if you like this ppt please comment and like. it help us to improve the things.

1. PRESENTED BY
MR. ABHIJIT BHOYAR
M. SC. NURSING
RENAL STONE
OR
RENAL CALCULI

2. OVERVIEW
OF
URINARY
SYSTEM

3. INTRODUCTION
• Kidney stones (also called renal calculi, nephrolithiasis or
urolithiasis) are hard deposits made of minerals and salts that
form inside your kidneys.
• Diet, excess body weight, some medical conditions, and certain
supplements and medications are among the many causes of
kidney stones.
• Kidney stones can affect any part of your urinary tract — from
your kidneys to your bladder. Often, stones form when the urine
becomes concentrated, allowing minerals to crystallize and
stick together.

4. DEFINITION:
Stones are formed in the urinary
tract when urinary
concentrations of substances
like calcium oxalate, calcium
phosphate and uric acid
increased.

5. INCIDENCE:
 Up to 4% of the populations in the United States have
Urolithiasis.
 About 12% of the male populations have a renal stone by age
70 years.
 More than 200,000 Americans require hospitalization for
treatment of stones each year.
 The recurrence rate for calcium oxalate stones is about 50%
within 5 year.

6. CAUSES & RISK FACTOR’S
Factors that increase risk of developing kidney stones include:
 Family or personal history. - If someone in family has had
kidney stones,
 Dehydration. Not drinking enough water each day can
increase your risk of kidney stones. People who live in warm,
dry climates and those who sweat a lot may be at higher risk
than others

7.  Certain diets. - Eating a diet that's high in protein, sodium (salt)
and sugar may increase risk of some types of kidney stones.
This is especially true with a high-sodium diet. Too much salt in
diet.
 Obesity. -High body mass index (BMI), large waist size and
weight gain have been linked to an increased risk of kidney
stones.
 Digestive diseases and surgery. -Gastric bypass surgery,
inflammatory bowel disease or chronic diarrhea can cause
changes in the digestive process that affect your absorption of
calcium and water, increasing the amounts of stone-forming
substances in urine

8.  Other medical conditions such as renal tubular acidosis,
cystinuria, hyperparathyroidism and repeated urinary tract
infections also can increase risk of kidney stones.
 Certain supplements and medications, such as vitamin C,
dietary supplements, laxatives (when used excessively),
calcium-based antacids, and certain medications used to treat
migraines or depression, can increase risk of kidney stones

9. TYPES OF RENAL STONES
Types of kidney stones include:
1.Calcium stones.
 Most kidney stones are calcium stones, usually in the form of
calcium oxalate.
 Oxalate is a substance made daily IN liver or absorbed from
diet. Certain fruits and vegetables, as well as nuts and
chocolate, have high oxalate content.
 Dietary factors, high doses of vitamin D, intestinal bypass
surgery and several metabolic disorders can increase the
concentration of calcium or oxalate in urine.
 Calcium stones may also occur in the form of calcium
phosphate. This type of stone is more common in metabolic
conditions, such as renal tubular acidosis.

10. 2. Struvite stones.
 Struvite stones form in response to a urinary tract infection.
 These stones can grow quickly and become quite large,
sometimes with few symptoms or little warning.
3. Uric acid stones.
 Uric acid stones can form in people who lose too much fluid
because of chronic diarrhea or malabsorption, those who eat
a high-protein diet, and those with diabetes or metabolic
syndrome.
 Certain genetic factors also may increase your risk of uric
acid stones.
4. Cystine stones.
 These stones form in people with a hereditary disorder
called cystinuria that causes the kidneys to excrete too much
of a specific amino acid

11. LOCATION OF CALCULI IN THE
URINARY TRACT.

12. PATHOPHYSIOLOGY
Super saturation of urine
Because of fluid loss dehydration, low urine
volume super saturation of urine develops.
Formation of crystals
Precipitate and unite
Stone formation

14.  Passing kidney stones can be quite painful, but the
stones usually cause no permanent damage if they're
recognized in a timely fashion
 A kidney stone usually will not cause symptoms until it
moves around within your kidney or passes into your
ureters — the tubes connecting the kidneys and the
bladder.
 If it becomes lodged in the ureters, it may block the flow
of urine and cause the kidney to swell and the ureter to
spasm, which can be very painful

15. signs and symptoms
 Severe, sharp pain in the side
and back, below the ribs
 Pain that radiates to the lower
abdomen and groin
 Pain that comes in waves and
fluctuates in intensity
 Pain or burning sensation
while urinating
Pain caused by a kidney stone may change — for instance,
shifting to a different location or increasing in intensity —
as the stone moves

16. Other signs and symptoms may include:
 Pink, red or brown urine
 Cloudy or foul-smelling urine
 A persistent need to urinate, urinating more often than
usual or urinating in small amounts
 Nausea and vomiting
 Fever and chills if an infection is present

17. DIAGNOSTIC EVALUATION
• HISTORY & PHYSICAL EXAMINATION
• BLOOD TEST- IT HELPS TO KNOW THE CALCIUM LEVEL,
URIC ACID LEVEL AND INFECTIONS FROM THE BLOOD.
• URINE TEST- TO KNOW THE PROPER FUNCTIONING OF
THE KIDNEY AND THE INFECTIONS.
• RADIOIMAGING TEST- X RAY, MRI, ULTRASONOGRAPHY,
Etc

18. MANAGEMENT
MEDICAL MANAGEMENT
• Hydrochlorothiazide: Prevent calcium
reabsorption in renal tubules.
• Allopurinol: used to prevent uric acid calculi.
• Sodium bicarbonate and sodium citrate: to
maintain urine PH
• Alpha penicillamine and tiopronin: to prevent

19. • The first approach is directed toward
management of the acute attack. This
involves treating the symptoms of pain,
infection, or obstruction as indicated for the
individual patient.
• At frequent intervals, opioids are typically
required for relief of renal colic pain. Many
stones pass spontaneously.
• The second approach is directed toward

20. SURGICAL MANAGEMENT
• Cystolithalopaxy
• Cystoscopic lithotripsy
• Percutaneous nephrolithotom

21. LITHOTRIPSY
•Extracorporeal shock wave lithotripsy (ESWL).
ESWL uses sound waves to create strong vibrations (shock
waves) that break the stones into tiny pieces that can be
passed in your urine. The procedure lasts about 45 to 60
minutes and can cause moderate pain, so you may be
under sedation or light anesthesia to make you comfortable

22. If the stone is too large or if Endourologic and
lithotripsy procedures fail to remove it, an open
surgical procedure is performed.
• A ureterolithotomy is the surgical removal of a
calculus from the ureter through a flank incision
for higher stones or an abdominal incision for
lower ones. A Penrose drain and ureteral
catheter are usually placed postoperatively for

23. • Cystolithotomy, removal of bladder calculi
through a suprapubic incision, is used only
when stones cannot be crushed and
removed transurethrally.
• A stone is removed from the renal pelvis by
Pyelolithotomy and from the renal calyx by
a nephrolithotomy.
• Rarely, a partial or total nephrectomy is
necessary because of kidney damage, over
whelming renal infection, or abdominal
renal parenchyma, which can be
responsible for stone formation.

24. URETEROSCOPY
• URETEROSCOPE MAY BE USED FORTHE
LOWER URINARY TRACT STONE

25. NUTRITIONAL MANAGEMENT
• Provide adequate amount of fluid more than 3 liter per day.
• Limitation of coffee and tea.
• Limiting the oxalate rich foods. eg. Dark roughage, Spinach,
cabbage, tomatoes, chocolate, tea, coffee.
• Limiting the purine and calcium rich foods.eg. Shellfish, liver,
kidney, meat, chicken, mutton, pork, beef, milk, cheese, ice
cream.

26. NURSING MANAGEMENT
ASSESSMENT
• Assessment the general condition of the patient
• Assess the all sign and symptoms pain, discomfort, nausea, vomiting,
and diarrhea.
• Observation for sign of urinary tract infection, chills, fever, dysuria,
frequency hesitancy.
• Assess family history, nutritional history.
• Assess the knowledge about renal stones and measures to prevent
their occurrence or recurrence is also assessed.

27. PRE-OPERATIVE NURSING
DIAGNOSIS
1. Acute pain related to irritation and spasm from stone
movement in the urinary tract.
Goal : Minimize pain level
2.Impaired urinary elimination related to blockage of ureters.
Goal: Maintains free flow of urine
3.Fear and anxiety related to disease condition and
prognosis.
Goal: minimize the anxiety level

28. POST-OPERATIVE NURSING
DIAGNOSIS
4.Pain related to surgery or surgical incision
Goal: relief pain
5.Risk for injury related to postoperative complications.
Goal: prevent injury.
6. Ineffective therapeutic regimen management related to
lack of knowledge regarding disease process.
Goal: Acquisition of knowledge.

29. Prevention
• Prevention of kidney stones may include a combination of
lifestyle changes and medications
LIFESTYLE CHANGES
You may reduce your risk of kidney stones if you:
1. Drink water throughout the day.
 For people with a history of kidney stones, doctors usually
recommend drinking enough fluids to pass about 2.1 quarts (2
liters) of urine a day.
 Your doctor may ask that you measure your urine output to
make sure that you're drinking enough water.
 If you live in a hot, dry climate or you exercise frequently, you
may need to drink even more water to produce enough urine. If
your urine is light and clear, you're likely drinking enough water.

30. 2. Eat fewer oxalate-rich foods.
If you tend to form calcium oxalate stones, your doctor may
recommend restricting foods rich in oxalates.
These include rhubarb, beets, okra, spinach, Swiss chard,
sweet potatoes, nuts, tea, chocolate, black pepper and soy
products.
3. Choose a diet low in salt and animal protein.
Reduce the amount of salt you eat and choose non-animal
protein sources, such as legumes.
Consider using a salt substitute, such as Mrs. Dash.

31. 4. Continue eating calcium-rich foods, but use caution
with calcium supplements.
Calcium in food doesn't have an effect on your risk of kidney
stones.
Continue eating calcium-rich foods unless your doctor advises
otherwise.
Ask your doctor before taking calcium supplements, as these
have been linked to increased risk of kidney stones.
Diets low in calcium can increase kidney stone formation in
some people.

32. COMPLICATIONS
Infection and sepsis
Obstruction of the urinary tract
Hydronephrosis
Hydroureter
Renal failure
Renal hematoma
Hypertension

33. BIBLIOGRAPHY
Lippincott “Medical surgical nursing”
10th edition
Joyce M Black ” Medical surgical
nursing”
Brunner And Suddharth “Medical
surgical nursing”

35. EXAMPLES how to write nursing
care plan
If the patient admitted with the complaints
of back pain, having discomfort and fever,

36. ASSESSMEN
T
NURSING
DIADNOSIS
GOAL PLANNING/INTERVENTIO
N
IMPLEMENTATIO
N
RATIONAL EVALUATI
ON
Subjective
data