4 Urolithiasis (Renal Calculi) 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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Impaired Urinary Elimination

Nursing Diagnosis

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: 

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  • Void in normal amounts and usual pattern.
  • Experience no signs of obstruction.
Nursing InterventionsRationale
Record I&O and characteristics of urine.Provides information about kidney function and presence of complications (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 the patient to walk if possible.To facilitate spontaneous passage.
Promote sufficient intake of fluids.Increased hydration flushes bacteria, blood, and debris and may facilitate stone passage.
Offer fruit juices ,particularly cranberry juice.To help acidify urine.
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 and 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 (urethral, urethral, or nephrostomy) when used.May be required to facilitate urine flow and 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.
Check laboratory studies (electrolytes, BUN, Cr).Elevated BUN, Cr, and certain electrolytes indicate presence and degree of kidney dysfunction.
Obtain urine for culture and sensitivities.Determines presence of UTI, which may be causing or complicating symptoms
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Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See also

Other recommended site resources for this nursing care plan:

Other care plans and nursing diagnoses related to reproductive and urinary system disorders:

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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