ACTIVE LEARNING TEMPLATE: System Disorder

STUDENT NAME______________________________________
renal calculi
DISORDER/DISEASE PROCESS___________________________________________________________ REVIEW MODULE CHAPTER____________

Alterations in Pathophysiology Related Health Promotion and

Health (Diagnosis) to Client Problem Disease Prevention
stones made of calcium oxalate/phosphate (or other
substances) formed in the kidneys that pass into/stuck in
the urinary tract. most pass without invasive intervention,
depending on size, composition, or location

ASSESSMENT SAFETY
CONSIDERATIONS
Risk Factors Expected Findings
secondary to
high calcium diet/metabolic disorder (increased intestinal absorption/renal diaphoresis, pallor
exretion of Ca, increased intake of purines like red meat, increased oxalate
intake or production peanuts, spinach, beets)
fever medication side
pain (flank pain may indicate presence in kidney, + radiating to
renal tubular dysfunction/urinary tract lining damage
results or effects of dehydration, urinary concentration, statis,poor fluid intake,
scrotum/testes, abdomen, vulva suggests presence in ureter or bladder effects- opiates,
urinary frequency/dysuria (if in the bladder), oliguria, anuria, hematuria
retention, immobility
male gender
VS remarkable for tachypnea, tachycardia, HTN (related to pain) or NSAIDS
family hx hypotension related to shock
calculi formation prior to age 25 risk for falls, risk
for bleeding

Laboratory Tests Diagnostic Procedures

UA- ^wbc, ^rbc, + bact, + crystals (microsope), KUB or IV pyelogram (not indicated if
^pH, urine- calcium or struvite stones obstruction)
dec. pH, urine- uric acid, cystine stones CT/MRI used for detection of cystine or
altered serum levels of Ca, PO4, uric acid with uric acid (won't show on xray)
presence of metabolic disorder
renal US or cystoscopy

PATIENT-CENTERED CARE Complications

Nursing Care Medications Client Education urosepsis- occurs
increased risk for future incidence with struvite,
report finding to provider, analgesics- dietary modifications (may be based on kind of stone, but
pre/post op care if necessary, strain urine
NSAIDS, opioids,
general information). CaPO4- limit animal protein/NA/CA rich
foods. CaC2O4- limit rich foods like spinach, chard, beets,
infection may
for stones, encourage fluid intake 3L/day/IV
fluids as ordered, encourage ambulation for spasmolytics for peanuts, tea, cocoa, strawberries, pecans, chocolate, black
tea. struvite- high PO4 like red meats, dairy, whole grains. spread to
passing calculi, assess/monitor bladder spasms cystine- animal protein. uric acid- organ meats, fish, poultry,
red wine bloodstream.
pain/complications (shock) antibiotics if real lemon juice/orange juice can help break down/prevent

presence of UTI
calculi formation
obstruction,
LUT meds to hydronephrosis
promote relaxation (stone inhibits flow
Therapeutic Procedures of lower urinary tract Interprofessional Care and may distend
(tamsulosin)
extracorporeal shock wave lithotripsy- use of laser/US/shock if metabolic, may the kidney) which
wave energy to fracture calculi (req. conscious sedation and urology for involvement of
ekg) require medications may result in renal
chemolysis
to prevent/inhibit urinary tract
surgical- stent placement damage
retrograde ureteroscopy- insertion via lower tract for manual
removal reabsorption/product nutrition for education
percutaneous ureterlithotomy/nephrolithotomy- through the
skin into the ureter/kidney to remove
ion of Ca/PO4/uric regarding dietary
open surgery- staghorn, large, or impacted unsuccessful
intervention with previous methods
acid modifications

ACTIVE LEARNING TEMPLATES Therapeutic Procedure  A11