Urinary tract Calculi Study Guide by cuiliqing


									                Urinary tract Calculi and Urinary Retention Study Guide
                     RNSG 1341 Common Concepts of Adult Health
   Lewis: calculi pg 1169, diagnostic tests pg 1146-1150, tubes and catheters pg 1187;
   pre and post operative management pg 1188; retention and instrumentation pg 1185-
1. Select the persons at risk for urinary tract calculi.
   a. ___x__ Person who lives in Arizona
   b. _____Resident of Washington State
   c. ___x__50 year old Caucasian male
   d. ___x__Black 45 yo male with family history of calculi.
   e. _____Mexican American female
   f. _____ Recent immigrant from India

2. Name 4 physiological factors that can increase the risk for stone formation.
   a. Urine that is highly concentrated because of dehydration.]
   b. Urine that is highly alkaline increases the precipitation of calcium and phosphate
   c. Urinary stasis-immobility, sedentary life style
   d. urinary tract infection with urea-splitting bacteria

3. List the signs and symptoms of various locations of stones.
   a. Stones that obstruct: UPJ (UreteroPelvic Junction), UVJ (UreteroVesical
       Junction): flank pain (usually severe), hematuria, and renal colic; may have
       nausea and vomiting.
   b. Non obstructing and not moving: no pain
   c. Stone moving down the ureter: intense, colicky pain; may radiate downward—in
       the testicles, labia, or groin
   d. If accompanied by infection may have fever and chills; confusion in the elderly

4. List the patient preparation, nursing measures, and any follow-up care for these
   diagnostic tests.
   a. IVP: cathartic or enema if ordered, NPO 8 hours, assess for iodine sensitivity,
       teach that may have warm sensation, flushed face, and salty taste during injection
       of contrast media; post procedure force fluids to flush out contrast
   b. Urinalysis: mid stream urine collection
   c. Urine culture: thorough cleansing of meatus for midstream cathch or cath
   d. Ultrasound: no preparation; explain procedure
   e. Retrieval and analysis of stones: provide cone for straining urine and teach how to

5. Identify the nurse’s role in managing an acute attack
   a. Pain medication: may need opiods
   b. Adequate fluid; Forcing fluids doesn’t help and may increase colic
   c. Ambulation will help pass stones (less than 4 mm)
   d. Strain all urine
6. Identify treatment for the 5 types of stones.
   a. Calcium oxalate: increase hydration; may need to reduce dietary oxalate (dark
      roughage, spinach, rhubarb, asparagus, cabbage, tomatoes, beets, nuts, celery,
      parsley, runner beans, chocolate, cocoa, instant coffee, Ovaltine, tea,
      Worchestershire sauce); thiazide diuretics; cellulose phosphate to chelate calcium
      and prevent GI absorption, potassium citrate to maintain alkaline urine;
      cholestramine to bind oxalate; calcium lactate to precipitate oxalate in GI tract;
      reduce sodium intake (reduces the calcium excretion); diet changes are usually
      make only for recurrent stones.
   b. Calcium phosphate: usually in mixed stones which may dictate treatment; treat
      hyperparathyroidism if present; reduce alkalinity of urine
   c. Struvite: more likely in women secondary to infection; measures to prevent and
      treat infection. Hydration is important. Large staghorn stones may require surgery
   d. Uric acid: cause is high uric acid from breakdown of purines in diet; Allopurinal
      reduce uric acid. If dietary management is necessary: reduce sardines, herring,
      mussels, liver, kidney, goose, venison, meat soups, sweetbreads are the highest.
   e. Calcium restrictions are not usual; may actually lower the risk by reducing the
      urinary excretion of oxalate

7. List the indications for endourologic, lithotripsy, or open surgical stone removal.
   a. Too large for spontaneous passage
   b. Associated with bacteriuria or symptomatic infection
   c. Impaired renal function
   d. Persistent pain, nausea, or ileus
   e. Inability of patient to be treated medically
   f. Only one kidney

8. List possible complications from stones.
   a. Obstruction
   b. hydronephrosis
   c. renal failure
   d. infection

9. Describe the nursing care for a patient having
   a. Cystoscopy-instrument passed through urethra into bladder; observe for
      hematuria, cystitis, patency of catheter
   b. Ureteroscopy- instrument passed through urethra into bladder into ureter; may
      leave a stent in place to maintain patency until edema has subsided; observe for
      patency; record drainage from foley and stent separately; measure output q2h
   c. Percutaneous nephrolithotomy-skin into renal pelvis; stones are crushed and
      irrigated out; percutaneous nephrostomy tube left in place to preserve renal
      function until the edema has subsided. May need to be irrigated with 5 ml of
      saline to prevent overdistention of pelvis and renal damage; observe for
      obstruction of tube; measure output and character of drainage
    d. Lithotripsy—ESWL (extracorporal shock-wave lithotripsy); outpatient procedure;
        done under anesthesia (routine post anesthesia care); observe urine for bleeding;
        pain may be moderate to severe; administer antibiotics and teach about use of
        ongoing antibiotics for 2 weeks teach to monitor for sepsis, hemorrhage, and
        abscess formation; may have a stent for 1-2 weeks—teach management of stent
    e. Open surgical procedures (small number of patients); in addition to post
        anesthesia care, nursing care is aimed at observation of urine, adequate fluid
        intake; maintaining patency of tubes; monitor for bleeding and infection, and pain
        management; teaching ongoing care and prevention of recurrence
        i) Nephrolithotomy-incision in the parenchyma of the kidney
        ii) Pyelolithotomy-incision into the renal pelvis
        iii) Ureterolithotomy-incision into the ureter
        iv) Cystotomy-incision into the bladder
10. List possible causes of urinary retention
    a. Edema-may be from surgery or trauma
    b. Any Bladder or urethral outlet obstruction
    c. Stricture of urethra
    d. Enlarged prostate
    e. Pelvic organ prolapse
    f. Underactive deltrusor muscle
    g. Anticholinergic drugs such as some used in surgery
    h. Neurogenic bladder (flaccid type)
Some general questions
11. Why is urinary retention an emergency?
    a. A full bladder can overcome the vesicoureteral junction and increase pressure on
        the kidney resulting in renal damage
12. Why is it critical to keep a nephrostomy tube open?
    a. It probably has been placed because of an obstruction to flow of urine; the renal
        pelvis is very small and any fluid build up can cause renal damage
13. List ways to help a person with urinary retention void.
    a. Runnig water
    b. Sit in a tub of warm water
    c. Sitz bath
    d. Coffee or tea may stimulate the urge
    e. Avoid being chilled before trying to urinate
    f. Scheduled toileting
    g. Double voiding
    h. Self catheterization

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