Renal Stone

definition of Renal stonesUrolithisis and nephrolithiasis refer to stones (calculi) in the urinary tract and kidney.

Pathophysiology

The different sites oc calculi formation in urinary tract are shown in figure.

Clinical manifestations Stones in the renal pelvis may be associated with an intense ,deep ache in the costovertebral region. Hematuria Pyuria Pain originating in the renal area radiates anteriorly and downward the bladder in the female and toward the testis in male Tenderness Nausea and vomiting appearThese GI symptoms are due to renointestinal reflexes and the anatomic proximity of the kidneys to the stomach, pancreas ,and large intestine

Assessment and diagnostic By x-ray of the kidneys . ureters And bladder(KUB) Ultrasonography Iv urographyRetrograde pyelography24-hour urine test

X-ray

Ct-scan

Medical management Opioid analgesics Non-steroidal anti-inflammatory drugs (NSAIDS)

Nutritional therapy Increase fluid intake is the mainstay a-calcium stones. Patient with calcium-based renal stones were advised to restrict calcium in their diet.B-uric acid stones .low-purine diet .foods high in purine (shellfish,anchovies,asparagus,mushroom,and organ meats) C-cystine stones .a low-protein diet D-oxalate stones .

Intake of oxalate is limitedTheses include spinach

strawbrries,rhubarb,chocolate,tea,peanuts ,and wheat barn.

Patien education Preventing kidney stonesAvoid protein intake Low-calcium diets Avoid intake of oxalate-containing food (eg.spinach,strawberries ,rhubarb ,tea ,peanuts ,wheat bran)Increase drink fluid Drink two glasses of water at bedtime Avoid dehydration.Avoid urinary tract infection

Interventional proceduresUreteroscopy. extracorporeal shock wave lithotripsy(ESWL)

(percuta-neous)stone removal1. Ureteroscopy involves first visualizing the stone

and then destroying it .access to the stone is accomplished by inserting a ureteoscope into the ureter and then inserting a laser .electrohydraulic lithotriptor,or ultrasound device through the ureleroscope to fragment and remove the stones

2. ESWL is a noninvasive procedure used to break up stones in the calyx of the kidney

Nursing care of.……………Fragmented to the size of grains of sand , the remnants the stones are spontaneously voided. ESWL shock wave

Discomfort from the multiple shocks may occur.

.The patient is observed for obstruction and infection result mg form blockage of the urinary tract by stone fragments

.I urine is strained after the procedure .voided gravel or and is sent to the

laboratory

.Early ambulate . Endourologic methods of stone removal

maybe used to extract renal calculi the cannot be removed by other procedures

Surgical management ; is indicated if the stone does not respond to other forms of treat ment nephrolithotomy (incision incision into the kidney with removal of the stone ) or a nephrectomy, if the kidney is nonfunctional secondary to infection or hydronephrosis. Stones in the kidney pelvis are removed by a pyelolithotomy and those in the bladder by cystotomy

Diagnosis Nursing Diagnosis

1 .Acute pain related to inflammation obstruction and abrasion of the urinary tract

2 . Deficient knowledge regarding prevention of recurrence of renal stones

Callabarative prgblemslPotential complications

.Infection and urosepsis.Obstruction of the urinary

tract by a stoneNursing Intervention Relieving pain Presenting symptom of a patient with renal Opioid analgesic agents

Manitoring and managing Potential Complications

1 .Increased fluid intake to prevent dehydration and increase hydrostatic pressure.

2 .The total urine output and patterns of voiding are monitored.

3 .Ambulation is encouraged 4 .All urine is strained through gauze

because5 .patient is instructed to report decreased

urine volume and bloody or cloudy urine 6 .frequent nursing observation to detect

the spontaneous passage of a stone7 .Vital signs, including temperature, are

monitored

Prgmoting Hama and community-based careIncluding maintaining a high fluid intake

Diet: decreas calcium in the food avoiding habit: avoid stay under the sun for along time

Exersic : walking at least 3ment/day

Follow up: first vist after one week second vist after one month thierd vist after three month in one year after six month in tow year than once yrealy increase fluid intake 3L/day

Urine cultures may be performed every 1 to 2 months the first year and periodically thereafter Recurrent UTI is treated vigorously

Urine cultures may be performed every 1 to 2 months the first year and periodically thereafter Recurrent UTI is treated vigorously

If ESWL1 increase fluid intake to assist in the

passage of stone fragments.2 Family are instructed about signs and

symptoms that indicate complication 3 Inform the patient to expect

hematuria4 temperature

5 pain is unrelieved by the prescribed medication--------------------Assess the patient understanding of ESWL

By: Student:

Qalit almutairi Nawal

almutairi Nora Haji

To : Dr: Jehan