4 Urolithiasis (Renal Calculi) Nursing Care Plans

Urolithiasis Nursing Care Plans
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Urolithiasis is the process of forming stones in the kidney, bladder, and/or urethra (urinary tract). Kidney stones (calculi) are formed of mineral deposits, most commonly calcium oxalate and calcium phosphate; however, uric acid, struvite, and cystine are also calculus formers. Although renal calculi can form anywhere in the urinary tract, they are most commonly found in the renal pelvis and calyces. Renal calculi can remain asymptomatic until passed into a ureter and/or urine flow is obstructed, when the potential for renal damage is acute.

There are four main types of kidney stones — calcium stones, uric acid stones, struvite stones and cystine stones.

Nursing Care Plans

Here are four nursing care plans (NCP) and nursing diagnosis for patients with Urolithiasis (renal calculi): 

  1. Acute Pain
  2. Impaired Urinary Elimination
  3. Risk for Deficient Fluid Volume
  4. Deficient Knowledge
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Acute Pain

Nursing Diagnosis

  • Acute Pain

May be related to

  • Increased frequency/force of ureteral contractions
  • Tissue trauma, edema formation; cellular ischemia
  • Possibly evidenced by
  • Reports of colicky pain
  • Guarding/distraction behaviors, restlessness, moaning, self-focusing, facial mask of pain, muscle tension
  • Autonomic responses

Desired Outcomes

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  • Report pain is relieved with spasms controlled.
  • Appear relaxed, able to sleep/rest appropriately.
Nursing Interventions Rationale
Determine and note location, duration, intensity (0–10 scale), and radiation. Document nonverbal signs such as elevated BP and pulse, restlessness, moaning, thrashing about. Aids to evaluate site of obstruction and progress of calculi movement. Flank pain suggests that stones are in the kidney area, upper ureter. Flank pain radiates to back, abdomen, groin, genitalia because of proximity of nerve plexus and blood vessels supplying other areas. Sudden, severe pain may precipitate apprehension, restlessness, severe anxiety.
Justify and clarify cause of pain and the need of notifying caregivers of changes in pain occurrence and characteristics. Provides opportunity for timely administration of analgesia (helpful in enhancing patient’s coping ability and may reduce anxiety) and alerts caregivers to possibility of passing of stone and developing complications. Sudden cessation of pain usually indicates stone passage.
Implement comfort measures (back rub, restful environment). Promotes relaxation, reduces muscle tension, and enhances coping.
Encourage use of focused breathing, guided imagery, diversional activities. Redirects attention and helps in muscle relaxation.
Assist with frequent ambulation as indicated and increased fluid intake of at least 3–4 L a day within cardiac tolerance. Renal colic can be worse in the supine position. Vigorous hydration promotes passing of stone, prevents urinary stasis, and aids in prevention of further stone formation.
Document reports of increased and persistent abdominal pain. Complete obstruction of ureter can cause perforation and extravasation of urine into perirenal space. This represents an acute surgical emergency.
Apply warm compresses to back. Relieves muscle tension and may reduce reflex spasms.
Check and sustain patency of catheters when used. Prevents urinary stasis or retention, reduces risk of increased renal pressure and infection.
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See Also

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Genitourinary Care Plans

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Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.

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