Download - Care Conference Urinary Tract Stone
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At the end of this session, you will be able to :
State the definition of urolithiasis. List the etiology of urolithiasis. Identify the pathophysiology of
urolithiasis. State the sign & symptom of
urinary tract stone.
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LEARNING OBJECTIVES cont.
Identify the complication of urinary tract stone.
Understand regarding treatment of urinary tract stone.
Identify the nursing intervention & appreciate the nursing care for urinary tract stone patient.
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PATIENT’S PROFILE
MR. T
MALE
44 YEARS OLD
TRAINER
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PATIENT’S PROFILE WHEEL CHAIR
ANXIOUS
ALLERGICS - NIL
D.O.A 4/6/14 @ 2100 Hr
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Mr T was admitted to 5XX-1 with complaint of right loin to groin
pain X 1/7 under Dr N.
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PATIENT’S PROFILE MEDICAL HISTORY HPT
SURGICAL HISTORY NIL
FAMILY MED HISTORY HPT (Both parents)
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CURRENT MEDICATION
Tab Amlodipine 1/1 Daily
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VITAL SIGN TEMPERATURE : 37.2˚C BLOOD PRESSURE : 160/95mmHg PULSE : 70 bpm RESPIRATION : 21 bpm PAIN SCORE : 2 Weight : 71kg
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ACTIVITY DAILY LIVING Anxious and asking many questions.
Bowel movement alternate day
Constipation (on high fiber diet)
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PHYSICAL EXAMINATION
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S/B Dr N in A&E
Light breakfast at 6am CM then fast Ural 1/1 TDS Norgesic 1/1 TDS IV Dynastat 40mg BD IV Pethidine 25mg STAT & repeat
another 25mg IV if pain not relief in 15 minutes
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Continue….
IM Pethidine 75mg 6 hourly PRN IM Maxalon 10mg 6 hourly PRN For right URS / lithotripsy CM ECG OT / Anaest / Consent
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Stone Types
• Calcium stones (60-80%)–Most primarily calcium oxalate– Less often, calcium phosphate
• Struvite (magnesium ammonium phosphate) (10-15%)
• Uric acid (if pure, then radiolucent) (5-10%)• Cystine (1%)• Other (indiavir, triamterene, etc) (1%)
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↓ fluid volume / substance that prevent crystallization (citrate,
magnesium, nephrocalcin / uropontin)
↑ urinary concentration of calcium oxalate / calcium phosphate / uric acid
Supersaturated urine
Crystallization of urine
Stone formation
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• Pain in abdomen, flank or groin (sudden onset, very severe and intermittent colic)• Haematuria• Decreased urine volume• Nausea and vomiting
SIGN & SYMPTOMS
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CLINICAL MANIFESTATIONS
• Manifestations depend on the presence of obstruction, infection, and edema. Symptoms range from mild to excruciating pain and discomfort.
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Ureteral Colic (Stones Lodged in Ureter)
• Acute, excruciating, colicky, wavelike pain, radiating down the thigh to the genitalia
• Frequent desire to void, but little urine passed; usually contains blood because of the abrasive action of the stone (known as ureteral colic)
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Stones in Renal Pelvis
• Intense, deep ache in costovertebral region• Hematuria and pyuria• Pain that radiates anteriorly and downward
toward bladder in female and toward testes in male
• Acute pain, nausea, vomiting, costovertebral area tenderness (renal colic)
• Abdominal discomfort, diarrhea
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Stones Lodged in Bladder
• Symptoms of irritation associated with urinary tract infection and hematuria
• Urinary retention, if stone obstructs bladder neck
• Possible urosepsis if infection is present with stone
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• Reduction of fluid intake• Recurrent UTI• Hyperuricemia-caused medication• Inflammatory bowel syndrome• History of gout• Poor micturation habit• Male
RISK FACTORS
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• Pyelonephritis• Urosepsis• Chronic renal failure
COMPLICATION
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• Lymphocyte- 17.7% (20-45%)
• Glucose- 6.8 (3.9 – 6.1mmol/L)
• Potassium- 3.3 (3.5 – 5.5mmol/L)
SURGICAL PROFILE
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• Bacteria - Occasional (Nil)
URINE FEME
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• Right VUJ stone ~5mm with obstructive hydronephrosis
CTU
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DRUGSIN WARD
DATEORDERED
DATE OFF
IV Pethidine 25mg STAT & rpt another 25mg if pain not relief after 15 min
4/6/14 4/6/14
IM Pethidine 75mg 6hourly PRN
4/6/14 6/6/14
IM Maxalon 10mg 6hourly PRN
4/6/14 6/6/14
IV Dynastat 40mg BD 4/6/14 6/6/14
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DRUGSIN WARD
DATEORDERED
DATE OFF
Ural 1/1 TDS 4/6/14 6/6/14
Norgesic 1/1 TDS 4/6/14 6/6/14
IV Sulperazone 1gm BD 5/6/14 6/6/14
Tab Prednisolone 10mg BD
5/6/14 6/6/14
Tab Hytrin 2mg ON 5/6/14 6/6/14
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Alteration in comfort : pain related to obstructive ureteric stone.
NURSING DIAGNOSIS
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Alteration in emotional status anxiety related to surgical management and treatment.
NURSING DIAGNOSIS
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Knowledge deficit related to management of blood pressure control.
NURSING DIAGNOSIS
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Potential infection related to intravenous cannulation.
NURSING DIAGNOSIS
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Potential bleeding related to surgical intervention.
NURSING DIAGNOSIS
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Potential infection related to surgical intervention.
NURSING DIAGNOSIS
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• Drink 2.5 – 3 litres H₂O per day (neutral pH)• Take 2 glasses of water at bedtime
to prevent urine concentration at night• Avoid excessive intake of milk or
alkaline drink
DRINK :
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• Minimize protein intake (60g/day) to decrease urinary excretion of calcium & uric acid
• Minimize sodium (3-4g/day) because sodium competes with calcium for reabsorption in kidneys
• Avoid oxalate-containing food (spinach, strawberry, tea, peanut & wheat bran)
DIET :
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• Regular exercise• Avoid strenuous activity leading to
sudden increase body temperature that lead to excessive sweating & dehydration
EXERCISE :
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• Maintain personal hygiene• Seek treatment immediately at 1st
sign & symptom of UTI
URINARY TRACT INFECTION :
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