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
- 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
- Report pain is relieved with spasms controlled.
- Appear relaxed, able to sleep/rest appropriately.
|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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Genitourinary Care Plans
Care plans related to the reproductive and urinary system disorders:
- Acute Glomerulonephritis | 4 Care Plans
- Acute Renal Failure | 6 Care Plans
- Benign Prostatic Hyperplasia (BPH) | 5 Care Plans
- Chronic Renal Failure | 11 Care Plans
- Hemodialysis | 3 Care Plans
- Hysterectomy | 6 Care Plans
- Mastectomy | 14+ Care Plans
- Menopause | 6 Care Plans
- Nephrotic Syndrome | 5 Care Plans
- Peritoneal Dialysis | 6 Care Plans
- Prostatectomy | 6 Care Plans
- Urolithiasis (Renal Calculi) | 4 Care Plans
- Urinary Tract Infection | 6 Care Plans
- Vesicoureteral Reflux (VUR) | 5 Care Plans