Dehydration

Increased Urine Concentration

Gender Excess intake of:
Age Calcium, Oxalate and Proteins
Hyperuricemia (Gout)
Labels according to color: - Expresses
Family History Hyperparathyroidism

Risk Factors
Repeated UTI concern and willing to learn
Dormant lifestyle
about the disease process,
Medical diagnosis
contributing factors, and
Nursing diagnosis management
Nephrolithiasis
Diagnostics
Clinical manifestations
Pharmacology
Expected outcomes
Nursing intervention Urine production must
Readiness for Enhanced
Pathophysiology balance
Knowledge about disease
process,
contributing factors, and
excretion of management
Water
salts with low
conservation
solubility
1. Assess understanding and previous learning. Relating information to previously
learned material enhances retention and understanding.
- Exhibit
Solubility is decreased 2. Teach about all diagnostic and treatment procedures. Knowing what to expect reduces
responsibility for
by multiple factors anxiety, enhances compliance, and hastens recovery.
such as: own learning by
a. Decreased 3. Present all material in a manner appropriate to knowledge base, developmental and
inihibitors such as seeking answers
nephrocalcin educational level, and current needs. Learning is an active process that requires the
to questions.
b. Decreased patient?s participation. Tailoring teaching to the individual increases involvement.
complexing agents - Verify accuracy of
such as citrate 4. Teach measures to prevent further urolithiasis:
c. Increased transit informational
time - Increase fluid intake to 2500 to 3500 mL per day.
resources.
- Follow recommended dietary guidelines.
Dehydration - Verbalize
- Maintain activity level to prevent urinary stasis and bone resorption.
understanding of
- Take medications as prescribed.
information gained.
5. Teach about the relationship between urinary calculi and UTI, emphasizing preventive
- Use information to
Imbalance between these 2 things measures and the importance of prompt treatment. Urinary tract infection promotes
develop individual
urolithiasis and thus requires prompt treatment to reduce this risk.
plan to meet
Leads to supersaturation as amount of substance exceeds healthcare
its solubility needs and goals.

Eventually urine
Crystal nuclei grow
reaches the Physiochemistry on existing surfaces
This metastable upper limit of of urine is now found within the papillary
allows for growth of metastability and can unstable and new ducts or collecting ducts of
performed crystals no longer hold crystals crystal nuclei form in kidney such as:
a. Epithelial cells
still held in solution in solution which the process of b. Urinary casts
results in product nucleation c. Red blood cells
formation

4 major substances
can lead to stone
formation in the Crystals bind
kidneys
each other in the
process of
aggregation

1. Monitor amount and character of urine output.

Calcium oxalate Ammonium 2. If catheterized, measure output hourly. Document any
stones magnesium Uric acid stones Cystine stones hematuria, dysuria, frequency, urgency, and pyuria
phosphate stones 3. Maintain patency and integrity of all catheter systems. Ceftriaxone Retentions can
2gm IV Stone retention be caused by
Secure catheters well, label as indicated, and use sterile
technique for all ordered irrigations or other procedures. allows for further anatomic or
growth functional
abnormalities

- Achieve normal
elimination pattern
Caused by
or participate in - Increased urinary
genetic
measures frequency
radiopaque on x-ray radiopaque on x-ray radiolucent on x-ray defect which
to correct or - Dysuria
prevents
compensate for - Hematuria
reabsorption Stones form within
defects.
of cystine papillae and follow 1 of
- Demonstrate
3 fates
behaviors and
2 subtypes: Caused by chronic Causes include: techniques to
a. Pure calcium urinart tract infections Gout prevent urinary
oxalate with urease splitting High purine diet infection.
b. mixed calcium organisms including: myeloproliferative
oxalate and a. Proteus disease
phosphate b. Kleibsiella tumor lysis syndrome

Pass through the

urinary system without
Impaired Urinary Elimination Obstruction Enter the ureter obstructing or causing
related to obstruction by pain
Pain Scale rated at Staghorn calculi
Leads to the 3/10
Causes include: formation of
RTA
Staghorn
Sarcoid Calculi - Report pain is Clinical manifestation:
Malignancy relieved or Severe pain
Thyrotoxicosis Acute Pain controlled. Hematuria
Low urinary related to - Follow prescribed Blocks outflow of urine
Increased urinary
citrate obstruction pharmacological leading to
Renal X-Ray frequency
Primary by Staghorn regimen hydronephrosis
Increased urinary
Hyperparathyroidism calculi - Verbalize urgency
Idiopathic nonpharmacological
- Flank pain radiating to Dysuria
hypercalcuria methods that
Hyperoxaluria the back
- Dysuria provide relief
- Renal colic

1. Assess pain using a standard pain scale and its

characteristics.
2. Administer analgesia or NSAIDs as ordered and monitor
its effectiveness
3. Unless contraindicated, encourage fluid intake and
Ketorolac 30mg IV PRN ambulation in the patient with renal colic.
Paracetamol 2 tabs 500mg 4. Use nonpharmacologic measures such as positioning,
moist, heat, relaxation techniques, guided imagery, and
diversion as adjunctive therapy for pain relief.