8/14/2019 441-ppt.ppt

1/22

NephrolithiasisMolly Tonder and Britta Jepsen

November 11, 2009

Seminar

http://www.youtube.com/watch?v=BLO5beZY4zchttp://www.youtube.com/watch?v=BLO5beZY4zchttp://www.youtube.com/watch?v=BLO5beZY4zchttp://www.youtube.com/watch?v=BLO5beZY4zchttp://www.youtube.com/watch?v=BLO5beZY4zchttp://www.youtube.com/watch?v=BLO5beZY4zchttp://www.youtube.com/watch?v=BLO5beZY4zchttp://www.youtube.com/watch?v=BLO5beZY4zchttp://www.youtube.com/watch?v=BLO5beZY4zc

8/14/2019 441-ppt.ppt

2/22

Pathophysiology

1. Ultra-concentrated urine allows crystals to form

more easily and also inhibits urine from flowing

freely.

2. Altered pH affects solubility of crystals

Calcium and

phosphate (higher)

Uric acid and

cystine (lower)

8/14/2019 441-ppt.ppt

3/22

Risk Factors

Inadequate fluid intake

Exposure to warm, dry weather

Male (except struvite stones)

20-55 years of age

Caucasian

Family history

Occupation that is outdoors and/or requires a great deal ofphysical activity

Increased oxalate, calcium, sodium or phosphate intake

Sedentary lifestyle

8/14/2019 441-ppt.ppt

4/22

What signs and symptoms does S.R.present to the ED with?

8/14/2019 441-ppt.ppt

5/22

Presenting Signs and Symptoms

Flank, back and/or abdominal pain (can radiate to groin as passing)

Guarding

Warm, moist skin

Nausea, vomiting Restlessness

Fatigue

Urinary infection (fever, chills)

Hematuria

Decreased urinary output

Frequency, urgency, feeling of bladder fullness

8/14/2019 441-ppt.ppt

6/22

Question 2: What questions do youneed to ask before an IVP? What do

you need to check in her blood?

Question 3: Alternative tests

8/14/2019 441-ppt.ppt

7/22

Normal IVP

8/14/2019 441-ppt.ppt

8/22

IVP showing stone

8/14/2019 441-ppt.ppt

9/22

Other Diagnostic Tests

Serum calcium, phosphorus, sodium, potassium,

bicarbonate, uric acid, creatinine, BUN (for renal

function and stone formation)

Urine pH

X-ray (will identify larger stones)

CT (differentiates stone from tumor)

IVP

8/14/2019 441-ppt.ppt

10/22

Question 4: Common types

Question 5: Causes

8/14/2019 441-ppt.ppt

11/22

Question 6: Treatment

8/14/2019 441-ppt.ppt

12/22

Percutaneous Ultrasonic Lithotripsy

(PUL)

8/14/2019 441-ppt.ppt

13/22

Extracorporeal Shock Wave

Lithotripsy (ESWL)

8/14/2019 441-ppt.ppt

14/22

Discuss Brown article

8/14/2019 441-ppt.ppt

15/22

Question 7: Specific instructions

Discuss Larkin article

Question 8: Care plan

8/14/2019 441-ppt.ppt

16/22

8/14/2019 441-ppt.ppt

17/22

Nursing Diagnoses

Acute pain related to ureteral stone as evidenced by pt

stating lots of pain, doubled over, clutching abdomen.

Ineffective therapeutic regimen management related to

not following prior advice for prevention as evidencedby PMH indicating 3 previous kidney stone attacks.

Risk for deficient fluid volume related to inadequate

fluid intake and occupation requiring work outside in

the hot weather.

Anxiety related to extreme prolonged pain as evidenced

by pacing, doubled over.

8/14/2019 441-ppt.ppt

18/22

Question 9/10: Prevention

Discuss Moyad article

8/14/2019 441-ppt.ppt

19/22

Prevention

Increase fluid intake to produce UO of2L/day (prevents supersaturation ofminerals)

Glass of lemonade per day (citrate bindswith calcium, so its not free and cant forma stone)

Low sodium diet (high sodium increasescalcium excretion, want to reabsorb so itdoesnt get into urine which also aids bone

strength) Normal calcium intake (promotes normal

oxalate excretion)

Low oxalate diet (if oxalate stone)

8/14/2019 441-ppt.ppt

20/22

Oxalate Foods

HIGH

Spinach, Asparagus, Beets, Celery

Rhubarb, Blackberries,Blueberries, Raspberries

Beans, Tomatoes

Nuts, Chocolate

Instant coffee, Ovaltine

Dark beer, Soy

Pretzels

High fiber cereal

LOW

Lemonade, certain herbal teas,Milk, Cola, Wine

Cabbage, Cauliflower, Cucumber,Radishes

Cheese, Grapefruit, Nectarines,Bananas, Melons

Bacon, Fish, Lamb

Cheerios, Macaroni, Pasta

Graham crackers

English muffins, Honey

Jello

8/14/2019 441-ppt.ppt

21/22

References

Brown, S.M. (1990). Quantitative measurement of anxiety in patients undergoing surgery for renal calculus disease. Journal

of Advanced Nursing, 15,962-970.

Deglin, J.H., & Vallerand, A.H. (2007). Daviss drug guide for nurses. Philadelphia: F.A. Davis Company.

Harwood, C.T. (1985). Pulverizing kidney stones: What you should know about lithotripsy. RN, 48(7),32-37.

Larkin, G.L., Peacock, W.F., Pearl, S.M., Blair, G.A., & DAmico, F. (1999). Efficacy of ketorolac tromethamine versus

meperidine in the ED treatment of acute renal colic.American Journal of Emergency Medicine 17(1),6-10.

Levine, D.Z. (1983). Care of the renal patient.Philadelphia: W.B. Saunders Company.

Lewis, S.L., Heitkemper, M.M., Dirksen, S.R., OBrien, P.G., & Bucher, L. (2007). Medical-surgical nursing.St. Louis: Mosby

Elsevier.

Low oxalate diet. (2003). University of Pittsburgh Medical Center. Retrieved from http://www.upmc. com/HealthAtoZ/patienteducation/Documents/LowOxalateDiet.pdf.

Mayo clinic staff. (2008). Kidney stones. Retrieved from http://www.mayoclinic.com/health/kidney-stones/DS00282.

8/14/2019 441-ppt.ppt

22/22

References Continued

Moyad, M.A. (2003). Calcium oxalate kidney stones: Another reason to encourage moderate calcium intakes and other

dietary changes. Urologic Nursing, 23(4),310-313.

OBrien, P.G., Dirksen, S.R., Lewis, S.L., Heitkemper, M.M., & Bucher, L. (2007). Medical-surgical nursing: clinical

companion. St. Louis: Mosby Elsevier.

Preusser, B.A. (2009). Critical thinking cases in nursing. St. Louis: Mosby, Inc.

Swearingen, P.L., & Ross, D.G. (1999). Manual of medical-surgical nursing care. St. Louis: Mosby, Inc.

(2008).Adult conditions: stones. Retrieved from http://www.urologyhealth.org/adult/index.cfm?cat =12&topic=102.