1. Disorders of the Urinary System
Renal Stones

2. Renal Stones Renal staghorn calculus
Variations in composition and environment (acidic or alkaline)
Major types including hereditary type
Identify the type and cause
Preventive measures based on type
Appropriate method of treatment

3. Causative Factors
Supersaturation of the urine with crystalloids that do not readily dissolve (e.g., calcium, uric acid, and cystine)
Urinary infections, which can produce bacteria and other debris that form a core for stone formation
Inadequate fluid intake, which results in concentrated urine and inadequate flushing of the urinary tract

4. Causative Factors (cont.)
Sluggish flow of urine, as may occur with bed rest or immobility
Certain substances in the urine (e.g., urate, a salt of uric acid), which encourage the formation of crystals of calcium oxalate or calcium phosphate

5. Renal Staghorn Calculus
See Figure 35-1 on p. 792.

6. Stone Types Calcium oxalate (most common) Calcium phosphate Uric acid
Struvite (more common in women)
Cystine
See Table 35-2 on p. 792.

7. Etiology and Pathophysiology
Calcium stones and parathyroid tumor
Males > females
Family history of stones
History of intestinal bypass surgery for obesity
Immobility
History of recurrent urinary tract infection

8. Prevention Adequate flow of dilute urine through the kidney
Prevent UTI
Urinary pH modification—ascorbic acid or dietary modifications

9. Signs and Symptoms
Severe pain—stones that are small enough to move along
Flank pain radiates downward to genitalia and inner thigh. This causes obstruction and swelling of ureter
Nausea and vomiting

10. Diagnosis UA and KUB IVP
Serum levels of calcium, uric acid, and cystine

11. Treatment Flushing the stone—oral intake or IV infusion
Pain management—opioids, NSAIDs, and antispasmodics
Antibiotics
Irrigation via ureteral catheter or percutaneous nephrostomy

12. Nursing Management Pain management Fluid intake of 3000-4000 mL
Early ambulation
Adjunctive therapy for ESWL: corticosteroids, calcium channel blockers, alpha agonists
Percussion, diuresis, and inversion (PDI) therapy

13. Nursing Management (cont.)
Cystoscopy or surgery
Nephrolithotomy, pyelolithotomy, and ureterolithotomy
Monitor: infection, hemorrhage, and leakage of fluid
Initial assessment: Changes in urinary output, characteristics of the urine, risk factors and history, and other assessment data
Straining of urine