4 Urolithiasis (Renal Calculi) Nursing Care Plans

Acute Pain

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.

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

• 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.