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Urolithiasis
Presentation by melissa vandyke
What is urolithiasis?????
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a formation of urinary calculi in any area of the urinary
tract.
Named specifically to indicate where they are located or
formed: nephrolithiasis (stones in the kidney),
ureterolithiasis (stones in the ureter), and
cystolithiasis (stones in the bladder)
Urolithiasis develops from minerals that have
precipitated out of solution and adhere, forming stones
that varie in size and shape
Some people are predisposed; people that are immobile,
are hyperparathyroid, people that have recurrent UTI’s,
Also individual history and some foods, nutrients, and
medications also contribute to development of stones.
Clinical Manifestations….
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Size and degree of mobility of the stone
influences what symptoms you might have
Patients with renal colic will receive attention
immediately whereas a patient with a less
mobile stone with wait until there are signs and
symptoms of infection to seek assistance
A look at stones………..
OUCH!!!!
Assesment of a patient with
urolithiasis……..
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Patient with mobile calculi will complain of
intractable pain and is usually accompanied by
nausea and vomiting
Patients has pain that starting in the flank and
radiating into the groin, genitalia, and the inner
thigh.
Patient with a less mobile stone will have signs and
symptoms as that with a UTI ( pain and burning with urination,
nocturia, abdominal discomfort, flank pain, hematuria, or pyuria.)
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Collection of objective data would include
assessing for presence of hematuria and vomiting
Diagnostic Test……….
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KUB and IVP/IVU radiography, ultrasound,
cystoscopy, and urinalysis.
Other test may also be ran to determine stone
content, presence of infection, and alterations in
blood chemistry that may influence stone
formation.
24 hour urine examination may be done to
detect abnormal excretion of calcium oxalate,
phosphorus, or uric acid.
Medical Management……
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Antiinfective agents may be administerd in the presence
of infection
Stones may need to be removed surgicaly
(ureterolithotomy, pyelolithotomy, nephrolitomy)
Chemolytic agents (alkylating or acidifying agents) may
be instilled to dissolve stones.
Lithotrispy- patient is submerged in a special tank of
water and ultrasonic shock waves are used to pulverize
the stone. (urine is still strained)
Long term management may include dietary adjustments
to influence the urine pH or to decrease availabilty of
certain substances to discourage stone formation
Moderate reduction of calcium phosphorus and purinecontaining foods when stones are caused by metabolic
abnormalites.
Medical Management con’t….
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Adequate daily fluid intake of 2000ml will help
cleanse urinary tract
Avoid foods such as cheese, greens, whole
grains, carbonated beverages, nuts, chocolate,
shellfish, and organ meat
In calcium stone formation, sodium cellulose
phosphate binds with ingested calcium and
prevents its absorbtion
Aluminum hydroxide gel with bind with excess
phosphorus allowing intestinal excretion rather
than urinary excretion
Allopurinol (Zyloprim) reduces serum nitrate
levels
Lithotripsy
Procedure
Nursing Interventions…….
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The patient should remain active and increase
fluid intake (at least 2000mL per day)
STRAIN ALL URINE!!!!!
Asses urine for hematuria
Monitor BUN and creatinine for indications of
continuing urinary obstruction
People that are calcium stone formers should
avoid dairy products and antiacids
Avoid foods such as cheese, greens, carbonated
beverages, whole grains, organ meats,
chocolate, and nuts.