Adult Nursing 1

Name : Angelica Williams

Batch: 125 B
 Objectives
 Definition of the term Renal Calculi
 State the etiology of Renal Calculi
 Identify the types of Renal Calculi
 State the pathophysiology of this condition
 Describe the clinical manifestation of Renal Calculi
 Identify the diagnostic investigations for this
condition
 Describe the medical, surgical and nursing
management of Renal Calculi
 Definition

A kidney stone, also known as a renal calculus or

nephrolithiasis, is a solid piece of material which is
formed in the kidneys from minerals in urine.

Kidney stones have many causes and can affect any part
of the urinary tract, from the kidneys to the bladder.
Kidney stones or nephrolithiasis are small, hard minerals
deposits that form inside your kidneys. The stones are
made of mineral and acid salts.
 Etiology
 Kidney stones often have no definite, single
cause, although several factors may increase
the risk. Kidney stones form when your urine
contains more crystal- forming substances
such as calcium, oxalate and uric acid than the
fluid in the urine can dilute. At the same time,
the urine may lack substances that prevent
crystals from sticking together, creating an
ideal environment for kidney stones to form.
 Metabolic- Abnormalities that results in increased urine
levels of calcium, oxaluric acid, uric acid, or citric acid.

 Climate- Warm climates that cause increased fluid loss,

low urine volume, and increased solute concentration in
urine.

 Diet- Large intake of dietary proteins that increases uric

acid. Excessive amounts of tea or fruit juices that elevate
urinary oxalate level, large intake of calcium and oxalate
and low fluid intake increases urinary concentration.
 Lifestyle- sedentary occupation and immobility.
 Types of kidney stones
 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. Your liver also produces oxalate. Dietary
factors, high doses of vitamin D, intestinal bypass
surgery and several metabolic disorders can increase the
concentration of calcium or oxalate in urine. Calcium
stones may also occur in the form of calcium phosphate.

 Struvite stones - Struvite stones form in response to an

infection, such as a urinary tract infection. These stones
can grow quickly and become quite large, sometimes
with few symptoms or little warning.
 Uric acid stones - Uric acid stones can form in
people who don't drink enough fluids or who
lose too much fluid and those who eat a high-
protein diet.
 Cystine stones - These stones form in people
with a hereditary disorder that causes the
kidneys to excrete too much of certain amino
acids (cystinuria).
 Pathophysiology
 Small crystals are formed in the kidney. The most common
crystals are made of calcium oxalate and they are generally
4-5 mm. Staghorn kidney stones are considerably larger. 1.
Calcium and oxalate come together to make the crystal
nucleus. Supersaturation promotes their combination. 2.
Continued deposition at the renal papillae leads to growth
of the kidney stones. 3. Kidney stones grow and collect
debris. In the case where the kidney stones block all routes
to the renal papillae, this can cause severe discomfort. 4.
The complete staghorn stone forms and retention occurs.
Smaller solids that break off can become trapped in the
urinary glands causing discomfort. 5. Displaced stones
travel through the ureter.
 Clinical manifestations
 A kidney stone may not cause symptoms until it
moves around within your kidney or passes into
your ureter, the tube connecting the kidney and
bladder. At that point, you may experience these
signs and symptoms:
 Severe pain in the side and back, below the ribs
 Pain that spreads to the lower abdomen and groin
 Pain that comes in waves and fluctuates in
intensity (colicky)
 Dysuria
 Hematuria
 Nausea
 Vomiting
 Renal colic
 Fever
 Chills
 Diagnostic Evaluation
 The definitive tests done for this condition are
urinalysis and urine culture.
 IVP (retrograde pylegram)
 Ultrasound
 Blood test
 Imaging
 Medical management
 Pain relievers: Passing a small stone can cause some
discomfort. To relieve mild pain it’s recommended to
use NSAID’s such as ibuprofen (Advil, Motrin IB),
acetaminophen or naproxen sodium (Aleve).
 Medical therapy: A medication will be prescribed to
help pass your kidney stone. This type of medication,
known as an alpha blocker, terazosin (Hytrin) and
Tamsulosin (Flomax) relaxes the muscles in your
ureter, helping the kidney stone to pass more quickly
and with less pain.
 Other medications include Allopurinol (for
uric acid stones), Antibiotics (for struvite
stones), diuretics, phosphate solutions, sodium
bicarbonate or sodium citrate, water pills
(thiazide diuretics) and tamsulosin to relax the
ureter and help the stones pass.
 For infection, antibiotics are prescribed,
ceptrin, flagyl and ciproflaxin.
 Antiemetics- Patients with frequent renal colic
experience intense nausea and vomiting.
Various antiemetics medications are used,
including phenothiazines and butyrophenones.
 Surgical management
 Large stones
Kidney stones that can’t be treated with
conservative measures, either because they’re
too large to pass on their own or because they
cause bleeding, Kidney damage or ongoing
urinary tract infections, these may require more
extensive treatment and surgical procedures may
be included:
 Extracorporeal shock wave lithotripsy
(ESWL)- This procedure uses sound waves
that break stones into tiny pieces that can be
passed in the urine. It last about 45 to 60mins.
 Percutaneous ultrasonic lithotripsy- Incision
and insertion of a neprhoscope into the
portion of the kidneys where the stones are
lodged.
 Electrohydraulic lithotripsy- High capacity
condenser creates a high voltage spark causing
a hydraulic shock that breaks up the calculi.
 Nursing management
 The nursing management will include the assessment
phase, assess for pain and discomfort, including
severity, location and radiation of pain.
 We will assess for associated symptoms, including
nausea, vomiting, diarrhea, and abnormal distension.
 Monitor vital signs.
 Observe for signs or urinary tract infection (chills,
fever and hesitancy) and obstruction of (oliguria and
anuria). Observe urine for blood, strain for stones or
gravel.
 Assess patient’s knowledge about renal stones
and measures to prevent recurrence.
 Administer medication as prescribed.
 Encourage patient to ambulate to assume a
position of comfort and also assist them to
ambulate to obtain some pain relief.
 Nutritional therapy

 
 Conclusion
 It can be concluded that renal calculi or
nephrolith is a solid piece of material which is
formed in the kidneys from minerals I the
urine. Kidney stones typically leaves in the
body in the urine stream and a small stone
may pass without causing symptoms. There
are different types and stones in which all are
treatable.