Transcript urolitiasis

UROLITHIASIS
(URINARY CALCULI)
Medical Surgical Nursing III
By : Rahayu Setyowati, SKp.
Nursing Academy of YPIB Majalengka
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OBJECTIVE
At the end of this session, student should be able to:
1. Understand and explain of the definition of urolithiasis
2. Understand and explain of the pathophisiology of urolithiasis
3. Understand and explain of the risk factor of urolithiasis
4. Understand and explain of the clinical manifestation of urolithiasis
5. Understand and explain of the complication of urolithiasis
6. Understand and explain of the diagnostic test of urolithiasis
7. Understand and explain of the medical management of urolithiasis
8. Understand and explain of the nursing process of urolithiasis
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DEFINITION
Urinary Calculi
adanya batu didalam sal. Kemih .
Lithiasis
formasi batu
- di dlm ginjal : nephrolitiasis
- pada sal kemih lain : urolithiasis
Lemone,P & Burke,K(2004)
Batu terbentuk karena konsentrasi yang tinggi zat2 seperti
calcium oxalate, calcium phosphate and asam urat didalam darah dan
Urin.
Smeltzer,SC & Bare,B(2004)
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cont… pathophysiology
TIPE BATU


Batu Calcium
75% to 80% dari batu ginjal . Batu Calcium biasanya karena
konsentrasi yang tinggi dalam darah dan urin.
Batu Asam Urat
adanya konsentrasi yang tinggi asam urat didalam darah dan
biasanya dihubungkan dengan penyakit gout
Batu Sturvite
dikaitkan dengan infeksi sal kemih
 Batu Cystine stones

jarang terjadi tetapi boasanya berhub dgn keturunan
Lemone,P & Burke,K(2004)
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RISK FACTORS
Calcium stones :
Hypercalciuria and hypercalcemia : hyperparathyroidm, immobility,
bone disease,vit D intoxication,multiple myeloma,renal tubular acidosis,
prolonged steroid intake
Uric acid stones :
Gout, tinggi intake purine, acid urine
Sturvite stones :
UTI, especially Proteus infections.
Cystine stones :
genetic defect.
Lemone,P & Burke,K(2004)
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CLINICAL MANIFESTATIONS
KIDNEY STONES
 sering asymptomatic
 sakit pada bagian pinggang
 microscopic hematuria
 manifestations of UTI (demam, frequency, urgency, dysuria)
URETERAL STONES
 Renal colic : - nyeri pinggang akut
- sering menjalar pada area suprapubik, pangkal paha dan
external genitals
 mual, muntah, pucat, kulit lembab
BLADDER STONE
 bisa asymptomatic
 sakit area suprapubic
 gross or mocroscopic hematuria
 manifestasi ISK
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COMPLICATIONS
MANAGEMENT OF URINARY CALCULI
-OBSTRUCTIONS-HYDRONEPHROSIS-INFECTION-
- relieving acute symptom
- removing stone
- preventing further
stone formation
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DIAGNOSTIC TESTS
Urinalysis
 assess for hematuria, WBCs and
crystal, pH urine.
 Urine calcium, uric asid, and oxalate.
(nursing responsibilities for
collecting at 24-hour urine specimen)
 X-Ray (Kidney Ureter Bladder – KUB)
 Ultrasonography
 CT Scan
 IVP ( Intravenous Pyelography)

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Created by ma2 kiyya
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MEDICATIONS and DIETARY
medications
Calcium Phospha
te and or oxalate
Thiazid diuretics,
Phosphates, calciumbinding agents
Sturvite
Antibotic therapy for
UTI
Uric acid
Potassium citrate,
Allopurinol
Cystine
Penicillamine,
Sodium bicarbonate
dietary
Kurangi makanan tinggi
calcium and oxalate,
Tingkatkan intake vit C,
Perbanyak minum,
Exercise (olah Raga)
operasi or lithotripsy
Diet rendah purine ,
Tingkatkan jml minum
Kurangi garam
Tingkatkan minum
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Smeltzer,SC & Bare,B(2004)
Examples of Food and Fluids for Teaching
Clients with Urolithiasis
Food high in
Calcium
Beans and lentils, chocolate, dried fruits, flour,
milk and milk products canned or smoked fish
except tuna.
Food high in
Oxalate
Asparagus, beer & colas, beets, cabbage, celery,
Cocolate, fruits, green beans, nuts, tea, tomatoes.
Purine-rich foods
Goose, organ meats, sardines and herring, venison
Moderate in beef, chicken, crab, pork, salmon, veal.
acidifying foods
Cheese, cranberries, eggs, grapes, meat and poultry
Plum and prunes, tomatoes, whole grains
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OPERASI
Tindakan operasi tergantung dari :
• the location of the stone,
• the extent of obstruction,
• renal function,
• the presence or absence of UTI
• the client’s general state of health.
In general, the stone is removed if it causing severe obstruction,
infection, unrelieved pein, or serious bleeding
(Braunwald et al., 2001)
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Cont…surgery
 LITHOTRIPSY
= using sound or shock waves to crush a stone.
Extracorporeal Shock Wave Lithotripsy (ESWL) is a noninvasive
Technique for fragmenting kidney stone using shock waves generated
outside the body.
Percutaneous Ultrasonic Lithotripsy uses a nephroscope inserted
into the kidney through a small flank incision.
Surgical intervention (rare) to remove a calculus in the renal pelvis or
Ureter  Ureterolitotomy, Pyelolithotomy, nephrolitotomy.
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NURSING CARE OF THE CLIENT HAVING LITHOTRIPSI
PREOPERATIVE CARE
 assess knowledge and understanding of the procedure, providing
information as needed.
 follow directions from the radiologis departement, psycian, or
anestheties for withholding food and fluids and for bowel preparation
prior to surgery.
POSTOPERATIVE CARE
 in the initial period, monitor vital sign frequently.
 monitor amount, color, and clarity of urine output
 maintain placement and patency of urinary catheters
 prepare for discharge by teching care of indwelling catheter, urinecollection device. Teach signs and symptoms of infection.
 teach measures to reduce the risk of further lithiasis
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NURSING PROCESS

ASSESSMENT
Health history :
-
complaints of flank, back, or abdominal pain, radiation,
characteristic and timing, aggravating or relieving factor;
nausea and vomiting;
posible contributing such as dehydration;
family history of kidney stone;
current or previous treatment measures.
Physical examination :
- position, vital sign, skin color, temperature, moisture, turgor
- costovertebral tenderness;
- amount, color and characteristics urine
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Cont…nursing process
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NURSING DIAGNOSES
1. Acut Pain releated to inflammation, obstruction, and abrasion of
the urinary tract.
2. Potential complication releated to obstruction
3. Deficient knowledge regarding prevention of recurrence of renal
stone.
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Cont…nursing process

PLANNING
1. Acut Pain releated to inflammation, obstruction, and abrasion of
the urinary tract.
Goal : relieving pain
Nursing interventions :
# assess pain using standard pain scale and its caracteristics.
# administer analgesia as ordered and monitor its effectiveness.
(intensity, type of pain, and responsiveness to analgetic)
# encourage fluid intake and ambulation in the client with renal
colic (increased fluid and ambulation increase urinary output,
facilitating movement of the calculus through the ureter and
decreasing pain)
# use nonpharmacologic measures such as positioning, moist
heat, relaxation technique, guided imagery. (adjunctive pain
relief measures can enhance the effeciveness of analgesics)
# if surgery has been performed, monitoring urinary output,
catheters, incision, and wound care. (pain may be a symptom
of proximal distention due to a blocked catheter. Infection or
hematoma at the surgical site can significantly increase pain)20
Cont…nursing process
2. Potential complication releated to obstruction
Goal : monitoring and managing potential complications
Nursing interventions :
# monitor amount and character of urine output. If catheterized,
measure output hourly. (the amount of urinary output helps
determine possible urinary tract obstruction and adequacy
hydration)
# document any hematuria, dysuria, frequency, urgency, and
pyuria. (hematuria is often associated with calculi and with
procedure used to remove stones)(dysuria, frequency, urgency
are symptom of UTI, often associated with urolithiasis)
# strain all urine for stone, saving any recovered stone for
laboratory analysis. (analysis of stone recovered from the
urine can direct measures to prevent further lithiasis)
# maintain patency and integrity of all catheter system.
# secure catethers well, label is indicated, and use sterile technique for all ordered irrigations or other procedure.
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Cont…nursing process
3. Deficient knowledge regarding prevention of recurrence of renal
stone.
Goal : teaching patient self care
Nursing interventions :
# assess understanding and previous learning.
# teach about all diagnostic and treatment procedures.
# teach measures to prevent further urolithiasis
- increase fluid intake to 2500-3500 ml per day
- follow recommended dietary guidelines
- maintain actifity level to prevent urinary statis and bone
resorption.
- take medications as prescribed.
(the risk current lithiasis is approximately 50%)
# teach about the relationship between urinary calculi and
UTI.
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Cont…nursing process
IMPLEMENTATION
 EVALUATION

Expected patient outcome may include :
1. report relief of pain
2. experiences no complications :
- report no sign or symptom of sepsis or infection
- voids 200 – 400 ml per voiding of clear urine without
evidence bleeding.
- experiences absence of dysuria, frequency, and urgency
- maintains normal body temperature
3. state increased knowledge :
- consumes increased fluid intake (2500-3000ml/day)
- participates in appropriate activity
- consumes diet prescribed
- takes prescribed medication as directed to reduce stone
formation.
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