Impaired Urinary Elimination — Urolithiasis Nursing Care Plan

Urolithiasis may form anywhere in the urinary tract but usually develop in the renal pelvis or the calyces of the kidneys. This is a nursing care plan for a patient with urolithiasis (renal calculi) experiencing impaired urinary elimination.

Nursing Diagnosis:

• Urinary Elimination, impaired

May be related to

• Stimulation of the bladder by calculi, renal or ureteral irritation
• Mechanical obstruction, inflammation

Possibly evidenced by

• Urgency and frequency; oliguria (retention)
• Hematuria

Goals: 

• Void in normal amounts and usual pattern.
• Experience no signs of obstruction.

Urolithiasis Nursing Interventions for Impaired Urinary Elimination with Rationale

Nursing Intervention	Rationale
Monitor I&O and characteristics of urine.	Provides information about kidney function and presence of complications, e.g., infection and hemorrhage. Bleeding may indicate increased obstruction or irritation of ureter. Note: Hemorrhage due to ureteral ulceration is rare.
Determine patient’s normal voiding pattern and note variations.	Calculi may cause nerve excitability, which causes sensations of urgent need to void. Usually frequency and urgency increase as calculus nears ureterovesical junction.
Encourage increased fluid intake.	Increased hydration flushes bacteria, blood, and debris and may facilitate stone passage.
Strain all urine. Document any stones expelled and send to laboratory for analysis.	Retrieval of calculi allows identification of type of stone and influences choice of therapy.
Investigate reports of bladder fullness; palpate for suprapubic distension. Note decreased urine output, presence of periorbital/dependent edema.	Urinary retention may develop, causing tissue distension (bladder/kidney), and potentiates risk of infection, renal failure.
Observe for changes in mental status, behavior, or level of consciousness.	Accumulation of uremic wastes and electrolyte imbalances can be toxic to the CNS.
Maintain patency of indwelling catheters (ureteral, urethral, or nephrostomy) when used.	May be required to facilitate urine flow/prevent retention and corresponding complications. Note: Tubes may be occluded by stone fragments.
Irrigate with acid or alkaline solutions as indicated.	Changing urine pH may help dissolve stones and prevent further stone formation. <
Monitor laboratory studies, e.g., electrolytes, BUN, Cr.	Elevated BUN, Cr, and certain electrolytes indicate presence/degree of kidney dysfunction.
Obtain urine for culture and sensitivities.	Determines presence of UTI, which may be causing/complicating symptoms

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