Kidney Stone Ncp
Kidney Stone Care Plan Admitting Diagnoses: Client not being admitted at this time Current Diagnosis: Ureteral Calculi Other Medical Diagnoses: HTN, Hyperlipidemia, Kidney stones, Smokes Tobacco, Tonsillectomy-child age yrs. Pathophysiology: Urinary calculi are solid particles in the urinary system. They may cause pain, nausea, vomiting, hematuria, and, possibly, chills and fever due to secondary infection. Diagnosis is based on urinalysis and radiologic imaging, usually noncontrast helical CT. Treatment is with analgesics, antibiotics for infection, and, sometimes, shock wave lithotripsy or endoscopic procedures.
About 1/1000 adults in the US is hospitalized annually because of urinary calculi, which are also found in about 1% of all autopsies. Up to 12% of men and 5% of women will develop a urinary calculus by age 70. Calculi vary from microscopic crystalline foci to calculi several centimeters in diameter. A large calculus, called a staghorn calculus, can fill an entire renal calyceal system. About 85% of calculi in the US are composed of Ca, mainly Ca oxalate. Composition of urinary calculi; 10% are uric acid; 2% are cystine; most of the remainder are Mg ammonium phosphate (struvite).
General risk factors include disorders that increase urinary salt concentration, either by increased excretion of Ca or uric acid salts, or by decreased excretion of urine or citrate. Urinary calculi may remain within the renal parenchyma or renal pelvis or be passed into the ureter and bladder. During passage, calculi may irritate the ureter and may become lodged, obstructing urine flow and causing hydroureter and sometimes hydronephrosis. (Preminger, MD, 2012) Common areas of lodgment include the ureteropelvic junction, the distal ureter, and the ureterovesical junction.
Larger calculi are more likely to become lodged. Typically, a calculus must have a diameter > 5 mm to become lodged. Calculi ? 5 mm are likely to pass spontaneously. Even partial obstruction causes decreased glomerular filtration, which may persist briefly after the calculus has passed. With hydronephrosis and elevated glomerular pressure, renal blood flow declines, further worsening renal function. Generally, however, in the absence of infection, permanent renal dysfunction occurs only after about 28 days of complete obstruction.
Secondary infection can occur with long-standing obstruction, but most patients with Ca-containing calculi do not have infected urine. Preminger, MD, G. M. (n. d. ). Nephrolithiasis; stones; urolithiasis. Retrieved from http://www. merckmanuals. com/professional/genitourinary_disorders/urinary_calculi/urinary_calculi. html Textbook clinical symptoms: The major manifestation of stones is severe pain, commonly called renal colic. Flank pain suggests the stone is located in the kidney or upper ureter. Flank pain that extends toward the abdomen or to the scrotum and testes or the vulva suggests that stones are in the ureters or bladder.
Nausea, vomiting, pallor, and diaphoresis often accompany the pain. Frequency or dysuria occurs when a stone reaches the bladder. (Ignatavicius & Workman, 2010) pg 1571 Actual symptoms: Flank pain extending toward the abdomen, dizziness, sweating, and nausea w/o vomiting. Patient states his pain is an 8/10 on the pain scale. Pain is described as constant and sharp with no alleviating factors. Complications or potential complications: Potential; Hydroureter, hematuria, hydronephrosis, abrasion, oliguria or anuria, and infection. Ignatavicius & Workman, 2010) pg 1571-1572 Safety Issues: Fall risk level – Low, but still a potential complication from patient’s c/o dizziness from pain. Delegation Issues: Assist patient when ambulating. |Client Data | |Age | |38 | |Physical Exam (include all body systems) | (Physical Exam) | |Age | |38 | | | |Male | | | |Height | |69. in | |Weight | |180lb | |Temp | |99F | |Pulse | |90 | |Apical Pulse | |88 | |Resp | |20 | |BP | |169/71 | |BP supine | |( Noted | |O2 Saturation | |100% RA | | | | | |NEURO: nonfocal, AXOX4, c/o pain. |HEENT: Denies headache; PERRLA, Ears unobstructed, symmetrical, no loss of hearing, Nares are clear, w/o drainage or obstruction, Oropharynx is clear w/ | |membranes pink in color and intact, Neck is supple with full range of motion, | |INTEGUMENT: Skin warm, moist-diaphoretic, intact w/saline lock in RU-AC, dressing is clean, intact, non-tender, free of redness. | |CARDIOVASCULAR: No JVD noted, apical pulse regular at 88bpm, S1/S2 auscultated, no c/o chest pain/pressure | |distal pulses palpated in all extremities, capillary refill