Kidney stones
Chapter 55
Pages 1591-1596
By: Heather Wacholz BSN,RN,CCRN-CMC,CNRN
Normal Kidney Function
Kidney Stones
O Kidney stones (renal Urolithiasis or nephrolithiasis) are small,
hard mineral deposits that form inside your kidneys. The
stones are made of mineral and acid salts.
O Kidney stones have many causes and can affect any part of
your urinary tract — from your kidneys to your bladder. Often,
stones form when the urine becomes concentrated, allowing
minerals to crystallize and stick together.
O Passing kidney stones can be quite painful, but the stones
usually cause no permanent damage. Depending on your
situation, you may need nothing more than to take pain
medication and drink lots of water to pass a kidney stone. In
other instances — for example, if stones become lodged in the
urinary tract or cause complications — surgery may be needed
Picture of Kidney Stone
More Pictures
Kidney Stone
O 50% of patients with a single renal stone will
develop another within five years
O Stones are usually formed in the urinary
tract
O Concentrations of substances such as
calcium oxalate, calcium phosphate, and
uric acid increase
O Stones may be found in the kidney, ureters,
and/or bladder
Pathophysiology
O Stone formation is not clearly understood
O One theory is there is a deficiency of
O
O
O
O
substances that normally prevent
crystallization in the urine
For example, citrate, Mg., Nephrocalcin, and
Uropontin
Dehydration
Immobility
infection
Pathophysiology Continued
O Cancer
O Excessive Vitamin D
O Excess milk and alkali
O Polycythemia Vera
O Hyperparathyroidism
O Renal tubular acidosis
Types of Stones
O Calcium
O Uric Acid
O Cystine
O Oxalate
Clinical Manifestations
O Infection (Bladder)
O Pain
O Hematuria
O Pain over the costovertebral area
O Nausea and Vomiting
O Stone in the ureter cause colicky pain
Diagnostics
O KUB
O Ultrasonography
O IV urography
O Retrograde Pyelography
O Blood Chemistries
O 24 Hour urine
X-ray of a Kidney Stone
Medical Management
O Eradicate the Stone
O Prevent nephron destruction
O Control infection
O Relive obstruction that may be present
O Opioid analgesic
O NSAIDS
O Hot Baths
O Moist heat
O Increase PO intake (2 L/day)
Surgical Management
O Surgery 1-2% of patients
O Nephrolithotomy
O Nephrectomy
O Ureteroscopy
Ureteroscopy
Nursing Care Plan
O Acute Pain
O Deficient knowledge
O Infection/Urosepsis
O Major goals include relief of pain and
prevention of reoccurrence
O Absence of complications