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.
- 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)
- Void in normal amounts and usual pattern.
- Experience no signs of obstruction.
Urolithiasis Nursing Interventions for Impaired Urinary Elimination with 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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