MN22104

NURSING
SCIENCES IV NAME MATRIC.NO

ABDUL AFIF ASROF BIN DN18110001

ABDUL GANI

ADIBAH FARHANA BINTI DN18110002

LAMSAH

ASLINA BINTI ABDUL GANI DN18110009

ASMIRA BINTI GAPAR DN18110061

NORSYHKERRA BINTI DN18110048

NAWIR

RENAL CALCULI
 Learning Objective
• Define renal calculi
• Explain the pathophysiology and etiology of renal calculi
• State the clinical manifestations of client with renal calculi
• State the predisposing factors of renal calculi
• Identify the diagnostic investigations for renal calculi
• Describe the treatment and management of renal calculi
(including medication)
• Describe the nursing management of client with renal calculi
• Summary of renal calculi
 Definition : Renal calculi
Urolithiasis :
 A kidney stone is a solid mass made
Formation of
up of tiny crystals.
stones or calculi
 Stones are formed in the urinary tract in urinary tract
when urinary concentration of
substances such as calcium oxalate,
Nephrolithiasis :
calcium phosphate and uric acid Ureterolithiasis :
A condition of
increase. stones formed in Formation of
 Small stone : <4mm (fine grain of the kidney stones in ureter
salt)
 Large stone : 5-10mm (walnut)
Types of renal calculi
 PATHOPHYSIOLOGY
Calcium & oxalate Continued
come together to Supersaturation deposition at the
promotes their renal papillae leads
make crystal to growth of the
nucleus. combination
kidney stones.

The complete In the case where the

kidney stones block Kidney stones
staghorn stone
all routes , this can grow and collect
forms and cause severe debris.
retention occurs. discomfort.
 ETIOLOGY OF RENAL CALCULI
CR Consuming high amount of oxalates, purine, animals protein, salt and
taking excessive amounts of calcium supplements with Vitamin D
YST
Recurrent Urinary Tract Infection (UTI)
AL
HYpocitraturia, HYpercalciuria, HYperparathyroidism

Structural blockage or stasis of the urine ( prostate problem , strictures ,

deformities )

Too much uric acid

Absorption problems : gut doesn’t absorb fats as with ulcerative colitis or

crohn’s disease

Low activity
 CLINICAL MANIFESTATION
• Pain
 Renal colic : dull , deep aching in the flank or
costovertebral area
 Ureteral colic : intense , sharp , radiating ,
wavelike pain to the genitalia
• Nausea and vomiting
 Fever , cloudy , odorous urine (when infection
develops)
 Urinary retention, dysuria – especially if stone
is stuck in neck of bladder.
 Asymptomatic : until stone moves within the
kidneys and to the ureters.
 Predisposing
factors
Dehydration :
Dehydration : Renal disease:
Stasis :
To increase
Obstruction of - Renal infection
reabsorption of
(producing urine
the urine flow water resulting in
alkaline)
encourage salt reduce urine volume
of highly -Renal tumor
precipitation (producing renal
concentrated filtrate
stasis)

Osteoporosis Prolonged
( bone being immobility
demineralized)
Diagnostic Investigations
• Urine analysis : RBC (+) , WBC (+) , mineral crystal (+) , cast (+) ,
calculus tear (+)
• Complete blood count : WBC
• Blood Biochemistry : BUN, uric acid, creatinine
• Xray : Identify stones
• CT scan
• USG : Detect obstructive changes
• Intravenous Pyelogram (IVP) : show defects caused by stoned
 Medical
Treatment &
management
of renal calculi
Surgical
MEDICAL MANAGEMENT
• Small calculi
- If the stone is small ( < 5mm ) , the pain is tolerable and also no obstruction , the
patient managed ,
 Vigorous Hydration
MEDICATION
• Pottasium citrate ; Urocit- K
• Thiazide diuretics
 Benroflimethiazide
 Metolazone
 Xipamide
 chlortalidone
• Analgesics (NSAID)
• Antibiotics therapy
SURGICAL MANAGEMENT
Extracoporeal Shock Wave Lithotripsy (ESWL)
 Shockwaves are created to
penetrate though the skin and body
tissue.

 Shockwaves will hit the stone and

break it down into grains of sand
like particles which can be passed
out.

 Stones that are between 4 mm

(0.16 in.) and 2 cm (0.8 in.) in
diameter are most likely to be
treated with ESWL.
Percutaneous Nephrolithotomy
 Used when the stone is large or can’t use
ESWL.

 The kidney stone is removed by a urologist

and doesn’t have to be passed by the
patient as with EWSL.

 An incision is made on the back where the

kidney is and an nephroscope is used to
remove the stone. Sometimes lithotripsy is
used to break up the stone.

 A nephrostomy tube may be placed to

drain urine until healed (this is a catheter
placed in the renal pelvis to drain urine)
Ureteroscopy
 Involves the passage of a small
telescope called ureteroscope.

 Scope is inserted through the

urinary system from urethra
to the kidneys.

 Remove the stone or break it

up with a laser or lithotripsy

 Stent may be placed to allow

fragments to pass.
 COMPLICATION
Migration Obstruction
-severe pain & - hydroureter &
obstruction hydronephrosis

Infection
Hematuria
- Cytitis eg.
- Due to injury of urinary Pyelonephiritis,pyoureter,
mucusa pyonephrosis
 Nursing management for client with renal
calculi
• ASSESSMENT
1. History taking : drug-allergy,
family history, daily food intake,

2. Vital sign monitoring,

3. Identify the pain complain (if

presence),
I. Symptoms
II. Location
4. Assess urine for infection and
III. Severity
hematuria.

Escherichia coli (E. coli)
 NURSING DIAGNOSIS 1
Acute pain related to inflammation or obstruction of urinary tract.
Nursing outcome : Patient will able to verbalizes pain is reduced.
Nursing intervention Rationale
1. Assess patient condition (eg: facial To identify the severity of pain.
expression, pain level, cope level towards pain)
2. Encourage patient to alter position as To bring comfort and body
needed. relaxation.
3. Reasses patient level of pain using Faces To assure that pain is slowly relief.
Pain Scale in rate 1-10.
4. Provide non-pharmalogical intervention To promotes relaxation of muscle and enhance
(eg: back rub, diversional therapies) coping towards pain.
5. Encourage patient to increase fluid intake To promotes passing of stone and prevent
as needed. urinary stasis.
6. Document reports of increases or persistent For record and further treatment if needed.
pain.

Evaluation : Patient able to report pain is relieved.

NURSING DIAGNOSIS 2
Deficient knowledge related to lack of recall or misconception of the disease.
Nursing outcome : Patient will able to verbalizes understanding of the disease.
Nursing Intervention Rationale
1. Recall disease process with patient. To obtain patient’s level of understanding.
2. Educate patient to always notice dry To decrease the opportunity of urinary
mouth condition and increase fluid stasis and prevent dehydration.
intake.
3. Explain for dietary plan as patient To understand reason for food restriction
needed. and may prevent recurrence.
4. Identify and inform patient’s drug To prevent adverse reaction towards the
allergy . patient.
5. Explain sign and symptom that require To avoid from further complication.
medical attention (eg: hematuria,
oliguria).
6. Encourage patient to ask questions To enhance and enlight patient’s
regarding the disease. understanding.

Evaluation : Patient able to verbalizes understanding of therapeutic

needs.
NURSING DIAGNOSIS 3
Impaired urinary elimination related to mechanical obstruction in the urinary tract.
Nursing outcome : Patient will able to urinate normally.
Nursing Intervention Rationale
1. Record Input and Output chart and To identify information about kidney
the characteristics of urine. function.
2. Determine patient’s voiding pattern To measure if the renal stone are likely
and noted for the frequency of passed located near the ureterovesicle junction.
urine daily.
3. Encourage patient to increases fluid To flushes bacteria, blood and may
intake daily. facilitate stone passage out from the
body.
4. Observes for mental status changes To identify any accumulation of uremic
and level of consciousness. wastes.
5. Document any stones expelled from To indicate the type of stone and choices
patient. of therapy needed.

Evaluation : Patient able to experience passed urine normally.

 SUMMARY
• The kidney are functionally to removes waste
products, controls the fluid balance and regulates
the balance of electrolytes in the body.

• Kidney stones are formed resulting from when an

excessive insoluble salt or uric acid has crystalized
in the urine.

• Reduce high protein dietary, low purine diet,

increases fluid, reduce intake of oxalate.
 REFERENCES. . .
• Mayo Foundation for Medical Education by Gianrico Farrugia on
(2020) ;
https://www.mayoclinic.org/diseases-conditions/kidney-stones/diag
nosis-treatment/drc-20355759
• Healthline media by Debra Sullivan on ( December 5, 2018) ;
https://www.healthline.com/health/kidney-stones
• Mayo Clinic Staff by Kidney stones (September 29, 2015 ) from ;
https://www.rnspeak.com/kidney-stones-nursing-care-plan/
• National center for biotechnology information, Rockville Pike (2018)
From ; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5817324/
ANY QUESTION ?