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UROLITHIASIS - UROLITHIASIS(RENAL CALCULI Kidney...

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UROLITHIASIS (RENAL CALCULI) Kidney stones (calculi) are formed of mineral deposits, most commonly calcium oxalate and calcium phosphate; however, uric acid, struvite, and cystine are also calculus formers. Although renal calculi can form anywhere in the urinary tract, they are most commonly found in the renal pelvis and calyces. Renal calculi can remain asymptomatic until passed into a ureter and/or urine flow is obstructed, when the potential for renal damage is acute. CARE SETTING Acute episodes may require inpatient treatment on a medical or surgical unit. RELATED CONCERNS Fluid and electrolyte imbalances Metabolic acidosis (primary base bicarbonate deficiency) Metabolic alkalosis (primary base bicarbonate excess) Psychosocial aspects of care Renal failure: acute Patient Assessment Database Dependent on size, location, and etiology of calculi. ACTIVITY/REST May report: Sedentary occupation or occupation in which patient is exposed to high environmental temperatures Activity restrictions/immobility due to a preexisting condition (e.g., debilitating disease, spinal cord injury) CIRCULATION May exhibit: Elevated BP/pulse (pain, anxiety, kidney failure) Warm, flushed skin; pallor ELIMINATION May report: History of recent/chronic UTI; previous obstruction (calculi) Decreased urinary output, bladder fullness Burning, urgency with urination Diarrhea May exhibit: Oliguria, hematuria, pyuria Alterations in voiding pattern FOOD/FLUID May report: Nausea/vomiting, abdominal tenderness Diet high in purines, calcium oxalate, and/or phosphates Insufficient fluid intake; does not drink fluids well May exhibit: Abdominal distension; decreased/absent bowel sounds Vomiting PAIN/DISCOMFORT May report: Acute episode of excruciating, colicky pain with location depending on stone location, e.g., in the flank in the region of the costovertebral angle; may radiate to back, abdomen, and down to the groin/genitalia. Constant dull pain suggests calculi located in the renal pelvis or calyces. Pain may be described as acute, severe, not relieved by positioning or any other measures May exhibit: Guarding; distraction behaviors; self-focusing Tenderness in renal areas on palpation
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SAFETY May report: Use of alcohol Fever; chills TEACHING/LEARNING May report: Family history of calculi, kidney disease, hypertension, gout, chronic UTI History of small-bowel disease, previous abdominal surgery, hyperparathyroidism Use of antibiotics, antihypertensives, sodium bicarbonate, allopurinol, phosphates, thiazides, excessive intake of calcium or vitamin D Discharge plan DRG projected mean length of inpatient stay: 2.9 days considerations: Refer to section at end of plan for postdischarge considerations. DIAGNOSTIC STUDIES Urinalysis: Color may be yellow, dark brown, bloody. Commonly shows RBCs, WBCs, crystals (cystine, uric acid, calcium oxalate), casts, minerals, bacteria, pus; pH may be less than 5 (promotes cystine and uric acid stones) or higher than 7.5 (promotes magnesium, struvite, phosphate, or calcium phosphate stones).
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