1. urolithiasis/NSU3062/rsetyowati
(URINARY CALCULI)
Medical Surgical Nursing III
By : Rahayu Setyowati, SKp.
Nursing Academy of YPIB Majalengka

2. OBJECTIVE At the end of this session, student should be able to:
1. Understand and explain of the definition of urolithiasis
2. Understand and explain of the pathophisiology of urolithiasis
3. Understand and explain of the risk factor of urolithiasis
4. Understand and explain of the clinical manifestation of urolithiasis
5. Understand and explain of the complication of urolithiasis
6. Understand and explain of the diagnostic test of urolithiasis
7. Understand and explain of the medical management of urolithiasis
8. Understand and explain of the nursing process of urolithiasis

3. DEFINITION Urinary Calculi adanya batu didalam sal. Kemih .
Lithiasis formasi batu
- di dlm ginjal : nephrolitiasis
- pada sal kemih lain : urolithiasis
Lemone,P & Burke,K(2004)
Batu terbentuk karena konsentrasi yang tinggi zat2 seperti
calcium oxalate, calcium phosphate and asam urat didalam darah dan
Urin.
Smeltzer,SC & Bare,B(2004)

5. cont… pathophysiology
TIPE BATU
Batu Calcium
75% to 80% dari batu ginjal . Batu Calcium biasanya karena
konsentrasi yang tinggi dalam darah dan urin.
Batu Asam Urat
adanya konsentrasi yang tinggi asam urat didalam darah dan
biasanya dihubungkan dengan penyakit gout
Batu Sturvite
dikaitkan dengan infeksi sal kemih
Batu Cystine stones
jarang terjadi tetapi boasanya berhub dgn keturunan
Lemone,P & Burke,K(2004)

6. RISK FACTORS Calcium stones :
Hypercalciuria and hypercalcemia : hyperparathyroidm, immobility,
bone disease,vit D intoxication,multiple myeloma,renal tubular acidosis,
prolonged steroid intake
Uric acid stones :
Gout, tinggi intake purine, acid urine
Sturvite stones :
UTI, especially Proteus infections.
Cystine stones :
genetic defect.
Lemone,P & Burke,K(2004)

7. CLINICAL MANIFESTATIONS
KIDNEY STONES
sering asymptomatic
sakit pada bagian pinggang
microscopic hematuria
manifestations of UTI (demam, frequency, urgency, dysuria)
URETERAL STONES
Renal colic : - nyeri pinggang akut
- sering menjalar pada area suprapubik, pangkal paha dan
external genitals
mual, muntah, pucat, kulit lembab
BLADDER STONE
bisa asymptomatic
sakit area suprapubic
gross or mocroscopic hematuria
manifestasi ISK

8. MANAGEMENT OF URINARY CALCULI
COMPLICATIONS
MANAGEMENT OF URINARY CALCULI
OBSTRUCTIONS-
HYDRONEPHROSIS-
INFECTION-
relieving acute symptom
removing stone
preventing further
stone formation

9. Urine calcium, uric asid, and oxalate. (nursing responsibilities for
DIAGNOSTIC TESTS
Urinalysis
 assess for hematuria, WBCs and
crystal, pH urine.
Urine calcium, uric asid, and oxalate.
(nursing responsibilities for
collecting at 24-hour urine specimen)
X-Ray (Kidney Ureter Bladder – KUB)
Ultrasonography
CT Scan
IVP ( Intravenous Pyelography)
Created by ma2 kiyya

11. MEDICATIONS and DIETARY
Calcium Phospha
te and or oxalate
Sturvite
Uric acid
Cystine
Thiazid diuretics,
Phosphates, calcium-
binding agents
Antibotic therapy for
UTI
Potassium citrate,
Allopurinol
Penicillamine,
Sodium bicarbonate
Kurangi makanan tinggi
calcium and oxalate,
Tingkatkan intake vit C,
Perbanyak minum,
Exercise (olah Raga)
operasi or lithotripsy
Diet rendah purine ,
Tingkatkan jml minum
Kurangi garam
Tingkatkan minum
Smeltzer,SC & Bare,B(2004)

12. Examples of Food and Fluids for Teaching Clients with Urolithiasis
Food high in
Calcium
Oxalate
Purine-rich foods
acidifying foods
Beans and lentils, chocolate, dried fruits, flour,
milk and milk products canned or smoked fish
except tuna.
Asparagus, beer & colas, beets, cabbage, celery,
Cocolate, fruits, green beans, nuts, tea, tomatoes.
Goose, organ meats, sardines and herring, venison
Moderate in beef, chicken, crab, pork, salmon, veal.
Cheese, cranberries, eggs, grapes, meat and poultry
Plum and prunes, tomatoes, whole grains

13. OPERASI Tindakan operasi tergantung dari : the location of the stone,
the extent of obstruction,
renal function,
the presence or absence of UTI
the client’s general state of health.
In general, the stone is removed if it causing severe obstruction,
infection, unrelieved pein, or serious bleeding
(Braunwald et al., 2001)

14. = using sound or shock waves to crush a stone.
Cont…surgery
LITHOTRIPSY
= using sound or shock waves to crush a stone.
Extracorporeal Shock Wave Lithotripsy (ESWL) is a noninvasive
Technique for fragmenting kidney stone using shock waves generated
outside the body.
Percutaneous Ultrasonic Lithotripsy uses a nephroscope inserted
into the kidney through a small flank incision.
Surgical intervention (rare) to remove a calculus in the renal pelvis or
Ureter  Ureterolitotomy, Pyelolithotomy, nephrolitotomy.

17. NURSING CARE OF THE CLIENT HAVING LITHOTRIPSI
PREOPERATIVE CARE
assess knowledge and understanding of the procedure, providing
information as needed.
follow directions from the radiologis departement, psycian, or
anestheties for withholding food and fluids and for bowel preparation
prior to surgery.
POSTOPERATIVE CARE
in the initial period, monitor vital sign frequently.
monitor amount, color, and clarity of urine output
maintain placement and patency of urinary catheters
prepare for discharge by teching care of indwelling catheter, urine-
collection device. Teach signs and symptoms of infection.
teach measures to reduce the risk of further lithiasis

18. NURSING PROCESS ASSESSMENT Health history :
- complaints of flank, back, or abdominal pain, radiation,
- characteristic and timing, aggravating or relieving factor;
- nausea and vomiting;
- posible contributing such as dehydration;
- family history of kidney stone;
- current or previous treatment measures.
Physical examination :
- position, vital sign, skin color, temperature, moisture, turgor
- costovertebral tenderness;
- amount, color and characteristics urine

19. urolithiasis/NSU3062/rsetyowati
Cont…nursing process
NURSING DIAGNOSES
1. Acut Pain releated to inflammation, obstruction, and abrasion of
the urinary tract.
2. Potential complication releated to obstruction
3. Deficient knowledge regarding prevention of recurrence of renal
stone.

20. urolithiasis/NSU3062/rsetyowati
Cont…nursing process
PLANNING
1. Acut Pain releated to inflammation, obstruction, and abrasion of
the urinary tract.
Goal : relieving pain
Nursing interventions :
# assess pain using standard pain scale and its caracteristics.
# administer analgesia as ordered and monitor its effectiveness.
(intensity, type of pain, and responsiveness to analgetic)
# encourage fluid intake and ambulation in the client with renal
colic (increased fluid and ambulation increase urinary output,
facilitating movement of the calculus through the ureter and
decreasing pain)
# use nonpharmacologic measures such as positioning, moist
heat, relaxation technique, guided imagery. (adjunctive pain
relief measures can enhance the effeciveness of analgesics)
# if surgery has been performed, monitoring urinary output,
catheters, incision, and wound care. (pain may be a symptom
of proximal distention due to a blocked catheter. Infection or
hematoma at the surgical site can significantly increase pain)

21. urolithiasis/NSU3062/rsetyowati
Cont…nursing process
2. Potential complication releated to obstruction
Goal : monitoring and managing potential complications
Nursing interventions :
# monitor amount and character of urine output. If catheterized,
measure output hourly. (the amount of urinary output helps
determine possible urinary tract obstruction and adequacy
hydration)
# document any hematuria, dysuria, frequency, urgency, and
pyuria. (hematuria is often associated with calculi and with
procedure used to remove stones)(dysuria, frequency, urgency
are symptom of UTI, often associated with urolithiasis)
# strain all urine for stone, saving any recovered stone for
laboratory analysis. (analysis of stone recovered from the
urine can direct measures to prevent further lithiasis)
# maintain patency and integrity of all catheter system.
# secure catethers well, label is indicated, and use sterile tech-
nique for all ordered irrigations or other procedure.

22. urolithiasis/NSU3062/rsetyowati
Cont…nursing process
3. Deficient knowledge regarding prevention of recurrence of renal
stone.
Goal : teaching patient self care
Nursing interventions :
# assess understanding and previous learning.
# teach about all diagnostic and treatment procedures.
# teach measures to prevent further urolithiasis
- increase fluid intake to ml per day
- follow recommended dietary guidelines
- maintain actifity level to prevent urinary statis and bone
resorption.
- take medications as prescribed.
(the risk current lithiasis is approximately 50%)
# teach about the relationship between urinary calculi and
UTI.

23. urolithiasis/NSU3062/rsetyowati
Cont…nursing process
IMPLEMENTATION
EVALUATION
Expected patient outcome may include :
1. report relief of pain
2. experiences no complications :
- report no sign or symptom of sepsis or infection
- voids 200 – 400 ml per voiding of clear urine without
evidence bleeding.
- experiences absence of dysuria, frequency, and urgency
- maintains normal body temperature
3. state increased knowledge :
- consumes increased fluid intake ( ml/day)
- participates in appropriate activity
- consumes diet prescribed
- takes prescribed medication as directed to reduce stone
formation.