Nursing Care Plan for Renal Calculi

Pathophysiology

Renal calculi, commonly known as kidney stones, are crystallized minerals, typically calcium or uric acid,  in your urine that stick together and form stones. These stones may pass through the urinary tract and be expelled in the urine, or may be large enough to require surgical intervention.

Etiology

Stones form when urine is concentrated and contains  more mineral deposits than fluid. These substances crystallize and stick together forming stones. Dehydration is a major risk factor for developing renal calculi. Other factors include infection, diet and heredity. Most stones will pass through the urinary tract without intervention, however some may require medication or surgery.

Desired Outcome

Normal voiding of urine without pain. Passing of the kidney stones without traumatic injury.

Renal Calculi Nursing Care Plan

Subjective Data:

  • Severe pain of back and side
  • Radiating pain to lower abdomen and groin
  • Nausea
  • Dysuria
  • Urinary urgency
  • Urinary frequency

Objective Data:

  • Hematuria
  • Cloudy / foul-smelling urine
  • Fever (with infection)

Nursing Interventions and Rationales

  1. Assess for and manage pain

    • Administer medications for pain relief, may include opioids
    • Assist in positioning patient for comfort
    • Assist with ambulation for pain relief
  2. The primary symptom of renal stones is excruciating pain. Monitor for location and character of pain to determine if stone is moving. Nausea and vomiting may occur due to intense pain.

  3. Assess for signs/symptoms of infection

    • Fever / chills
    • Oliguria
    • Hematuria
    • Administer antibiotics as necessary
  4. Monitor for signs and symptoms of infection such as malodorous urine, fever and chills. Hematuria may be  a sign of infection or movement of a renal calculi.

  5. Monitor for dehydration

    • Dry mucous membranes
    • Skin turgor / tenting
  6. Nausea and vomiting as well as high levels of pain may prevent the patient from eating or drinking.

  7. Encourage intake of fluids

  8. Encourage oral fluids and initiate IV fluids if necessary. Optimal hydration may help the movement of the stone and prevent further complications..

  9. Monitor urine output for evidence of stones

  10. Provide urinary basin (hat) for toilet to measure urinary output. Inspect urine and any blood clots for possible stones.

  11. Monitor diagnostic tests

    • Labs
      • Serum
      • Urinalysis
      • Urine Culture
    • Radiology (KUB, CT, Ultrasound)
    • BUN/Cr will be elevated in serum, but decreased in urine levels due to the kidneys impaired ability to filter waste
    • Urine– may be dark yellow or brown and bloody. Urinalysis will help determine if infection is present and the overall health of the kidneys.
    • Hgb/Hct (CBC) may be abnormal if dehydration is an issue
    • KUB x-rays, ultrasound and CT can show the presence of and location of calculi as well as other masses or abnormalities.

  12. Prepare patient for and assist with procedures for removing or managing renal stones

    • Extracorporeal shock wave lithotripsy (ESWL)
    • Percutaneous nephrolithotomy
    • Ureteroscopy
  13. Depending on the size and location of the stone, surgical intervention may be necessary.

    • ESWL- is strong sound waves that are used to break the stone into smaller pieces under anesthesia or sedation.
    • Nephrolithotomy- Patient will require general anesthesia for an incision made in the back to remove large stones and place stents
    • Ureteroscopy- Done under general or local anesthesia using a scope through the ureters and bladder to find and break the stones.

  14. Provide nutrition education depending on type of calculi:

    • Calcium stones
    • Uric stones
    • Cystine stones
    • Oxalate stones
    • Calcium stones:  Reduce dietary protein and sodium intake, increase fluid intake
    • Uric stones:  Low purine diet (organ meats such as liver), limited protein
    • Cystine stones:  Low protein diet and increase fluids
    • Oxalate stones:  Increase fluid intake to dilute urine, reduce intake of oxalate (found in strawberries, spinach, chocolate, tea, peanuts and wheat bran)


References

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