VI. Nursing Diagnosis
• Pain related to inflammation, obstruction, and abrasion of the urinary tract
• Deficient knowledge regarding prevention of recurrence of renal stones
• Ineffective coping related to anxiety, lower activity level and the inability to perform normal activities of daily living
• Impaired urinary elimination related to renal calculi
• Risk for infection
VII. Nursing Management
Provide comfort measures.
• Encourage bed rest.
• Teach relaxation techniques.
• Provide hot baths or moist heat to the flank areas
Prepare the client who cannot pas the calculus spontaneously for one of the following nonsurgical procedures:
• Extracorpeal shock wave lithotripsy – which is used to break up calculi so that the client can pass the particles during urination.
• Ureteroscopy – which involves insertion of instruments through a cystoscope to visualize and access the calculus and then remove or fragment it with laser energy or ultrasound.
• Stone dissolution – which involves infusion of chemolytic solutions (i.e. alkylating ore acidifying agents) through a percutaneous nephrostomy tube. This procedure is used for clients who are poor risks for other treatments.
Prepare the client for nephrolithotomy (incision into the kidney for removal of the calculus) if nonsurgical methods fail.
• Monitor for signs and symptoms of dehydration resulting from postobstructive dieresis.
• Intervene as necessary to restore fluid balance.
Inform the client that chemical analysis of the calculus is performed to determine the composition (i.e. calcium oxalate, calcium phosphate). The composition guides further diet therapy.
Institute measures to help prevent calculi recurrence.
Encourage dietary modifications based on the calculi composition.
-Those with calcium calculi should avoid dietary calcium and phosphorus.
-Those with uric calculi should avoid food high in purine, such as shellfish, anchovies, asparagus, and organ meats.
-Those with oxalate calculi should avoid green leafy vegetables, beans, celery, beets, tea and coffee.
Increase fluid intake to 3 to 4 L per day.
Instruct the client to drink fluids in the late evening to prevent stasis of urine in kidneys and bladder.
Promote increased physical activity.
Monitor urine pH.
Administer prescribed medications such as:
-Aluminum hydroxide – which binds with excess phosphorus, causing it to be excreted through the intestinal tract.
-Sodium cellulose phosphate – which helps prevent calcium stones.
-Allopurinol – which reduces serum uric acid levels and urinary uric acid excretion.
Instruct the client to avoid sudden increases in environmental temperatures, which may cause a fall in urinary volume.
Encourage around-the-clock, high-fluid intake if the client is not nauseated or vomiting.