UNIT NINE
700
Understanding the Urinary System
Table 37.3 Renal Calculi Summary
high in fructose, oxalate, animal protein, vitamin C, sodium, and sucrose. Specific causes and ways to prevent stones are determined through analysis of the passed stone. Stones are more common in men than in women. After having one stone, risk of recurrence increases Signs and Symptoms Table 37.3 summarizes renal calculi and its signs and symp- toms. Stones can pass asymptomatically, but pain usually occurs when the stone moves. The most common signs and symptoms are mild to severe pain that occurs in waves (renal colic, flank pain) and hematuria.
Signs and Symptoms
Nephrolithiasis: Costovertebral angle pain Hematuria Ureterolithiasis: Severe, colicky (wavelike) pain from obstructed urine flow Flank, side, or lower abdomen pain radiating to genitalia Intense urge to void Frequency, dysuria, reduced output Hematuria due to irritation from stone Nausea/vomiting with severe pain Bladder stones: Hematuria Oliguria with obstruction of bladder outlet Computed tomography (CT) Renal ultrasound Abdominal x-ray Blood tests: Calcium, uric acid, blood urea nitrogen (BUN), creatinine Urinalysis: Hematuria, crystals, urine pH Two 24-hour urine collections Small stones : Hydration, analgesics, alpha blocker (Tamsulosin) Large stones, symptomatic: IV fluids Pain control Thiazide diuretic Allopurinol (Zylorprim) Lithotripsy Surgery: Percutaneous nephrolitho- tomy, ureteroscopy, cystoscopy, cystolitholapaxy
CUE RECOGNITION 37.1 A patient with renal calculus moans and yells when experiencing renal colic. What action do you take? Suggested answers are at the end of the chapter.
Diagnostic Tests
Complications Obstructed urine flow leads to hydroureter and hydrone- phrosis over time. If the obstruction is not relieved, shock and sepsis can occur. Damage from the pressure can occur, causing CKD. Prevention Adequate hydration (2–3 quarts) daily is recommended to prevent concentrated urine. Sweetened beverages and grape- fruit juice should be avoided. The Dietary Approaches to Stop Hypertension (DASH) eating plan and Mediterranean diet are recommended. For dietary guidelines, see “Nutrition Notes.” Encourage the patient to walk, which promotes the excretion of stones and reduces bone calcium resorption (release). Urocit-K (potassium citrate), which restores chem- icals in the urine that prevent crystals from forming to prevent calcium oxalate and uric acid stones, might be prescribed. Nutrition Notes Calcium oxalate stones. To prevent oxalate stones, limit sodium and animal protein, and consume adequate calcium to bind with oxalate. If a low-oxalate diet is pre- scribed, many foods may be restricted, including beets, chocolate, spinach, rhubarb, nuts, peanuts, and sweet potatoes. Calcium phosphate stones. Reducing dietary sodium and animal protein, avoiding cola beverages, and getting adequate calcium help prevent these stones. Uric acid stones. Renal calculi can be a complication of gout, which is a disorder of purine metabolism. Limit high- purine foods such as organ meats, anchovies, herring, sardines, alcoholic beverages, and gravy. Increasing fruits and vegetables may reduce uric acid stone formation.
Therapeutic Measures
Complications
UTI Hydroureter Hydronephrosis
Shock Sepsis Chronic kidney disease Acute Pain Risk for Infection Deficient Knowledge
Priority Nursing Diagnoses
Diagnostic Tests Blood tests (i.e. BUN, creatinine) assess renal function and urinalysis assesses for hematuria and infection. Imaging tests for renal stones and hydronephrosis include noncontrast
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