Nursing care plan urolithiasis renal calculi

I. Pathophysiology
a. Presence of stones anywhere in the urinary tract
i. Most commonly found in the renal pelvis and calyces
1. Stones forming in the kidney—nephrolithiasis
2. Stones formed in the ureters—ureterolithiasis
ii. May be single or multiple calculi, ranging in size from a
grain of salt to the size of a pebble or staghorn calculus
b. Composition of calculi
i. Formed of mineral deposits—predominantly calcium
oxalate and calcium phosphate
ii. Uric acid, struvite, and cystine are also calculus formers
II. Etiology
a. Slow urine flow allows accumulation of crystals—damaging
the lining of the urinary tract and decreasing the number of
inhibitor substances that would prevent crystal accumulation
(Winkleman, 2006).
b. May remain asymptomatic until passed into a ureter or
urine flow is obstructed, at which time the potential for
renal damage is acute and the level of pain is at its highest
c. Causes: dehydration; heredity; excessive intake of vitamins
C and D, grapefruit juice, and purines (gout); congenital
renal abnormalities; and some medications, such as
acetazolamide (Diamox) or indinavir (Crixivan)
d. Risk factors: men aged 30 to 50, postmenopausal women;
gender, male-to-female ratio 3:1; heredity; recurrent urinary
tract infections; inflammatory bowel disease; hyperparathyroidism;
hypertension; insulin resistance; prolonged bedrest;
spinal cord injury; geographic location—southeastern United
States; use of antacids or aspirin
III. Statistics (Centers for Disease Control and Prevention
[CDC], 2006)
a. Morbidity: In 2000, there were 2 million doctor visits and
outpatient hospital visits by adults with primary diagnosis
of “calculus of kidney and ureters”; in 2004, there were
171,000 adult hospital admissions with primary diagnosis of
“calculus of kidney and ureters.”
b. Mortality: Rare and related to development of acute renal
failure or comorbidities.
c. Cost: In 2000, $2.07 billion expended for evaluation and
treatment of kidney stones.

Care Setting
Treatment is often handled at the community level or as an
outpatient; acute episodes occasionally require inpatient
treatment on a medical or surgical unit. On occasion, surgery
is necessary to remove the stone(s).

Related Concerns
Fluid and electrolyte imbalances,
Metabolic acidosis—primary base bicarbonate deficiency,
Metabolic alkalosis—primary base bicarbonate excess,
Psychosocial aspects of care,
Renal failure: acute,

Nursing Priorities
1. Alleviate pain.
2. Maintain adequate renal functioning.
3. Prevent complications.
4. Provide information about disease process, prognosis, and
treatment needs.

Discharge Goals
1. Pain relieved or controlled.
2. Fluid and electrolyte balance maintained.
3. Complications prevented or minimized.
4. Disease process, prognosis, and therapeutic regimen
5. Plan in place to meet needs after discharge.

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