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NEPHROLITHIASIS

Presented to :Mrs. Sarabjit Mam


Presented by: L Premeshwori Devi
M. Sc Nursing 1
st
year

Definition
Calculi form in the kidney is known as
Nephrolithiasis.
A kidney stone, also known as a renal
calculus.

Kidney stones are solid accumulations of
material that form in the tubal system of the
kidney. Kidney stones cause problems
when they block the flow of urine through
or out of the kidney. When the stones move
along the ureter, they cause severe pain.

Risk factor
Immobility and sedentary life style, which
increase stasis.
Dehydration which leads to supersaturation
Metabolic disturbance that result in an
increase in calcium and other ions in the
urine
Previous history of urinary calculi
Living in stone belts area
High mineral content in drinking water
A diet high in purines, oxalates, calcium
supplements, animal proteins
UTIs
Contd
Prolonged indwelling catheterization
Neurogenic bladder
History of female genital mutilation
ETIOLOGY
The two primary causative factors are
1 Urinary stasis
2 Supersaturation of urine
Stasis of urine from bladder neck obstruction,
continent urinary diversion and
immobilization increase the risk of
development of stone because the crystal
in unmoving urine precipitate more readily.
Contd
Infection
Foreign bodies
Failure to empty the bladder completely
Metabolic disorders
Obesity and weight gain.
Lack of inhibitors such as citrate and
magnesium
Medication such as acetazolamide,
absorbable alkalis (e.g. calcium carbonate
and sodium bicarbonate)
Types of calculi
Calcium stones. Most kidney stones are
calcium stones, usually in the form of
calcium oxalate. Oxalate is a naturally
occurring substance found in food. Some
fruits and vegetables, as well as nuts and
chocolate, have high oxalate levels. liver
also produces oxalate. Dietary factors, high
doses of vitamin D, several metabolic
disorders can increase the concentration of
calcium or oxalate in urine. Calcium stones
may also occur in the form of calcium
phosphate.

Contd
Struvite stones. Struvite stones form in
response to an infection, such as a urinary
tract infection. These stones can grow
quickly and become quite large.
Uric acid stones. Uric acid stones can
form in people who don't drink enough
fluids or who lose too much fluid, those
who eat a high-protein diet, and those who
have gout. Certain genetic factors also may
increase risk of uric acid stones.

Contd
Cystine stones. These stones form in
people with a hereditary disorder that
causes the kidneys to excrete too much of
certain amino acids

Pathophysiology
Urine saturation

Supersaturation

Crystal nucleation


Aggregation


Retention and growth
Clinical manifestation
Sudden onset of sharp and severe pain
cause by the movement of the calculus and
consequent irritation.
Renal colic originates deep in the lumbar
region and radiates around the side and
down towards the testicle for male and the
bladder in the female.
Ureteral colic radiates towards the genitelia
and thigh.
Nausea and vomiting.
Pallor.
Grunting respiration
Elevated blood pressure and pulse.

Contd
Diaphoresis.
Anxiety.
Urgency and frequency.
Hematuria.
Chronic cystitis.
Heavy feeling in the suprapubic region.
Obstruction in voiding
Decreased bladder capacity
Intermittent urinary stream
Diarrhoea
Abdominal discomfort .
Diagnostic evaluation
History collection
Physical examination
Blood analysis
24 hours urine test
X ray (KUB)
Ultrasonography
Intravenous urography or
Retrograde pyelography.

Medical management
The goals of medical management are
increase fluids, reduce pain, minimize
calculus formation by implementing diet
change and administering medication.
Increase fluids
Encourage the clients to increase fluids to
3 to 4L daily, unless contraindicated, to
ensure urine output of 2.5 to 3L. Increase
fluid may decrease pain, prevent an
increase in stone size and prevent
infection.
Contd
Reduce pain
Increase fluid intake
OpIoids such as Morphine sulphate (IM/IV)
NSAIDs may be effective because they
inhibits the synthesis of prostaglandin E.
Antispasmodic agent such as oxybutynin
chloride( Ditropan) for relieving and
controlling colic pain.


Contd..
Prevent stone recurrence
Diet modification and medication may be
required to prevent further calculus
formation.
Implement Dietary changes
Clients with oxalate stone should avoid
high oxalate foods such as tea, tomatoes,
instant coffee, cola drinks, beer, green
beans, spinach, cabbage, chocolate, citrus
fruits, apples, grapes, peanuts and peanuts
butter.

Contd
If the stone is composed of uric acid, the
client should follow a low purines diet,
which involve limiting such as cheeses,
wine, bony fish and organs meats.
Administer medication
For hypercalciuric clients thiazide diuretics
such as hydrochlorothiazide.
For low urine citrate level potassium and
sodium citrate should be provided.
Calcium oxalate stones may be treated
with vitamin B6(pyridoxine), magnesium
oxide or cholestyramine.

Contd
Uric acid stones are treated with drugs to
lower uric acid concentration such as
allopurinol
Surgical management
Endourologic procedure
Lithotripsy
A Laser lithotripsy
B Extracorporeal shock wave lithotripsy
C Percutaneous lithotripsy
Open surgical procedure.
Ureterolithotomy( removal of stone from the
ureter)
Cystolithotomy(bladder calculi)
Pyelolithotomy (renal pelvis)
Nephrolithotomy(renal calyx)
Nephrectomy (partial or complete)
Nursing diagnosis
Acute pain related to irritation and spasm
from stone movement in the urinary tract
Nursing intervention
Assess the location and severity of pain
Provide hot bath and moist heat to the flank
area.
Administer analgesic
Encourage the patient to drink more water.

Contd
Impaired urinary elimination related to
mechanical obstruction of urinary flow.
Nursing intervention
Determines the clients previous pattern of
elimination and compare with the current
situation.
Maintain intake and output chart.
Encourage the patient to drink more water.
Administer medication.
Contd
Risk for deficient fluid volume related to
nausea and vomiting.
Nursing interventions
Weigh the client and compare with recent
weigh history
Assess skin turgor
Encourage oral intake
Monitor intake and output balance.
Contd
Risk for infection related to stasis of urine
Nursing interventions
Observe sign and symptoms of infection.
Administer medication
Contd
Deficient knowledge regarding condition
,prognosis and treatment
Nursing interventions
Assess the knowledge
Explain about the causes of the disease
Educate the patient about the treatment
and self care
Bibliography

Suddarths & Brunner; Text book of
Medical Surgical Nursing; 10
th
Edition;
Published by Lippincott; Page no 1337 to
1341
Black M Joycee; Textbook of Medical
Surgical Nursing; Published by Elssevier;1
st

Edition; Page no 748 to 756.

Thank You