At the end of this session, you will be able to :

State the definition of urolithiasis. List the etiology of urolithiasis. Identify the pathophysiology of

urolithiasis. State the sign & symptom of

urinary tract stone.

LEARNING OBJECTIVES cont.

Identify the complication of urinary tract stone.

Understand regarding treatment of urinary tract stone.

Identify the nursing intervention & appreciate the nursing care for urinary tract stone patient.

PATIENT’S PROFILE

MR. T

MALE

44 YEARS OLD

TRAINER

PATIENT’S PROFILE WHEEL CHAIR

ANXIOUS

ALLERGICS - NIL

D.O.A 4/6/14 @ 2100 Hr

Mr T was admitted to 5XX-1 with complaint of right loin to groin

pain X 1/7 under Dr N.

PATIENT’S PROFILE MEDICAL HISTORY HPT

SURGICAL HISTORY NIL

FAMILY MED HISTORY HPT (Both parents)

CURRENT MEDICATION

Tab Amlodipine 1/1 Daily

VITAL SIGN TEMPERATURE : 37.2˚C BLOOD PRESSURE : 160/95mmHg PULSE : 70 bpm RESPIRATION : 21 bpm PAIN SCORE : 2 Weight : 71kg

ACTIVITY DAILY LIVING Anxious and asking many questions.

Bowel movement alternate day

Constipation (on high fiber diet)

PHYSICAL EXAMINATION

S/B Dr N in A&E

Light breakfast at 6am CM then fast Ural 1/1 TDS Norgesic 1/1 TDS IV Dynastat 40mg BD IV Pethidine 25mg STAT & repeat

another 25mg IV if pain not relief in 15 minutes

Continue….

IM Pethidine 75mg 6 hourly PRN IM Maxalon 10mg 6 hourly PRN For right URS / lithotripsy CM ECG OT / Anaest / Consent

Stone Types

• Calcium stones (60-80%)–Most primarily calcium oxalate– Less often, calcium phosphate

• Struvite (magnesium ammonium phosphate) (10-15%)

• Uric acid (if pure, then radiolucent) (5-10%)• Cystine (1%)• Other (indiavir, triamterene, etc) (1%)

↓ fluid volume / substance that prevent crystallization (citrate,

magnesium, nephrocalcin / uropontin)

↑ urinary concentration of calcium oxalate / calcium phosphate / uric acid

Supersaturated urine

Crystallization of urine

Stone formation

• Pain in abdomen, flank or groin (sudden onset, very severe and intermittent colic)• Haematuria• Decreased urine volume• Nausea and vomiting

SIGN & SYMPTOMS

CLINICAL MANIFESTATIONS

• Manifestations depend on the presence of obstruction, infection, and edema. Symptoms range from mild to excruciating pain and discomfort.

Ureteral Colic (Stones Lodged in Ureter)

• Acute, excruciating, colicky, wavelike pain, radiating down the thigh to the genitalia

• Frequent desire to void, but little urine passed; usually contains blood because of the abrasive action of the stone (known as ureteral colic)

Stones in Renal Pelvis

• Intense, deep ache in costovertebral region• Hematuria and pyuria• Pain that radiates anteriorly and downward

toward bladder in female and toward testes in male

• Acute pain, nausea, vomiting, costovertebral area tenderness (renal colic)

• Abdominal discomfort, diarrhea

Stones Lodged in Bladder

• Symptoms of irritation associated with urinary tract infection and hematuria

• Urinary retention, if stone obstructs bladder neck

• Possible urosepsis if infection is present with stone

• Reduction of fluid intake• Recurrent UTI• Hyperuricemia-caused medication• Inflammatory bowel syndrome• History of gout• Poor micturation habit• Male

RISK FACTORS

• Pyelonephritis• Urosepsis• Chronic renal failure

COMPLICATION

• Lymphocyte- 17.7% (20-45%)

• Glucose- 6.8 (3.9 – 6.1mmol/L)

• Potassium- 3.3 (3.5 – 5.5mmol/L)

SURGICAL PROFILE

• Bacteria - Occasional (Nil)

URINE FEME

• Right VUJ stone ~5mm with obstructive hydronephrosis

CTU

DRUGSIN WARD

DATEORDERED

DATE OFF

IV Pethidine 25mg STAT & rpt another 25mg if pain not relief after 15 min

4/6/14 4/6/14

IM Pethidine 75mg 6hourly PRN

4/6/14 6/6/14

IM Maxalon 10mg 6hourly PRN

4/6/14 6/6/14

IV Dynastat 40mg BD 4/6/14 6/6/14

DRUGSIN WARD

DATEORDERED

DATE OFF

Ural 1/1 TDS 4/6/14 6/6/14

Norgesic 1/1 TDS 4/6/14 6/6/14

IV Sulperazone 1gm BD 5/6/14 6/6/14

Tab Prednisolone 10mg BD

5/6/14 6/6/14

Tab Hytrin 2mg ON 5/6/14 6/6/14

Alteration in comfort : pain related to obstructive ureteric stone.

NURSING DIAGNOSIS

Alteration in emotional status anxiety related to surgical management and treatment.

NURSING DIAGNOSIS

Knowledge deficit related to management of blood pressure control.

NURSING DIAGNOSIS

Potential infection related to intravenous cannulation.

NURSING DIAGNOSIS

Potential bleeding related to surgical intervention.

NURSING DIAGNOSIS

Potential infection related to surgical intervention.

NURSING DIAGNOSIS

• Drink 2.5 – 3 litres H₂O per day (neutral pH)• Take 2 glasses of water at bedtime

to prevent urine concentration at night• Avoid excessive intake of milk or

alkaline drink

DRINK :

• Minimize protein intake (60g/day) to decrease urinary excretion of calcium & uric acid

• Minimize sodium (3-4g/day) because sodium competes with calcium for reabsorption in kidneys

• Avoid oxalate-containing food (spinach, strawberry, tea, peanut & wheat bran)

DIET :

• Regular exercise• Avoid strenuous activity leading to

sudden increase body temperature that lead to excessive sweating & dehydration

EXERCISE :

• Maintain personal hygiene• Seek treatment immediately at 1st

sign & symptom of UTI

URINARY TRACT INFECTION :