Urolithiasis Presentation by melissa vandyke

What is urolithiasis????? a formation of urinary calculi in any area of the urinary tract. a formation of urinary calculi in any area of the urinary tract. Named specifically to indicate where they are located or formed: nephrolithiasis (stones in the kidney), ureterolithiasis (stones in the ureter), and cystolithiasis (stones in the bladder) Named specifically to indicate where they are located or formed: nephrolithiasis (stones in the kidney), ureterolithiasis (stones in the ureter), and cystolithiasis (stones in the bladder) Urolithiasis develops from minerals that have precipitated out of solution and adhere, forming stones that varie in size and shape Urolithiasis develops from minerals that have precipitated out of solution and adhere, forming stones that varie in size and shape Some people are predisposed; people that are immobile, are hyperparathyroid, people that have recurrent UTI’s, Some people are predisposed; people that are immobile, are hyperparathyroid, people that have recurrent UTI’s, Also individual history and some foods, nutrients, and medications also contribute to development of stones. Also individual history and some foods, nutrients, and medications also contribute to development of stones.

Clinical Manifestations…. Size and degree of mobility of the stone influences what symptoms you might have Size and degree of mobility of the stone influences what symptoms you might have Patients with renal colic will receive attention immediately whereas a patient with a less mobile stone with wait until there are signs and symptoms of infection to seek assistance Patients with renal colic will receive attention immediately whereas a patient with a less mobile stone with wait until there are signs and symptoms of infection to seek assistance

A look at stones……….. OUCH!!!!

Assesment of a patient with urolithiasis…….. Patient with mobile calculi will complain of intractable pain and is usually accompanied by nausea and vomiting Patient with mobile calculi will complain of intractable pain and is usually accompanied by nausea and vomiting Patients has pain that starting in the flank and radiating into the groin, genitalia, and the inner thigh. Patients has pain that starting in the flank and radiating into the groin, genitalia, and the inner thigh. Patient with a less mobile stone will have signs and symptoms as that with a UTI ( pain and burning with urination, nocturia, abdominal discomfort, flank pain, hematuria, or pyuria.) Patient with a less mobile stone will have signs and symptoms as that with a UTI ( pain and burning with urination, nocturia, abdominal discomfort, flank pain, hematuria, or pyuria.) Collection of objective data would include assessing for presence of hematuria and vomiting Collection of objective data would include assessing for presence of hematuria and vomiting

Diagnostic Test………. KUB and IVP/IVU radiography, ultrasound, cystoscopy, and urinalysis. KUB and IVP/IVU radiography, ultrasound, cystoscopy, and urinalysis. Other test may also be ran to determine stone content, presence of infection, and alterations in blood chemistry that may influence stone formation. Other test may also be ran to determine stone content, presence of infection, and alterations in blood chemistry that may influence stone formation. 24 hour urine examination may be done to detect abnormal excretion of calcium oxalate, phosphorus, or uric acid. 24 hour urine examination may be done to detect abnormal excretion of calcium oxalate, phosphorus, or uric acid.

Medical Management…… Antiinfective agents may be administerd in the presence of infection Antiinfective agents may be administerd in the presence of infection Stones may need to be removed surgicaly (ureterolithotomy, pyelolithotomy, nephrolitomy) Stones may need to be removed surgicaly (ureterolithotomy, pyelolithotomy, nephrolitomy) Chemolytic agents (alkylating or acidifying agents) may be instilled to dissolve stones. Chemolytic agents (alkylating or acidifying agents) may be instilled to dissolve stones. Lithotrispy- patient is submerged in a special tank of water and ultrasonic shock waves are used to pulverize the stone. (urine is still strained) Lithotrispy- patient is submerged in a special tank of water and ultrasonic shock waves are used to pulverize the stone. (urine is still strained) Long term management may include dietary adjustments to influence the urine pH or to decrease availabilty of certain substances to discourage stone formation Long term management may include dietary adjustments to influence the urine pH or to decrease availabilty of certain substances to discourage stone formation Moderate reduction of calcium phosphorus and purine- containing foods when stones are caused by metabolic abnormalites. Moderate reduction of calcium phosphorus and purine- containing foods when stones are caused by metabolic abnormalites.

Medical Management con’t…. Adequate daily fluid intake of 2000ml will help cleanse urinary tract Adequate daily fluid intake of 2000ml will help cleanse urinary tract Avoid foods such as cheese, greens, whole grains, carbonated beverages, nuts, chocolate, shellfish, and organ meat Avoid foods such as cheese, greens, whole grains, carbonated beverages, nuts, chocolate, shellfish, and organ meat In calcium stone formation, sodium cellulose phosphate binds with ingested calcium and prevents its absorbtion In calcium stone formation, sodium cellulose phosphate binds with ingested calcium and prevents its absorbtion Aluminum hydroxide gel with bind with excess phosphorus allowing intestinal excretion rather than urinary excretion Aluminum hydroxide gel with bind with excess phosphorus allowing intestinal excretion rather than urinary excretion Allopurinol (Zyloprim) reduces serum nitrate levels Allopurinol (Zyloprim) reduces serum nitrate levels

Lithotripsy Procedure

Nursing Interventions……. The patient should remain active and increase fluid intake (at least 2000mL per day) The patient should remain active and increase fluid intake (at least 2000mL per day) STRAIN ALL URINE!!!!! STRAIN ALL URINE!!!!! Asses urine for hematuria Asses urine for hematuria Monitor BUN and creatinine for indications of continuing urinary obstruction Monitor BUN and creatinine for indications of continuing urinary obstruction People that are calcium stone formers should avoid dairy products and antiacids People that are calcium stone formers should avoid dairy products and antiacids Avoid foods such as cheese, greens, carbonated beverages, whole grains, organ meats, chocolate, and nuts. Avoid foods such as cheese, greens, carbonated beverages, whole grains, organ meats, chocolate, and nuts.