Urolithiasis Overview and Management

Study Notes

Urolithiasis Overview

Affects 8% of people in the United States.
Risk factors include family history, residing in industrialized countries, malabsorption conditions like Crohn's disease, and dehydration.

Pathophysiology

Microscopic crystals in the urinary tract aggregate, forming stones (calculi).

Clinical Manifestations

Severe pain when a stone lodges in the ureter.
Gross hematuria (blood in the urine).

Diagnosis

Non-contrast stone survey computed tomography (CT) scan.
Kidney, ureter, and bladder (KUB) x-ray.
Ultrasound.

Treatment

Up to 50% of stones pass spontaneously.
Pain management is crucial.

Surgical Management

Ureteroscopy: a procedure to remove stones using a small scope inserted through the urethra.
Extracorporeal shock-wave lithotripsy: a procedure that uses shock waves to break down the stone into smaller pieces.

Complications

Pyelonephritis (kidney infection).
Urosepsis (a severe bloodstream infection associated with a urinary tract infection).
Irreversible renal damage.

Nursing Management

Assessments:
- Vital signs.
- Pain or renal colic (severe pain in the flank and back).
- Nausea and vomiting.
- Urine pH.
Nursing Diagnoses:
- Acute pain.
- Altered elimination.
- Risk for infection.
Nursing Interventions:
- Administer medications as ordered.
- Maintain fluid status.
- Strain urine to monitor for stone passage.
- Insert a Foley catheter if necessary.
- Administer alpha blockers such as Tamsulosin (Flomax), doxazosin (Cardura), or terazosin (Hytrin) to help dilate and relax the lower ureter, facilitating stone passage.
  - Educate patients about the possible side effect of lightheadedness and advise them to rise slowly from a seated position to prevent orthostatic hypotension.
Patient Teaching:
- Strain urine to monitor for stone passage.
- Contact healthcare provider immediately for fever, chills, nausea/vomiting, or uncontrolled pain.
- Discuss kidney stone prevention strategies.
- Monitor sodium intake.
Evaluating Care Outcomes:
- Prevented future stone formation.
- Preservation of kidney function.
- Relief from pain.
- Absence of fever.
- Adequate production of clear yellow urine.

Urolithiasis (Kidney Stones)

Prevalence: Affects approximately 8% of people in the United States
Risk Factors:
- Family history
- Living in industrialized countries
- Malabsorption conditions like Crohn's disease
- Dehydration
Pathophysiology:
- Microscopic crystals in the urinary tract aggregate, forming a stone (calculus)
Clinical Manifestations:
- Severe pain when a stone lodges in the ureter (renal colic)
- Gross hematuria (blood in the urine)
Medical Management:
- Diagnosis:
  - Non-contrast computed tomography (CT) scan
  - Kidney, ureter, and bladder (KUB) x-ray
  - Ultrasound
- Treatment:
  - Approximately 50% of stones pass spontaneously
  - Pain control with medications
Surgical Management:
- Ureteroscopy: A small, flexible scope is inserted into the ureter to remove the stone
- Extracorporeal shock-wave lithotripsy (ESWL): Shock waves are used to break up the stone
Complications:
- Pyelonephritis (kidney infection)
- Urosepsis (bloodstream infection)
- Irreversible renal damage
Nursing Management:
- Assessment and Analysis:
  - The most prominent symptom is pain related to the stone lodging in the ureter and causing inflammation
- Nursing Diagnoses:
  - Acute pain
  - Altered elimination
  - Risk for infection
- Nursing Interventions:
  - Assessments:
    - Vital signs
    - Pain or renal colic
    - Nausea and vomiting
    - Urine pH
  - Actions:
    - Administer medications as ordered
    - Maintain fluid status
    - Strain urine
    - Insert Foley catheter, if necessary
    - Administer alpha blockers (Tamsulosin (Flomax), Doxazosin (Cardura), or Terazosin (Hytrin)) as ordered: These medications help dilate the lower ureter, facilitating stone passage. Educate patients about the common side effect of lightheadedness and to rise slowly from a seated position to avoid orthostatic hypotension.
- Teaching:
  - Strain urine
  - Contact provider for fever, chills, nausea/vomiting, or uncontrolled pain
  - Kidney stone prevention strategies
  - Monitor sodium intake
Evaluating Care Outcomes:
- Prevention of future stones
- Preservation of kidney function
- Absence of pain
- Afebrile (no fever)
- Adequate amounts of clear yellow urine

Description

This quiz covers the essential aspects of urolithiasis, including its prevalence, risk factors, pathophysiology, clinical manifestations, diagnosis, and treatment options. Gain insights into surgical management techniques and potential complications associated with kidney stones.