Kidney stones, medically known as renal calculi or urolithiasis, are hard masses that develop from crystallized minerals and salts within the kidneys. These stones can cause significant pain and complications as they travel through the urinary tract. Understanding the different types of kidney stones is crucial for effective nursing care and patient management. The main types include:
- Calcium oxalate stones: Often linked to hypercalciuria, a condition with excessive calcium in the urine.
- Struvite stones: These are typically associated with urinary tract infections (UTIs).
- Uric acid stones: Form when urine is persistently acidic.
- Cystine stones: A less common type resulting from cystinuria, a genetic disorder causing the kidneys to excrete too much of certain amino acids.
This article provides a detailed overview of the nursing process for patients with kidney stones, focusing on nursing assessment, interventions, and care plans to effectively manage this condition and prevent recurrence.
Nursing Process
The cornerstone of effective care for patients with kidney stones lies in a thorough nursing process. This involves a systematic approach to patient care, encompassing assessment, diagnosis, planning, implementation, and evaluation. For kidney stones, nursing care is primarily aimed at pain relief, preventing potential complications, and ensuring the maintenance of adequate renal function. Patient education is paramount, particularly in preventing the recurrence of kidney stones. Patients need to be well-informed about treatment options, necessary dietary adjustments, the importance of 24-hour urine testing, and what to expect during surgical recovery if needed.
Nursing Assessment
The initial phase of the nursing process is assessment, where the nurse gathers comprehensive data about the patient. This includes physical, psychosocial, emotional, and diagnostic information. In the context of kidney stones, this involves collecting both subjective and objective data to gain a holistic understanding of the patient’s condition.
Review of Health History
1. Identify General Symptoms.
Kidney stones manifest through a range of symptoms, primarily related to pain and urinary changes. Key symptoms to assess include:
- Severe, Sharp Pain: Typically located in the side and flank area, often described as renal colic.
- Radiating Pain: Pain may extend to the lower abdomen and groin as the stone moves.
- Wave-like Pain: Characterized by pain that comes in waves due to ureteral spasms.
- Dysuria: Painful urination.
- Hematuria: Urine that appears brown, pink, or red due to the presence of blood.
- Cloudy Urine: Indicates potential infection or increased concentration of urine.
- Foul-smelling Urine: Another sign of possible urinary tract infection.
- Frequent Urination: Urge to urinate more often than usual.
- Nausea and Vomiting: Common due to severe pain and the body’s stress response.
- Fever and Chills: Suggestive of infection, particularly if associated with struvite stones or complications.
2. Determine Risk Factors.
Understanding the patient’s risk factors is crucial for identifying potential causes and guiding preventive strategies. Common risk factors for kidney stone formation include:
- Excess Body Weight: Obesity is linked to increased risk due to metabolic and dietary factors.
- Dietary Habits: A diet high in oxalates, sodium, or protein can increase stone formation risk.
- Certain Supplements and Medications: Some supplements (like excessive vitamin C) and medications can contribute to stone development.
- Dehydration: Insufficient fluid intake leads to concentrated urine, facilitating stone formation.
- Gastric Bypass Surgery or Inflammatory Bowel Disease: These conditions can alter nutrient absorption and increase stone risk.
- Medical Conditions Affecting the Urinary System: Conditions like hyperparathyroidism, renal tubular acidosis, and cystinuria predispose individuals to kidney stones.
3. Review Medications.
Certain medications can increase the likelihood of developing kidney stones. It’s important to review the patient’s current medication list, paying attention to:
- Diuretics: Can alter urine composition and concentration.
- Calcium-based Antacids: May increase calcium levels in the urine.
- Antiviral Medications: Some antivirals can contribute to crystal formation in the kidneys.
- Antiseizure Drugs: Certain antiseizure medications can affect kidney function and stone risk.
- Antibiotics: Some antibiotics, particularly sulfonamides, have been linked to stone formation.
4. Inquire About Urination Experience and Urine Output.
Changes in urination patterns and urine characteristics are significant indicators. Nurses should ask about:
- Hematuria: Visible blood in the urine.
- Pain During Urination: Dysuria, indicating irritation or obstruction in the urinary tract.
- Urinary Retention: Inability to empty the bladder, which could be caused by a stone obstructing the urethra or bladder neck.
- Inability to Pass Stone: If the patient is aware of trying to pass a stone, assess their progress and any associated symptoms.
It’s crucial to recognize that obvious hematuria, unremitting pain, urinary retention, and the inability to pass a stone are critical indicators requiring immediate medical intervention.
5. Monitor Pain Frequency and Intensity.
Pain associated with renal calculi is often severe and requires careful monitoring. Key aspects of pain assessment include:
- Location of Pain: Typically starts in the flank area and may shift as the stone moves.
- Pain Characteristics: Often described as sudden, sharp, and colicky, originating in the flank and radiating downwards.
- Pain Intensity: Use a pain scale (e.g., 0-10 numeric scale) to quantify pain levels regularly.
- Pain Triggers and Relieving Factors: Identify what exacerbates or alleviates the pain.
Physical Assessment
1. Abdominal Assessment.
In contrast to acute abdominal conditions, an abdominal assessment for kidney stones is often unremarkable in terms of classic abdominal signs. This differentiation is important to rule out other abdominal diagnoses. However, note any mild distention or tenderness.
2. Observe for Signs of Infection.
Infection is a potential complication of kidney stones, particularly if they cause urinary obstruction. Assess for:
- Fever and Chills: Systemic signs of infection.
- Urosepsis: Be vigilant for signs of systemic infection spreading from the urinary tract, which can include altered mental status, rapid heart rate, and low blood pressure.
3. Monitor Fluid Intake and Output (I&O).
Accurate monitoring of fluid balance is crucial. This involves:
- Intake Assessment: Document all oral and intravenous fluids.
- Output Measurement: Measure urine output with each void, noting the amount, color, and clarity.
- Voiding Difficulty: Assess for any difficulty or changes in voiding patterns.
- Fluid Balance: Evaluate for signs of dehydration or fluid overload.
The size and position of kidney stones can lead to urinary obstruction, which can result in infection, kidney damage, or urinary injury. Close monitoring is essential.
4. Observe Physical Cues of Pain Intensity.
Patients experiencing renal colic often exhibit significant physical manifestations of pain. Observe for:
- Restlessness and Agitation: Inability to find a comfortable position.
- Writhing in Pain: Physical contortions and movements in response to severe pain.
- Pacing: Restless walking in an attempt to alleviate discomfort.
- Facial Expressions of Pain: Grimacing, furrowed brow, or other facial cues indicating distress.
Diagnostic Procedures
1. Urine Sample Examination.
Urinalysis is a fundamental diagnostic tool. Examining a urine sample helps in:
- Identifying Hematuria: Presence of blood in the urine.
- Detecting Leukocytes: Indicates possible infection.
- Identifying Crystals: May provide clues about the type of stone.
- Detecting Bacteria: Confirms urinary tract infection.
- Microscopy: Microscopic examination can further identify crystals, cells, and bacteria.
2. Serum Blood Tests.
Blood tests are essential to evaluate kidney function and detect systemic issues. Key blood tests include:
- Complete Blood Count (CBC) with Differential: To assess for infection (elevated white blood cell count) and overall health.
- Blood Urea Nitrogen (BUN) and Creatinine: To evaluate kidney function. Elevated levels may indicate kidney impairment due to obstruction or other complications.
- Serum Electrolyte Levels: To check for imbalances, especially if nausea and vomiting are present.
- Parathyroid Hormone (PTH): If hypercalcemia is suspected as a cause of calcium stones.
3. Imaging Scans.
Various imaging techniques are used to visualize kidney stones and assess their size and location:
- Plain Radiography (KUB – Kidneys, Ureters, Bladder): Useful for detecting radio-opaque stones, assessing size, shape, and location.
- Computerized Tomography (CT) Scan: Non-contrast CT is the gold standard for detecting kidney stones, as it is highly accurate in identifying even small, non-radio-opaque stones. It is also effective in detecting obstruction and hydronephrosis.
- Ultrasound: Often used for pregnant patients and children to avoid radiation exposure. However, it may not detect smaller stones as effectively as CT.
Note: When kidney stones are suspected, contrast medium is generally avoided in initial imaging as it can obscure the stones and complicate diagnosis.
4. Passed Stone Analysis.
If the patient passes a kidney stone, it is crucial to collect it for lab analysis. Stone analysis reveals the chemical composition of the stone, which is vital for:
- Determining Stone Type: Identifying whether it’s calcium oxalate, uric acid, struvite, or cystine.
- Guiding Preventive Strategies: Tailoring dietary and medication recommendations to prevent future stone formation based on the stone composition.
Alt text: Different types of kidney stones including calcium oxalate, struvite, uric acid, and cystine, and their respective causes.
Nursing Interventions
Nursing interventions are crucial in managing patients with kidney stones, focusing on symptom relief, facilitating stone passage, and preventing recurrence.
Relieve Symptoms and Promote Stone Passage
1. Kidney Stone Removal Strategies.
Treatment strategies depend largely on the size and location of the kidney stone.
- Spontaneous Passage: Small kidney stones may pass through the urinary tract without medical intervention, typically with increased fluid intake and pain management.
- Urgent or Surgical Intervention: Larger stones or those causing obstruction, severe pain, or infection may require more aggressive treatments, potentially including surgical procedures.
2. Administer Antibiotics.
If a urinary tract infection is diagnosed concurrently with kidney stones, antibiotic therapy is essential to treat the infection and prevent complications like urosepsis.
3. Pain Relief Management.
Renal colic is known for causing excruciating pain. Effective pain management is a priority.
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Often used for mild to moderate pain relief.
- Narcotic Analgesics (Opioids): May be necessary for severe pain that is not adequately controlled by NSAIDs.
4. Treat Nausea and Vomiting.
Nausea and vomiting are common symptoms, affecting up to 50% of patients with kidney stones. Untreated, they can lead to dehydration and electrolyte imbalances.
- Antiemetics: Medications to relieve nausea and vomiting are often prescribed.
5. Promote Kidney Stone Passage with Medications.
Certain medications can aid in the spontaneous passage of kidney stones.
- Alpha-blockers: These medications relax the smooth muscles in the ureter, facilitating stone passage. Tamsulosin is a commonly used alpha-blocker.
- Combination Therapy: Combining an alpha-blocker with an analgesic like ibuprofen can improve stone passage rates while managing pain and potentially reducing the need for surgical intervention.
6. Strain Urine.
Instruct the patient on the importance of straining their urine using a urine strainer (hat) in the toilet. This allows for the collection of any passed stones for subsequent analysis.
7. Anticipate Extensive Treatment for Large Stones.
Stones larger than 8mm are less likely to pass spontaneously and may require more invasive treatments. These interventions include:
- Extracorporeal Shock Wave Lithotripsy (ESWL): Uses shock waves to break the stone into smaller fragments that can be passed more easily.
- Percutaneous Nephrolithotomy: A surgical procedure to remove large stones directly from the kidney through a small incision in the back.
- Stent Placement: A ureteral stent may be placed to relieve obstruction and facilitate urine flow, often used before or after stone removal procedures.
- Ureteroscopy: A minimally invasive procedure using a small scope inserted through the urethra to locate and remove or break up stones in the ureter or kidney.
Alt text: Various kidney stone removal procedures including ESWL, percutaneous nephrolithotomy, stent placement, and ureteroscopy.
Prevent Kidney Stone Recurrence
Preventing the recurrence of kidney stones is a critical aspect of long-term patient care.
1. Encourage Increased Fluid Intake.
Hydration is the most essential intervention to prevent future stone formation.
- Fluid Goal: Patients should aim to consume enough fluids to produce at least 2.5 liters of urine per day.
- Fluid Types: Water is the best choice, but other clear fluids are also beneficial. Advise limiting sugary drinks and excessive caffeine.
2. Medication Recommendations.
For patients with recurrent kidney stones, medications may be prescribed to regulate urine composition. Specific medications depend on the type of stone:
- Calcium Oxalate Stones: Thiazide diuretics can reduce calcium excretion in the urine.
- Uric Acid Stones: Allopurinol reduces uric acid production, and alkalizing agents (like potassium citrate) increase urine pH.
- Struvite Stones: Acetohydroxamic acid can help prevent struvite stone formation by inhibiting bacterial urease.
- Cystine Stones: Tiopronin or penicillamine can reduce cystine levels in the urine, but these are less commonly used due to side effects.
3. Achieve and Maintain Desired Weight.
Obesity is a significant risk factor for kidney stones. Advise patients on:
- Weight Management: Encourage weight loss through diet and exercise if the patient is overweight or obese.
- Avoid Certain Weight-Loss Medications: Orlistat (increases oxalate stone risk) and topiramate (increases urine pH and decreases urinary citrate) should be avoided in patients prone to kidney stones.
4. Educate on 24-Hour Urine Study.
For patients with recurrent stones, a 24-hour urine study is valuable to identify specific metabolic abnormalities contributing to stone formation.
- Procedure Explanation: Instruct patients on how to properly collect urine over a 24-hour period for lab analysis.
- Purpose: The study assesses urine volume, pH, calcium, oxalate, uric acid, citrate, sodium, and phosphate levels to guide tailored preventive strategies.
5. Dietary Modifications.
Diet plays a crucial role in kidney stone prevention. Key dietary recommendations include:
- Limit Sodium Intake: High sodium intake increases calcium excretion in the urine, raising stone risk.
- Moderate Protein Intake: Excessive animal protein can increase uric acid levels and urine acidity, promoting uric acid and calcium oxalate stones.
- Uric Acid Stone Prevention: For uric acid stones, reduce intake of purine-rich foods such as red meat, shellfish, organ meats, alcohol, and high-fructose corn syrup.
6. Calcium Intake Considerations.
Contrary to common misconceptions, calcium restriction is generally not recommended and can be counterproductive.
- Adequate Calcium Intake: Encourage normal calcium intake as dietary calcium binds to oxalate in the gut, reducing oxalate absorption and the risk of calcium oxalate stones.
- Combine Calcium-rich and Oxalate-rich Foods: Advise patients to consume oxalate-rich foods (e.g., spinach, chocolate, nuts, rhubarb) with calcium-rich foods (e.g., milk, yogurt, cheese) to facilitate oxalate binding in the digestive tract.
Nursing Care Plans
Once nursing diagnoses are identified, nursing care plans are developed to prioritize care and guide interventions towards achieving short-term and long-term patient goals. Here are examples of nursing care plans for common nursing diagnoses related to kidney stones.
Acute Pain
Urolithiasis is characterized by severe pain, making pain control a primary nursing priority.
Nursing Diagnosis: Acute Pain
Related to:
- Kidney stones
- Spasms of the ureter
- Inflammation within the kidney and urinary tract
- Urinary system obstruction
- Decreased oxygenated blood supply to the kidney tissues
- Trauma to ureter tissue
As evidenced by:
- Reports of colicky pain
- Complaint of sharp and severe pain in the side or back (flank), radiating to the groin and lower abdomen
- Dysuria
- Distraction behaviors (e.g., pacing, restlessness)
- Guarding behavior of the affected area
- Positioning to ease pain
- Facial grimacing and expressions of distress
Expected Outcomes:
- Patient will report a reduction in pain or pain relief using a numeric pain scale within a specified timeframe.
- Patient will appear relaxed, with reduced facial grimacing and absence of crying or restlessness.
- Patient will verbalize absence of pain and burning sensation during urination.
Assessment:
1. Describe Pain Characteristics.
Rationale: Kidney stone pain is typically acute and severe. Renal colic is characterized by severe, constant pain punctuated by waves of excruciating pain, lasting hours with fluctuations and mild relief periods.
2. Pain Rating.
Rationale: A numerical pain rating scale (0-10) provides a subjective measure of pain intensity. Most patients with kidney stones experience moderate to severe pain (4-10).
3. Costovertebral Angle (CVA) Tenderness.
Rationale: CVA tenderness, pain upon percussion in the area of the 12th rib and spine, is indicative of kidney pathology, including urolithiasis or kidney infection.
Interventions:
1. Promote Pain Relief Measures.
Rationale: Kidney stone pain is intense and often necessitates pharmacological interventions for effective relief, including NSAIDs or opioid analgesics as prescribed.
2. Administer Over-the-Counter (OTC) Pain Relievers.
Rationale: For milder pain, healthcare providers may recommend OTC NSAIDs like ibuprofen or naproxen sodium, especially in outpatient settings.
3. Treat Underlying Cause.
Rationale: Identifying and addressing the root cause of stone formation (infection, obstruction, dietary factors, etc.) is crucial for effective treatment and prevention of recurrence.
4. Facilitate Stone Passage.
Rationale: Alpha-blockers and calcium channel blockers may be prescribed to relax ureteral muscles, aiding in easier passage of kidney stones.
Deficient Knowledge
Lack of information and misconceptions about kidney stones can hinder effective management and prevention.
Nursing Diagnosis: Deficient Knowledge
Related to:
- Misinformation regarding kidney stones and their management
- Unfamiliarity with kidney stones as a health condition
- Limited access to reliable resources and information
- Inadequate commitment to learning about kidney stone management
- Misconceptions about preventing kidney stones
- Insufficient participation in care planning and educational sessions
As evidenced by:
- Frequent inquiries about kidney stones, their causes, and management strategies
- Inaccurate follow-through of recommended instructions or treatment plans
- Expressing inaccurate statements or beliefs about kidney stones
- Nonadherence to prescribed treatment regimens
- Development of recurrent kidney stones despite prior episodes
Expected Outcomes:
- Patient will verbalize at least two effective strategies to prevent kidney stone recurrence by discharge.
- Patient will adhere to recommended dietary modifications and fluid intake guidelines to prevent kidney stones.
- Patient will accurately identify signs and symptoms of kidney stones and understand when to seek timely medical treatment.
Assessment:
1. Dietary Review.
Rationale: Diets high in protein, oxalates, sodium, and purines, and low in fluids contribute to stone formation. Assessing dietary habits helps identify modifiable risk factors.
2. Medication Review.
Rationale: Certain medications (antacids, diuretics, vitamin C supplements, some antibiotics) increase kidney stone risk. Identifying these helps in risk assessment and patient counseling.
3. Analysis of Passed Stones.
Rationale: Laboratory analysis of stone composition identifies the type of stone, guiding tailored interventions and preventive strategies.
Interventions:
1. Recognize Dehydration Signs and Increase Fluid Intake.
Rationale: Educate patients to recognize signs of dehydration (headache, dry mouth, increased heart rate, fatigue) as indicators to increase fluid intake. Urine color should be straw-colored, not dark amber, as a hydration guide.
2. Post-Surgical Expectations.
Rationale: Inform patients undergoing lithotripsy or surgery that post-procedure urine may be pink or contain small clots. Stone fragments will pass over days to weeks. Provide clear instructions on when to seek medical attention (fever, chills, heavy bleeding, inability to urinate).
3. Dietitian Referral.
Rationale: A dietitian can provide specialized dietary counseling to create a kidney stone-preventive diet plan.
- *High Oxalates:* Advise avoidance for calcium oxalate stone formers (rhubarb, spinach, soy products, beets, okra, sweet potatoes, almonds, tea, chocolate).
- *High Sodium:* Explain the link between high sodium intake, increased urinary calcium excretion, and stone formation.
- *Adequate Calcium:* Reassure patients that adequate calcium intake is needed for bone health and can reduce oxalate absorption in the gut.
- *High Purines:* For uric acid stone formers, advise limiting high-purine foods (alcohol, soda, sardines, mussels, scallops, bacon, organ meats).4. When to Seek Medical Attention.
Rationale: Educate patients on critical symptoms requiring urgent medical care to prevent complications: uncontrolled pain, severe nausea/vomiting, fever/chills, complete urinary blockage.
Imbalanced Nutrition: Less Than Body Requirements
Dietary factors significantly influence kidney stone formation, particularly sodium, oxalate, and purine intake.
Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements
Related to:
- Inadequate water intake leading to concentrated urine
- Insufficient knowledge of optimal nutrient requirements for kidney stone prevention
- High dietary intake of proteins, especially animal proteins
- Excessive salt intake contributing to increased urinary calcium excretion
- Low dietary calcium intake (can indirectly increase oxalate absorption)
- High oxalate intake from certain foods
As evidenced by:
- Recurrent kidney stone formation episodes
- Inappropriate dietary choices that increase stone risk
- Concentrated urine, indicated by dark color and strong odor
- Difficulty urinating, potentially due to stone obstruction
- Hematuria, presence of blood in urine
- Dysuria, painful urination
Expected Outcomes:
- Patient will not experience recurrent kidney stone formation during the follow-up period.
- Patient will identify at least three specific foods or food categories to avoid or limit to prevent kidney stone formation.
Assessment:
1. Dietary Assessment.
Rationale: Understanding current dietary habits, including fluid intake, helps identify necessary modifications to prevent future stones.
2. Laboratory Studies.
Rationale: Microscopic urinalysis can confirm kidney stones and help determine stone type, guiding treatment and dietary adjustments.
3. Hydration Status.
Rationale: Poor hydration contributes to stone formation by reducing urine volume and increasing urine concentration. Assess for signs of dehydration.
Interventions:
1. Increase Fluid Intake.
Rationale: Proper hydration is vital for preventing kidney stones. Recommend at least 2-3 liters of fluid daily.
2. Dietary Modifications Based on Stone Type.
Rationale: Tailor dietary advice to stone type. For calcium oxalate stones, reduce sodium and consume oxalate-rich and calcium-rich foods together. For uric acid stones, reduce purine-rich foods.
3. Dietitian Referral for Nutritional Counseling.
Rationale: For recurrent stones, a dietitian can create a detailed dietary plan to meet nutritional needs while reducing stone risk and preventing malnutrition.
4. Limit or Discontinue Certain Supplements.
Rationale: Calcium supplements may increase calcium oxalate stone risk; excessive vitamin C supplements can increase oxalate production. Advise on appropriate supplement use.
Impaired Urinary Elimination
Kidney stones can obstruct the urinary tract, leading to various urinary elimination issues.
Nursing Diagnosis: Impaired Urinary Elimination
Related to:
- Bladder stimulation due to the presence of calculi in the urinary tract
- Mechanical obstruction of the urinary tract by kidney stones
- Scarring within the urinary tract from previous stones or procedures
- Spasms of the bladder or ureter muscles
- Inflammation of the urinary tract lining
As evidenced by:
- Dysuria (painful urination)
- Nocturia (frequent nighttime urination)
- Frequent voiding (increased urinary frequency)
- Urinary incontinence (involuntary urine leakage)
- Urinary hesitancy (difficulty starting urination)
- Urinary urgency (sudden, compelling urge to urinate)
- Hematuria (blood in urine)
- Urinary retention (inability to empty bladder)
Expected Outcomes:
- Patient will demonstrate urine output within expected normal limits for their age and condition.
- Patient will report urination without difficulty, urgency, or increased frequency.
- Patient will exhibit urine that is clear and yellow, with minimal to no abnormal odor.
Assessment:
1. Urine Characteristics.
Rationale: Urine may be red, pink, or brown (hematuria), cloudy, and foul-smelling, indicating stone presence and potential infection. Hematuria occurs in about 85% of patients.
2. Urinalysis Sample.
Rationale: Urinalysis may show hematuria, and presence of nitrites, leukocytes, and bacteria suggests infection.
3. Kidney, Ureter, and Bladder (KUB) X-ray Report.
Rationale: KUB can detect blockages and measure resistive index, indicating ureteral obstruction. It is useful for visualizing larger stones.
4. CT Scan Results.
Rationale: Non-contrast CT of the abdomen and pelvis is highly sensitive and accurate for detecting kidney stones, blockages, or infections.
Interventions:
1. Promote Adequate Fluid Intake.
Rationale: Hydration increases urine production, flushing out bacteria and aiding stone passage.
2. Allow Spontaneous Passage of Small Stones.
Rationale: Small stones may pass naturally within one to four weeks, depending on size and location.
3. Prepare for Surgical Interventions.
Rationale: Larger stones may require interventions if they do not pass spontaneously:
- *Extracorporeal Shock Wave Lithotripsy (ESWL):* Uses sound waves to break stones.
- *Ureteroscopy:* Surgically removes stones via the urethra.
- *Percutaneous Nephrolithotomy:* Surgically removes large kidney stones through the kidney.4. Encourage Ambulation.
Rationale: Ambulation can promote spontaneous movement and passage of kidney stones.
Ineffective Tissue Perfusion
Untreated kidney stones can lead to complications affecting renal tissue perfusion.
Nursing Diagnosis: Ineffective Tissue Perfusion (Renal)
Related to:
- Disease process (kidney stone formation and presence)
- Urinary tract obstruction caused by stones
- Inflammatory process within the urinary system
- Infection secondary to urinary stasis or obstruction
As evidenced by:
- Severe flank pain indicative of renal colic
- Dysuria, painful urination
- Hematuria, blood in urine
- Urinary retention, inability to void
- Fever and chills, suggesting infection
- Poor urine output, oliguria
- Altered kidney function tests (elevated BUN, creatinine)
Expected Outcomes:
- Patient will maintain adequate renal perfusion, evidenced by normal urinary elimination patterns without retention, pain, or hematuria.
- Patient will exhibit adequate renal perfusion, as evidenced by urine output of at least 0.5mL/kg/hr.
Assessment:
1. Urinary Elimination Patterns and Urine Characteristics.
Rationale: Problems like hematuria, dysuria, and retention indicate potential obstruction and reduced renal perfusion.
2. Diagnostic Studies.
Rationale: Renal CT scans detect obstruction, abscesses, or hydronephrosis, indicating perfusion issues.
3. Kidney Function Tests.
Rationale: BUN, creatinine, and glomerular filtration rate assess kidney function. Urinalysis confirms infection, crystals, hematuria, and protein.
Interventions:
1. Increase Fluid Intake.
Rationale: Hydration facilitates stone passage, prevents obstruction and hypoperfusion, and ensures adequate circulating volume to kidneys.
2. Administer Medications.
Rationale: Alpha-adrenergic blockers relax ureter muscles to aid stone passage. Antibiotics treat infections.
3. Monitor Intake and Output.
Rationale: Urine output below 0.5mL/kg/hr indicates poor kidney function. Measure urine output regularly.
4. Assist with Surgical Stone Removal.
Rationale: ESWL, percutaneous nephrolithotomy, or stent placement may be needed for large stones causing obstruction and impaired renal perfusion.
