Nursing Care Plan for Urolithiasis

Urolithiasis

Urolithiasis is the condition where urinary calculi are formed in the urinary tract.

The term kidney stone (or "renal calculus") is sometimes used to refer to urolithiasis in any part of the urinary tract, however it is more properly reserved for stones that are actually in the collecting duct of the kidney itself.

The term nephrolithiasis can be used to describe the condition of having kidney stones, and ureterolithiasis can be used to describe the condition of having stones in the ureter.

Obstruction of the ureter by the kidney stones causes a renal colic attack which is why intense pain is felt in groin and back.

The term bladder stone is more frequently associated with veterinary science.


Causes

Bladder stones can occur if kidney(s), the bladder or urinal tracts get inflamed. Another reason is if a patient has frequent insertion of urinary catheters. Some people who are paralyzed and unable to pass urine require small plastic tubes (catheters) placed in the bladder. These tubes are prone to infection which irritates the bladder resulting in stone formation. Finally kidney stones can travel down the ureter into the bladder and grow in to bladder stones. There is some evidence indicating that chronic irritation of the bladder by retained stones may increase the chance of bladder cancer.


Composition

Urinary stones may be composed of the following substances :

* Calcium oxalate monohydrate (whewellite)
* Calcium oxalate dihydrate (weddellite)
* Calcium phosphate
* Magnesium phosphate
* Ammonium phosphate
* Ammonium magnesium phosphate (struvite)
* Calcium hydroxyphosphate (apatite)
* Uric acid and its salts (urates)
* Cystine
* Xanthine
* Indigotin (rare)
* Urostealith (rare)
* Sulphonamide (rare)


Nursing Care Plan for Urolithiasis

Nursing Assessment for Urolithiasis

History of Nursing and Physical Assessment : based on the Doenges classification (2000), history of nursing that need to be assess are :

1. Activity / rest :
   Symptoms :
   • History of work monotony, physical activity is low, more sedentary.
   • History of working in an environment of high temperature.
   • The limited physical mobility due to other systemic diseases (cerebrovascular injury, long bed rest).
2. Circulation
   Signs :
   • Increased blood pressure (pain, anxiety, kidney failure)
   • Skin warm and reddish or pale.
3. Elimination
   Symptoms :
   • History UTI chronic, History obstruksi
   • Decrease in urine volume
   • Burning, urge to urinate
   • Diarrhea
   Signs :
   • Oliguria, haematuria, piouria
   • Changes in urination pattern
4. Food and liquids :
   Symptoms :
   • Nausea / vomiting, abdominal tenderness
   • History diet high-purine, calcium oxalate or phosphate
   • Hydration is not adequate, do not drink water with enough
   Signs :
   • Distension Abdominal, decline / no noisy intestine
   • Throw up
5. Pain and comfort :
   Symptoms :
   • Pain is severe in the acute phase (colicky pain), location of pain depends on the location of stones (kidney stones cause pain shallow constant)
   Signs :
   • Behavior careful, behavioral distraction
   • Tenderness in the area of kidney pain
6. Security :
   Symptoms :
   • The use of alcohol
   • Fever / chills
7. Counseling / learning :
   Symptoms :
   • History of urinary tract stones in the family, kidney disease, hypertension, gout, UTI Chronic
   • History of disease small intestine, abdominal surgery before, hyperparathyroidism
   • The use of antibiotics, antihypertensives, sodium bicarbonate, alopurinul, phosphate, tiazid, excessive input of calcium or vitamin.

Nursing Diagnosis for Urolithiasis

• Impaired sense of comfort : pain related to an increased frequency / impulse ureteral contraction, tissue trauma, edema formation.
• Changes in elimination of urine related to bladder stimulation by stones, kidney or ureteral irritation, mechanical obstruction, inflammatory.

Nursing Intervention for Urolithiasis

1. Impaired sense of comfort : pain related to an increased frequency / impulse ureteral contraction, tissue trauma, edema formation.

Goal :
The pain may be missing or less

Result Criteria :

• Report the pain disappear
• Relaxed, able to sleep / rest with the appropriate

Intervention :

• Record the location, duration of the intensity (scale 0-10) and deployment. Consider non-verbal signs, for example increased blood pressure, pulse, restless and whimpering.
• Explain the cause of pain and the importance of reporting to the nurse to changing events / characteristics of pain.
• Give the actions comfortable, eg, back massage patients, the environment a break.
• Assist the use of breath focused, the guidance of imagination and the therapeutic activity.
• Note the complaint improvement / establishment of abdominal pain.
• Give appropriate therapy program.

2. Changes in elimination of urine related to bladder stimulation by stones, kidney or ureteral irritation, mechanical obstruction, inflammatory.

Goal :
The elimination of urine in the normal amount

Result Criteria :

• voiding with a normal amount and the pattern usually
• Not have any signs of obstruction

Intervention

• Monitor the income and expenditure and characteristics of urine
• Determine the patient's normal micturition pattern and notice the variation
• Encourage increased fluid intake
• Check all the urine, note the output of stone and send to laboratory for analysis.
• Observation of changes in mental status, behavior or level of consciousness
• Supervise laboratory
• Give appropriate therapy program

Source : http://en.wikipedia.org