Describe the different types of renal calculi? How does each present? What dietary
recommendations would you include in patient teaching? What nursing
... [Show More] interventions would be
appropriate for these patients?
Urolithiasis is the presence of calculi (stones) in the urinary tract.
Nephrolithiasis is the formation of stones in the kidney.
Ureterolithiasis is the formation of stones in the ureter.
Most stones contain calcium, struvite (15%), uric acid (8%), and cysteine (3%).
Formation of urine involves:
Slow urine flow, which results in supersaturation of the urine with the particular element
(examp. Ca).
Damage to the lining of the urinary tract.
Decreased amounts of inhibitor substances in the urine that would otherwise prevent
supersaturation.
High urine acidity (as with uric acid and cysteine stones) or alkalinity (as with calcium phosphate
and struvite stones), and drugs (such as triamterene, indinavir, acetazolamide) contribute to stone
formation.
Types of Renal Calculi and nutrition:
Calcium oxalate:
Dietary recommendations:
Avoid oxalate sources such as, spinach, black tea, rhubarb, Swiss chard,
cocoa, beets, wheat germ, pecans, peanuts, okra, chocolate, and lime
peel, strawberries.
Decreased sodium intake. (High sodium intake reduces kidney tubular
calcium reabsorption.)
Calcium Phosphate:
Dietary recommendations:
Limit intake of foods high in animal protein (5-7 servings per week) and
never more than 2 a day.
(Reduction of protein intake reduces acidic urine and prevents calcium
precipitation.)
Some pt’s may benefit from a reduced calcium intake (limiting milk and
other dairy products).
Decrease sodium intake.
Struvite (magnesium ammonium phosphate)
Dietary recommendations:
Limit high phosphate foods, such as dairy products, organ meats, and
whole grains.
Uric Acid (urate):
Dietary recommendations:
Decrease intake of purine sources, such as organ meats, poultry, fish,
gravies, red wines, and sardines.
A percentage of pt with gout will develop these stones.
Cystine:
Dietary recommendations:
Limit animal protein
Encourage oral fluid intake (400 mL every 4 hrs while awake and 750
mL at night).
Goals/Interventions
o Eradicate stone, determine type, prevent nephron destruction,
control infxn, relieve obstruction
o IV Opioids (increase risk of bleeding)
o Avoid over/under hydration
o Strain urine and teach pt. to strain for stones
o Most heat
o Push PO fluid if tolerated
o Give Thiazide and Allopurinol to aid expulsion/excretion
o SWL: Shock wave lithotripsy
Sound laser/dry shock to break up stones
Surgical Management
o Nephrostomy tube/Foley
o Monitor for bleeding/pneumothorax, infxn
o Infection control
Give broad spectrum antibiotics
Struvite stones – prevent urea splitting
Prevent Obstruction
o Hypercalciuria: thiazides promote renal absorption from tubules
to decrease Ca
o Hyperoxaluria: Allopurinol/febuoxstat
o Hyperuricemia/chronic gout: allopurinol/febuoxstat
o Cystinuria: AMPG and captopril = lower urine cysteine levels
Desired Urine pH: 6-6.5
Location of the stone:
Flank pain suggests that the stone is in the kidney or upper ureter. Flank pain that
extends toward the abdomen or to the scrotum and testes or the vulva suggests that stones
are in the ureters or bladder. Pain is most intense when the stone is moving or when the
ureter is obstructed. Frequency and dysuria occur when the stone has reached the
bladder. Oliguria or anuria suggests obstruction, possibly at the bladder neck or urethra.
(Urinary tract obstruction is an emergency).
Teaching:
Finish entire px of antibiotics to prevent UTI
May resume daily activities
Balance exercise/rest/sleep
Return to work in 2-6 weeks
Diet may be restricted
Drink at least 3L fluid daily to dilute potential stone-forming crystals, prevent
dehydration, promote urine flow
Monitor pH
Expect bruising after lithotripsy
Urine may be bloody
Pain in kidneys/bladder may signal infxn
o Report any fevers, chills, difficulty urinating
Assessment:
Does the patient have personal or a family history of urologic stones?
Renal colic (severe pain) is normally present.
o Renal colic begins suddenly and is often described as “unbearable”. Nausea,
vomiting, pallor, and diaphoresis often accompany the pain.
o A large stationary stone rarely causes pain because it isn’t moving.
Oliguria and Anuria (occurs when stone [Show Less]