GU Calculi

Kidney Stones

Natalie BennettChristina KaranasosJessica Reetz

Stone Formation

Highly concentrated urine constituents crystallize and harden to form calculi.

Contributing factors: Altered pH Age/gender Urine stasis and/or retention UTI Dehydration Genetics Climate Underlying disorders Diet

(Hanson, 2005) and (Lewis, et al., 2007)

Types of Stones

Calcium oxalate

Calcium phosphate

Struvite

Uric acid

Cystine

(Morton, Iliescu, and Wilson, 2002)

Diagnostic Tests

Urinalysis IVP Abdominal ultrasound CT KUB Cystoscopy

(MayoClinic, 2008)

Treatment

TREAT THE PAIN!!!

Lithotripsy

Ureteroscopy

Surgical removal

Percutaneous nephrolithotomy

Nutritional therapy

(Hanson, 2005)

Trivia

What are common signs and symptoms of kidney

stones?

Answer Severe flank or lower abdominal pain Dysuria Hematuria N/V Chills and fever (if infection is present) Blocked urinary flow Anxiety Pallor and/or cool, clammy skin

(Moe, 2006) and (National Kidney Foundation, 2009)

Trivia

Case Study #2: The MD orders an IVP (intravenous pyelogram). What question

do you need to ask S.R. before the test is

conducted?

Answer

Ask if patient is allergic to shellfish or iodine.

*Note: If patient is severely dehydrated, IVP may cause renal shutdown.

Trivia

This is the famous logo of which band?

Answer

The Rolling Stones!!!!!

Trivia

List nursing interventions for the following diagnosis: Acute pain r/t effects of renal

stone and inadequate pain control or comfort measures

Answer

PQRST pain assessment Pain control measures to prevent break

through pain Administer pain meds as ordered Teach use of nonpharmacologic

techniques

(Lewis, et al., 2007)

Trivia

Case Study #4: What are the two most common types

of stones?

Answer

Calcium and struvite stones

(Lewis, et al., 2007)

Trivia

What is the name of this famous landmark?

Answer

Stonehenge!!!

Trivia

Case Study #10: Because S.R.’s stone has been reported as calcium oxalate, what type of diet would be recommended?

Answer

Increase fluid intake Consume adequate amounts of

calcium Limit dietary oxalates Limit sodium intake

(Krieg, 2005)

Trivia

What is the name of the first book in the Harry Potter

series?

Answer

Harry Potter and the Sorcerer’s Stone!!!

Trivia

What commonly prescribed drug increases the risk of developing kidney

stones due to increased renal excretion of calcium?

Answer

Lasix

*Note: Topamax and Indinavir also increase the risk for kidney stones.

(Deglin and Vallerand, 2007) and (WebMD, 2006)

Trivia

True/False: It is important to force fluids on a patient with a kidney stone.

Why or why not?

Answer

False. It is not effective in assisting the patient to pass the stone and may exacerbate the pain.

(Lewis, et al., 2007)

Trivia

Name two nursing diagnosis besides pain and list two interventions for each.

Answer

Impaired urinary elimination Monitor I&O’s and urine characteristics Teach patient to drink adequate amounts of

liquids Teach s/s of UTI

Anxiety Remain with and calm patient Provide education on condition Teach relaxation techniques

Trivia

Fill in the Blank:

The term __________ refers to the stone, and _________ refers to stone

formation.

Answer

The term calculus refers to the stone, and lithiasis refers to stone formation.

(Lewis, et al., 2007)

Trivia

What’s the name of the

“modern stone-age family, from the town of Bedrock (They’re a page right out of

history…)”

Answer

The Flintstones!!!

Trivia

Case Study #7: S.R. was discharged with instructions to strain all urine and return if she experienced pain unrelieved by pain meds or increased N/V.

What specific instructions will you give S.R. about her urine, fluid intake, meds, and activity?

Answer

Urine: check for cloudy, malodorous urine, presence of blood (may be tea colored)

Fluid intake: ensure adequate hydration (6-8 glasses/day), avoid overhydration

Meds: teach about side effects, don’t take more than directed

Activity: teach pt. that ambulation will help with passage of stone

ReferencesDeglin, J. & Vallerand, A. (2005). Davis’s drug guide for nurses (10th ed.). Philedelphia: F. A. Davis Company.

Flagg, L. (2007). Dietary and holistic treatment of recurrent calcium oxalate kidney stones: Review of literature to guide patient education. Urologic Nursing, 27, 113-121.

Guan, N. (2009). Melamine-contaminated powdered formula and urolithiasis in young children. The New England Journal of Medicine, 360, 1067-1074.

Hanson, K. (2005). Minimally invasive and surgical management of urinary stones. Urologic Nursing, 25, 458-464.

Krieg, C. (2005). The role of diet in the prevention of common kidney stones. Urologic Nursing, 25, 451-456.

Lewis, S., Heitkemper, M., Dirksen, S., O’Brien, P., & Bucher, L. (2007). Medical surgical nursing: Assessment and management of clinical problems (7th ed.). St. Louis: Mosby Elsevier.

Mayo Clinic. (2008). Kidney stones. Retrieved April 20, 2009 from http://www.mayoclinic.com/health/kidney-stones/ds00282.

Moe, O. (2006). Kidney stones: Pathophysiology and medical management. The Lancet, 367, 333-344.

Morton, A., Iliescu, E., & Wilson, J. (2002). Nephrology: Investigation and treatment of recurrent kidney stones. Canadian Medical Association Journal, 166, 213-218.

Moyer, M., O’Gara, J., & Burrus, L. (1988). General anesthesia for extracorporeal shock wave lithotripsy. Journal of the American Association of Nurse Anesthetists, 56, 121-125.

Schardt, D. (2009). Skipping stones: How to avoid kidney stones. Nutrition Action Healthletter, 9-11.

Stegall, M. (2001). Urinary tract stones: Causes, complications and treatment. British Journal of Nursing, 10.

Taylor, E. & Curhad, G. (2008). Fructose consumption and the risk of kidney stones. Kidney International, 73, 207-212.

U.S. Department of Health and Human Services. (2007). Kidney stones in adults. Retrieved April 20, 2009 from http://kidney.niddk.nih.gov/kudiseases/pubs/pdf/KidneyStonesAdults.pdf.