appropriate risk factors e about
deficien individual risk interventions that contribute causative
cy r/t factors and to fluid volume agent or
fluid appropriate deficit factors
volume interventions  Note pt. age,
 Low oral level of
fluid consciousness
intake  Assess other
etiologic
factors present
 Demonstrate  Discuss to the  To have  Demonstrated
increase in oral pt. the the info. behaviors that
S– fluid intake possible About prevent
demonstrate preventiv development of
behaviors of behaviors or e fluid volume
lifestyle lifestyle measures deficit
changes to changes that
prevent can prevent
development of the
fluid vole deficit development
of fluid volume
deficit  To
 Encourage pt. prevent
to increase the
oral fluid occurrenc
intake e of deficit

 Establish
individual
needs
replacement
schedule
 Provide
supplemental
fluids as
indicated
 Monitor intake
and output
balance
 Maintain  Assess skin  Maintained
positive outlook turgor positive outlook
towars health towards health
 To build a
A – maintain  Introduce self strong
positive outlook  Build trust and nurse -
toward health rapport pt.
relationshi
 State the p
 purpose and  To gain
explain the trust
procedure
 Include client
in planning of
care  For the
 Health effectivity
teaching about of plan
natural
remedies that
can prevent
deficit