Urolithiasis, commonly known as kidney stones, is a painful and debilitating condition affecting millions of people worldwide. According to statistics, the incidence of kidney stones has increased in recent years, making it a significant public health concern. Nurses play a crucial role in managing urolithiasis by providing comprehensive nursing care plans to help prevent, assess, diagnose, and treat kidney stones effectively. This article provides a guide on urolithiasis nursing care plans to assist nurses in caring for patients with kidney stones.
What is Urolithiasis?
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
Nursing goals for patients with urolithiasis aim to provide comprehensive care to manage pain, prevent complications, and facilitate the passage of kidney stones.
Here are four nursing care plans (NCP) and nursing diagnosis for patients with Urolithiasis (renal calculi):
Acute pain is common in patients with urolithiasis because the passage of kidney stones through the urinary tract can cause irritation, inflammation, and obstruction, leading to intense pain. The severity of the pain can vary depending on the size and location of the stone.
- 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
- The patient will report relief of pain with spasms controlled.
- The patient will appear relaxed and will be able to sleep/rest appropriately.
Nursing Assessment and Rationale
1. 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, and severe anxiety.
2. 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.
Nursing Interventions and Rationale
1. Implement comfort measures (back rub, restful environment).
Promotes relaxation, reduces muscle tension and enhances coping.
2. Encourage use of focused breathing, guided imagery, and diversional activities.
Redirects attention and helps in muscle relaxation.
3. 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 stones, prevents urinary stasis, and aids in prevention of further stone formation.
4. 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.
5. Apply warm compresses to the back.
Relieves muscle tension and may reduce reflex spasms.
6. Check and sustain patency of catheters when used.
Prevents urinary stasis or retention, and reduces risk of increased renal pressure and infection.
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other care plans and nursing diagnoses related to 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 | 10 Care Plans
- Hemodialysis | 3 Care Plans
- Hysterectomy (TAHBSO) | 6 Care Plans
- Mastectomy | 15 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 | 4 Care Plans
- Vesicoureteral Reflux (VUR) | 5 Care Plans