Renalcalculippt
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This document discusses renal calculi (kidney stones). It begins by listing learning objectives about the renal system, renal calculi, types of stones, clinical manifestations, diagnosis, medical and surgical management, and nursing management. It defines renal calculi as stones formed from crystallization of substances excreted in urine. Risk factors include slow urine flow and decreased inhibitors. Types of stones include calcium, uric acid, cystine, and struvite. Diagnosis involves urinalysis, urine culture, cystoscopy, ultrasound and x-rays. Treatment involves medications, hydration, diet changes, and sometimes surgery. Nursing focuses on pain management, education, and preventing infections.
Renalcalculippt
- 1. HE L LO
- 2. LEARNING OBJECTIVES • review the anatomy and physiology of the renal system • interpret the term renal calculi • describe the etiology of renal calculi • discuss the pathogenesis involved in the disease process • list the types of renal calculi
- 3. LEARNING OBJECTIVES • examine the clinical manifestations closely • differentiate the various diagnostic measures • explain the medical management • Identify the surgical management of renal calculi • distinguish the nursing management for renal calculi including the nursing diagnosis
- 6. DEFINITION • Nephrolithiasis refers to renal stone disease; urolithiasis refers to the presence of stones in the urinary system. Stones, or calculi, are formed in the urinary tract from the kidney to bladder by the crystallization of substances excreted in the urine •
- 7. ETIOLOGY
- 8. ETIOLOGY
- 9. RISK FACTORS
- 10. RISK FACTORS
- 11. PATHOPHYSIOLOGY • Slow urineflow,resulting in supersaturation of the urinewith the particular element that first become crystallized and later becomestone
- 12. PATHOPHYSIOLOGY • Damageto the lining of the urinarytract
- 13. PATHOPHYSIOLOGY • Decreased inhibitorsubstances in the urinethat wouldotherwise prevent supersaturation and crystalline aggregation
- 14. TYPES OF STONES • Calcium Phosphate • Calcium oxalate • Uric acid • Cystine • Struvite
- 15. CLINICAL MANIFESTSTIONS • Severe abdominal or flank pain • Frequency and dysuria • Oliguria and anuria in obstruction
- 16. CLINICAL MANIFESTSTIONS • Hematuria • Renal colic • Nausea • hydronephrosi s
- 23. MANAGEMENT
- 24. MEDICAL • DRUG THERAPY Opioid agents NSAIDS Spasmolytic agents
- 25. COMPLIMENTARY THERAPY •Hypnosis, imagery, therapeutic or healing touch, acupuncture and breathing techniques •Positioning the client to comfortable position aids in pain reduction
- 26. OTHER TECHNIQUES • Avoiding over hydration and under hydration • Strain the urine • Send any strained stone to laboratory to aid in preventive treatment in the future
- 27. SPECIFIC APPROACHES URINARY STONE CHARACTERIST ICS PREDISPOSING FACTORS THERAPEUTIC MEASURES Calcium oxalate 35-40 Small often possible to get trapped in ureter ,mor e frequent in men Idiopathic hypercalciuria hyperoxaluria ,I ndependent of urinary pH ,family history Increase hydration Reduce dietary oxalate Give thiazide diuretics cellulose phosphate,(chelate calcium and prevent GI absorption), potassium citrate(alkaline urine), cholestyramine(bind oxalate), calcium lactate(precipitate oxalate in GI tract) Reduce daily sodium intake
- 28. SPECIFIC APPROACHES URINARY STONE CHARACTE RISTICS PREDISPOSING FACTORS THERAPEUTIC MEASURES Calcium phosphate 8-10% Mixed stones with struvite or oxalate stones Alkaline urine, primary hyperthyroidism Treat underlying cause and other stones
- 29. SPECIFIC APPROACHES URINARY STONE CHARACTERIS TICS PREDISPOSING FACTORS THERAPEUTIC MEASURES Struvite 10-15 % 3 to 4 times common in women ≥ men,always in association with urinary tract infection urinary tract infections Antimicrobial agents acetohydroxamic acid Surgical interventions Measures to acidify urine
- 30. SPECIFIC APPROACHES URINARY STONE CHARACTERIS TICS PREDISPOSING FACTORS THERAPEUTIC MEASURES Uric acid 5-8 % Predomin ant in men high incidence in jewish men Gout, acid urine ,inherit ed conditions Reduce urinary concentration of uric acid Alkanize urine with potassium citrate Administer allopurinol Reduce dietary purines
- 31. 31 SPECIFIC APPROACHES URINARY STONE CHARACTERISTICS PREDISPOSING FACTORS THERAPEUTIC MEASURES Cystine 1-2 % Genetic autosomal recessive defect,defective absorption of gi cystine from gi tract and kidney excess concentrations causing stone formation Acid urine Increase hydration Give α pencillamine and tiopronin to prevent cystine crystallization Potassium citrate to alkaline urine
- 39. NURSING DIAGNOSIS • Acute pain related to irritation and spasm from stone movement in the urinary tract as manifested by complaints of pain, facial grimacing, restlessness
- 40. • Anxiety related to uncertain outcome and lack of knowledge regarding possible surgery as manifested by expressions NURSING DIAGNOSIS
- 41. • Ineffective therapeutic regimen management related to lack of knowledge as manifested by repeated questions NURSING DIAGNOSIS
- 42. • Impaired urinary elimination related to trauma or blockage of ureters or urethra as manifested by decreased urinary output and bloody urine NURSING DIAGNOSIS
- 43. • Risk for infection related to introduction of bacteria following manipulations of the urinary tract and obstructed urinary blood flow NURSING DIAGNOSIS
- 44. PREVENTION • Avoid proteinintake; usuallyproteinis restrictedto 60g/day to decrease urinary excretionof calciumand uric acid. • A sodium intakeof 3 to 4 g/day is recommended. Table salt andhigh-sodium foods shouldbe reduced, because sodiumcompetes withcalciumfor reabsorptionin the kidneys.
- 45. • Low-calcium diets are not generallyrecommended,except for true absorptive hypercalciuria. Evidence shows thatlimiting calcium, especially in women, can lead to osteoporosis and does not prevent renal stones. • Avoid intakeof oxalate-containingfoods (eg, spinach,strawberries, rhubarb, tea, peanuts,wheat bran). PREVENTION
- 46. • During the day, drink fluids(ideallywater) every1 to 2 hours. • Drink two glassesof water atbedtime andan additional glassat each nighttimeawakening to prevent urine from becoming too concentratedduring the night. PREVENTION
- 47. • Avoid activitiesleadingto suddenincreasesin environmental temperatures that may cause excessive sweatingand dehydration. • Contact your primary healthcare provider at the first sign of a urinary tract infection PREVENTION
- 49. QUESTIONS ???
- 50. ? a)Cystic fibrosis b) sjogrens syndrome c) gout d) myasthenia gravis Genetic factor involved in renal calculi formation:
- 51. ? a) nephrolithiasis b) ureterolithiasis c ) cystolithiasis d ) cholelithiasis Stone in the kidney is called as
- 52. ? a)Allopurinol b)thiazide diuretic c)pencillamine d)potassium citrate Uric acid stones can be reduced or prevented by the use of:
- 53. ? a)Morphine b) ketorolac c)propanthelene d)tramadol hydrochloride Preferred opioid agent used in renal calculi pain manageme nt initially is:
- 54. REFERENCES • Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al., editors. Harrison’s principles of internal medicine. 17th ed. New York: McGraw Hill; 2008
- 55. • Johnson J.Y.Brunner anD Suddharth`s:Textbook of Medical Surgical Nursing. 11th edn. Philadelphia:Lippincott;2008. REFERENCES
- 56. • Black M.J, Hawks H.K. Medical Surgical Nursing. 7th edn. Missouri: Saunders;2005 REFERENCES
- 57. • Taal M.W,Cherton G,Marsden P.A. Brenner and Rector`s: The Kidney. 9th edn.Philadelphia: Elsevier;2012 REFERENCES
- 58. • Walsh C.Urology. 10th edn. Philadelphia: Elsevier;2012 REFERENCES
- 59. • Nettina S M, Mills E.J.Lippincott Manual of Nursing Practice. 8th edn.Philadelphia :Lippincott Williams & Wilkins; 2006 REFERENCES