Urolithiasis

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Urolithiasis

• Presentation by melissa vandyke

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What is urolithiasis?????

• 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 UTIs,
• Also individual history and some foods,
  nutrients, and medications also contribute to
  development of stones.

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Clinical Manifestations.

• 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

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A look at stones..
OUCH!!!!
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Assesment of a patient with urolithiasis..

• 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.)
• Collection of objective data would include
  assessing for presence of hematuria and vomiting

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Diagnostic Test.

• 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.

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Medical Management

• 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
  purine-containing foods when stones are caused by
  metabolic abnormalites.

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Medical Management cont.

• 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

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Lithotripsy Procedure
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Nursing Interventions.

• 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.

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